Repairing and Preventing Obstetric Fistula in Sierra Leone

At the Aberdeen Women’s Centre (AWC) in Freetown, Sierra Leone, women from around the country receive life-changing surgery to repair obstetric fistula. This year, AWC opened an emergency obstetric services department so that more women have the chance to avoid developing this devastating and eminently preventable condition.

EngenderHealth’s Fistula Care Project, supported by the U.S. Agency for International Development (USAID), partners with the Aberdeen Women’s Centre, where more than 1,000 fistula repairs have been performed since the partnership began in 2007. Restoring health and dignity to the women of Sierra Leone is a tall order, given that the nation’s rate of maternal mortality is among the highest in the world. Now, in addition to supporting fistula repair services (e.g., surgeries, postoperative care, nutrition, housing, and patient recruitment), Fistula Care is supporting training for nurse midwives, medical supplies, and prenatal screenings in the new maternity wing.

Read more and view a slideshow at EngenderHealth.org.

Action Alert: Urge Congress to End Fistula

Today, EngenderHealth joined a broad coalition of organizations in applauding Rep. Carolyn Maloney (D-NY) and Rep. Michael Castle (R-DE) for introducing important legislation that will help transform the lives of millions of women worldwide. The Obstetric Fistula Prevention, Treatment, Hope and Dignity Restoration Act of 2010, H.R. 5441, would authorize funding to prevent obstetric fistula and treat women suffering from this debilitating condition. Read the joint press release here.

“We are thrilled to see that the bill recognizes the importance of partnering with national governments and institutions and strengthening local capacity as the way forward,” said Ana Langer, M.D., President of EngenderHealth. “We know this is the most sustainable approach to preventing and treating obstetric fistula. This captures the spirit and intent of the Obama Administration’s Global Health Initiative.”

H.R. 5441 was introduced just days before the start of Women Deliver, the largest-ever conference on maternal and reproductive health, convened in Washington, DC, from June 7–9, 2010. Download the full legislation here (PDF, 41KB).

Take a moment now to write to your representatives today and ask them to co-sponsor the bill.

Learn more about Fistula Care, which is bringing vital fistula prevention and treatment services to women in 11 countries, with support from the U.S. Agency for International Development.

Experts Meeting to Address Obstetric Fistula in Rwanda

KIGALI, RWANDA—Leading experts and physicians working in the reproductive and maternal health field will convene in Kigali December 7–8, 2009, to identify challenges and solutions to a pressing and preventable health concern in Rwanda—obstetric fistula. Hosted by the Ministry of Health, in collaboration with the Rwanda Medical Association and the U.S. Agency for International Development-supported Fistula Care Project (managed by EngenderHealth), the meeting will engage policymakers, health officials, medical staff, and community leaders to set achievable goals for preventing fistula and improving Rwandan women’s health.

Fistula affects an estimated 2–4 million women globally, including in Rwanda. It is a devastating gynecological injury usually caused by prolonged labor without medical intervention or cesarean section. As a result, women with fistula have chronic leakage of urine and/or feces. In most cases, fistula can be repaired through surgery, and it is almost always preventable—with timely, high-quality obstetric care as well as family planning.

At the meeting, national and international experts will strategize on how to best to integrate family planning with maternal health services to prevent fistula and improve the health and lives of Rwandan women. Leading physicians will be available to offer their expertise and comment on the issues, including:

• Dr. Isaiah Ndong, Vice President for Programs, EngenderHealth
• Dr. Joseph Ruminjo, Clinical Director of Fistula Care, EngenderHealth
• Dr. Theobald Hategekimana, Director, University Central Hospital of Kigali
• Dr Serigne Magueye Gueye, Fistula Master Trainer, Cheikh Anta Diop University/Grand Yoff General Hospital, Senegal

The meeting will be held at the Serena Hotel in Kigali. Members of the media are invited to attend the opening ceremony on December 7 and the morning session on December 8. Please contact Kellen Kebikomi by telephone at 250-25257-0912 or by email at kkebikomi@engenderhealth.org to confirm your attendance.

About Fistula Care
The Fistula Care project is a five-year cooperative agreement funded by USAID and managed by EngenderHealth. The project works to address the enormous backlog of women awaiting life-altering fistula repair, ensuring they receive timely and quality care from trained providers. At the same time, we work to remove barriers to emergency obstetric care that lead to fistula in the first place, so that women in labor get to the right place with the right services at the right time. The project is supporting a network of facilities offering a continuum of services, from emergency obstetric care, referrals, and family planning, to complex fistula repairs and advanced surgical training. Visit www.fistulacare.org for more information or contact us at: fistulacare@engenderhealth.org.

