OBSTETRIC FISTULA RESEARCH:

• THE EXTENT OF THE PROBLEM,

• COST

• REINTEGRATION CHALLENGES IN KENYA

Submitted to Global Forum for Health Research by:

• Yvonne Wettsteinin partnership with

• Dr. Raassen and his Patients

with the Institutional Support of The African Medical and Research Foundation

(AMREF) and,The Geneva Foundation for Medical Education

and Research (GFMER)

BACKGROUND

• 4000 BC - first fistula recorded I• Obstetric Fistulas have become

an exclusive problem of developing countries due to varied reasons that include:

• Early Marriage (bef. Full pelvic growth ]

• FGM• Chronic Malnutrition, • lack of qualified healthcare

professionals, • lack of access to medical

facilities during child birth (their obstructed labour may be protracted for days or weeks ]

BRIEF DEFINITION

•Vesico-Vaginal Fistula (VVF), a hole between the bladder and thevagina leading to uncontrolledLeakage of urine and •Recto Vaginal Fistula (RVF) a hole between the rectum and thevagina causing the unabatedleakage of faeces (1). Complex Cases:fistulas where there is « poor accessfor repair, significant tissue loss,ureteric involvement or coexistent Recto Vaginal Fistula. (2).

CURRENT NUMBERS: Kenya, Uganda, Tanzania

80 million people,

3.6 million women in deliver babies every year.

1 to 3 per 1000deliveries results in an Obstetric Fistula.

At least 7,200 new Fistula cases in East Africa, every year.

Only 750-1000 fistulas are operated on annually

less than 15% of women currently afflicted.

OVERVIEW

This Initiative will:1. Address the outcomes of TREATMENT 2. Document local myths and traditional

practices leading to Obstetric Fistulas,3. Provide recommendations and simple

guidelines for Prevention and Reintegration• in order to improve community education, social and

public health response systems in the context of governmental and community policies.

PRIMARY SITES

• Kenyatta National Hospital (National Referral Hospital, Nairobi

• Ortum Mission Hospital(Northern Kenya),

• Mutomo Hospital(Northwestern Kenya) and

• Garissa Hospital (Northeastern Kenya).

• Machakos Hospital (Central Kenya)

OVERALL OBJECTIVE

• To Increase Awareness about the Magnitude of the Problem, the Availability of Treatment and the Challenges of Reintegration in Kenya.

STRATEGIES TO ACHIEVE OBJECTIVES• Needs Assessment and Situational Update • Research Framework• Direct Field Research• Documentation of prevention, treatment and

reintegration resources available in the various provinces for the development of an informational manual.

• Partnership• Community Interventions through informal workshops

on basic health and hygiene, reproductive health, and the use and availability of local and regional medical facilities.

S T U D Y P H A S E O B J E C T I V E S A C T I V I T YI . P R E - P R O J E C TA C T I V I T I E S ( N A I R O B I & G E N E V A ) 1 . N E E D S A N A L Y S I S c o m p l e t e d

2 . S I T U A T I O N A L U P D A T E c o m p l e t e d

3 . R E S E A R C H D E S I G N R e p r o d u c t i v e H e a l t h R e s e a r c h T r a i n i n g P a r t i c i p a t e i n 7 w e e k P o s t G r a d u a t e R e p r o d u c t i v e H e a l t h R e s e a r c h C o u r s e o f f e r e d b y t h e G F M E R * a n d t h e W H O I I . F I E L D W O R K I N K E N Y A 1 . C O M P L E T E D i s t r i b u t i o n o f I n d i v i d u a l q u e s t i o n a i r e s t o w o m e n i n I N D I V I D U A L t h e f o u r r e g i o n s i n K e n y a a s p a r t o f D r . R a a s s e n ’ s

Q U E S T I O N A I I R E S t e a m i n t e r v i e w i n g h i s p a t i e n t s

2 . C O M M U N I T YS U R V E Y S A N D I n i t i a t e , w i t h t h e a s s i s t a n c e o f A M R E F * c o m m u n i t y

A C T I V I T I E S a w a r e n e s s w o r k s h o p s w i t h l o c a l c h i e f s , e l d e r s , a n d

c o m m u n i t y l e a d e r s c e n t e r e d a r o u n d s a f em o t h e r h o o d

