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Thursday, March 15, 2012

True Heroes of the Congo

When Dr. Christophe Kimona treated a young mother for her fistula recently, he repaired more than just her body—she said he restored her spirit.

“I am motivated by compassion for women who have no other sources of support,” Dr. Kimona said. “It is satisfying to aid my fellow countrymen and women.”

His colleagues agree that “it is the work of the heart.”  Dr. Kimona, Dr. Mukwege, Dr. Amisi, Dr. Nembunzu, Dr. Ahuka, Dr. Manga, Dr. Mubikayi, Dr. Tchangou, Dr. Denon, Dr. Aime-Manga—these are the names of some of the dedicated surgeons who are healing women living with obstetric fistula in the Democratic Republic of the Congo (DRC). They are few in number.

Patients come to them in despair, many having been abandoned by their husbands or family and sometimes having lost their will to live. Many have endured years of isolation because of their fistula, a devastating condition in which a hole develops between the birthing canal and the bladder or rectum, causing chronic incontinence. Fistula can result from prolonged or obstructed labor when women lack access to emergency obstetric care.  In the Eastern Congo, a region plagued by years of conflict, fistula has also been caused by sexual violence. 

Yet, in the face of the most difficult circumstances, these surgeons, together with their teams of nurses, anesthetists, social workers, and administrators, find a way every day to restore dignity and hope for women.

These are the individuals whom U.S. Secretary of State Hillary Rodham Clinton calls “true heroes” in the Congo—a selfless breed of surgeons, nurses, and other staff who dedicate themselves to giving women with fistula a second chance at a fulfilling, productive life.
A Community of Practice

Last week, for the third year in a row, these surgeons came together with staff from the Ministry of Health and others who provide care and advocate for women with fistula to review progress in providing these services in the Congo. Coinciding with International Women’s Day, the March 8-9 meeting was hosted by Fistula Care (managed by EngenderHealth and funded by USAID) and Panzi Hospital, a facility supported by the project in Bukavu, South Kivu Province of Eastern Congo. 

On March 8, Secretary Clinton sent a message to the participants, commending them for their dedication: “Facing difficult challenges every single day, the surgeons and health care providers at this meeting are truly heroes, committed to supporting Congolese women and girls by providing the high-quality fistula services that are desperately needed to restore health, dignity, and lives.”

The community of practice (CoP) included fistula surgeons, nurses, anesthesiologists, social workers, and administrators, many of whom are women and all of whom work in fistula repair and prevention. Also present were local partners, Ministry of Health representatives, and global players such as the United Nations Population Fund, World Health Organization, and U.S. Agency for International Development.

Fistula Prevention, Surgeon Training, and a National Strategy for Fistula

Participants discussed the successes and obstacles of working in an environment where access to resources for surgical care is challenging. The surgeons emphasized time and again the importance of increasing access to quality emergency obstetric services to prevent fistula from happening in the first place. Mme Lucie Zikudieka from PROSANI, a USAID-funded integrated health project, reviewed with participants the recent national revision to the partograph and the plans for its introduction. The tool is used to monitor and manage women in labor and delivery to ensure that appropriate actions are taken if complications arise. 

Professor Serigne Magueye Gueye, an eminent Senegalese urologist, led a discussion on training fistula surgeons and introduced a recently completed, internationally recognized Competency-based Training Manual for Fistula Surgery. Participants agreed on the need for a formalized training strategy for fistula surgery as part of a national strategy to address obstetric fistula, which participants also reviewed.  Women’s health advocates have long fought for a high-level plan, which would establish policies to increase access to quality fistula services.

In all, the annual CoP meetings have provided a space for surgeons, practitioners, and policy makers to work together toward a unified vision for addressing obstetric fistula. Dr. Denis Mukwege, Founder and Director of Panzi Hospital, made an impassioned plea to the Ministry of Health to urgently finalize and implement the strategy. Every day of delay means more women continue to experience this devastating condition.  Fistula Care will work with the Ministry and other key stakeholders to advance the strategy within the next few months. For more information, visit

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