3 . W O M E N 'S G R O U P S W o r k d i r e c t l y w i t h g r o u p s o f w o m e n w i t h i n t h e W O R K S H O P S c o m m u n i t y t o f i l l o u t c o m m u n i t y s u r v e y s a n d p r o v i d e

i n f o r m a t i o n o n r e p r o d u c t i v e h e a l t h , O b s t e t r i cF i s t u a l s

a n d S a f e M o t h e r h o o d t h r o u g h i n f o r m a l w o r k s h o p s . I I I . D A T A A N A L Y S I S 1 . I N T E R P R E T A T I O N C o n s u l t a t i o n w i t h P a r t n e r s , O F R E S U L T S E x p e r t s a n d E c o n o m i s t s I V . R E P O R T 1 . G U I D E L I N E S B a s e d o n s o u n d e v i d e n c e f r o m r e s e a r c h r e s u l t s .

W i t h p r a c t i c a l c o m m e n t s f r o m A M R E F , l o c a lp a r t n e r s

F e m a l e G e n i t a l M u t i l a t i o n s p e c i a l i s t , a n ds t a k e h o l d e r s

2 . R E C C O M E N D A T I O N S C o n s u l t w i t h F i s t u l a S p e c i a l s f o r r e c c o m e n d a t i o n s d e r i v e d f r o m r e s e a r c h f i n d i n g s V . P U B L I C A T I O N 1 . P U B L I C A T I O N R e p o r t P u b l i s h i n g a n d P r e s e n t a t i o n . 2 . R O U N D - U P M E E T I N G L a u n c h o f C o n t i n u e d A d v o c a c y a n d L o b b y i n g I n i t i a t i v e . M e e t w i t h K e y p a r t n e r s t o r e v i e w t h e i n i t i a t i v e ’ s p r o c e s s a n d i d e n t i f y t h e f u t u r e d i r e c t i o n o f t h e O b s t e t r i c F i s t u l a I n i t i a t i v e s u c h a s t h e O F M A N U A L G F M E R ( G e n e v a F o u n d a t i o n f o r M e d i c a l E d u c a t i o n R e s e a r c h )A M R E F ( A f r i c a n M e d i c a l a n d R e s e a r c h F o u n d a t i o n )

JUNE JULY[1 - 21] NAIROBI / AMREF [7 - 9] KENYATTA NAT. HOSPITAL [25 - 28] GARISSA DISTRICT [14 - 18] MUTOMO DISTRICT [21 - 25] MACHAKOS DISTRICT

AUGUST SEPTEMBER[5 - 9] NAIROBI / AMREF [2 - 6] MACHAKOS DISTRICT [12 - 16] GARISSA DISTRICT [9 - 13] KISUMU CITY [26 - 30] KENYATTA NAT. HOSPITAL [16-20] ORTUM MISSION HOSPITAL *progress report sent to partners [23-27] MUTOMO DISTRICT

OCTOBER NOVEMBER[6-10] NAIROBI / AMREF [4 - 8]NAIROBI / AMREF [13-17] KENYATTA NAT. HOSPITAL [11-22] KISUMU CITY [20-30] ORTUM MISSION HOSPITAL [25-28] KENYATTA NAT. HOSPITAL *progress report sent to partners

DECEMBER JANUARY/FEBRUARYNAIROBI NAIROBI/GENEVA* DATA COMPILATION * FINAL REPORT DISTRIBUTION** DATA ANALYSIS *** DISSEMINATION OF PRELIMINARYREPORT **STAKEHOLDERS MEETING****PUBLIC PRESENTATION OF FINDINGS ***MANUAL DEVELOPMENT

*progress report sent to partners**** FINAL REPORT &RECCOMENDATIONS

SENT TO PARTNERS.

EXPECTED RESULTS

• Development of an Informational Manual • Continued Research in Kenya. • Expanded Research to Western Africa: Benin. • Lobbying for the training of more Obstetric Fistula

Surgeons and for the integration of the Obstetric Fistula corrective surgery procedure into the curriculum of all government run University Medical Schools

• Advocacy for a formal reintegration and rehabilitation process for women who develop Obstetric Fistula