About EngenderHealth
EngenderHealth is a leading international reproductive health organization working to improve the quality of health care in the world’s poorest communities. EngenderHealth empowers people to make informed choices about contraception, trains health providers to make motherhood safer, promotes gender equity, enhances the quality of HIV and AIDS services, and advocates for positive policy change. The nonprofit organization works in partnership with governments, institutions, communities, and health care professionals in more than 20 countries around the world. For more than 65 years, EngenderHealth has reached more than 100 million people to help them realize a better life. For more information, visit www.engenderhealth.org.

(From the EngenderHealth press release)

First Lady of Tanzania Visits EngenderHealth-Supported Clinic

In November 2009, the First Lady of Tanzania, Mama Salma Kikwete, visited Madaba Health Centre, a facility in the Ruvuma Region in southwestern Tanzania that is supported by EngenderHealth and that serves 50,000 people. The First Lady was there as part of a national campaign to reduce maternal and neonatal mortality, and she spoke about the importance of avoiding early pregnancy, improving maternal health care, and openly discussing HIV and preventing its spread.

EngenderHealth, through a U.S. Agency for International Development–supported ACQUIRE Project Associate Award, is helping to equip facilities in the Ruvuma Region with obstetric wards and is improving the quality and use of family planning services by training health care staff, strengthening supervisors’ skills, and raising awareness in communities. Over the past year, more than 400 clients received long-acting or permanent methods of contraception at Madaba, and nearly 9,000 clients received these methods in the region overall. EngenderHealth, through funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), also trains health care professionals to provide counseling and testing for HIV and AIDS, other reproductive health services, and life-skills coaching to youth.

Last year, EngenderHealth assisted 38 facilities throughout Tanzania in improving the quality of their maternal health and family planning services.

Learn more about EngenderHealth’s work in Tanzania.

Bringing Back Dignity: Fistula Survivors in Ethiopia

Three newly-posted videos tell the stories of Tihun, Yeserash, and Abebu -- three young women from Ethiopia who have survived obstetric fistula. The women and their family members give insight into the difficulties of life with fistula, the joys of being repaired, and the lessons learned from their experiences. These videos are excerpts from the film "Bringing Back Dignity," produced under the ACQUIRE Project funded by USAID.

Despite the double tragedy of losing her baby and developing a fistula, Tihun has been blessed with a supportive husband who did not leave her when she was ill. Her husband Aweke explains that everyone urged him to leave his wife with beliefs that he would contract her condition, but he would not do so. Both Tihun and Aweke have learned valuable lessons from Tihun's fistula. Aweke regrets not being careful to use protection that would prevent an early pregnancy. Tihun vows that if she ever has a daughter she will not marry her off, and instead will let her go to school and then choose her own husband.

Yeserash and her father, Simeneh, express the hardships of obstetric fistula as well as the lessons learned from their experience. Simeneh's father regrets marrying off his daughter at the young age of 12 or 13 and vows that he will not do the same with his other daughters. He wishes other people would learn from his "painful mistake", urging them not to arrange early marriages and to allow their daughters to consent to marriage. Yeserash is now fully recovered and has since had a health baby boy.

Abebu, a 20-year-old fistula survivor, describes the hardships of living with a fistula and how her life has been transformed by repair. Abebu was married at the age of 15 and developed her fistula after four days of prolonged labor. When her leaking began, her husband stole her property and threw her out and her parents shunned her. Now that she is cured, Abebu is glad to be able to mingle with friends and participate in community events.

These videos recount hardships and celebrate achievements related to the participant's daily struggles with pregnancy, loss, and relationships, as well as their search for safety, acceptance, and dignity. Our hope is that viewers will come away with greater compassion, as well as an understanding of what causes fistula, how women can be repaired, and why community members, the health sector, and policymakers all have critical roles to play in prevention.

EngenderHealth's Fistula Care Project Highlighted at the Huffington Post

Hanna Ingber Win, the World Editor of the Huffington Post, writes about obstetric fistula today as part of her series on mothers in Ethiopia. As part of her research, Hanna talked to Karen Beattie, project director of EngenderHealth's global Fistula Care Project (funded by USAID), who is featured in the column. Read the full column.

PBS's FRONTLINE/World and Obstetric Fistula in Sierra Leone

PBS's FRONTLINE/World recently published a video by Jenny Chu—Sierra Leone: Yeabu's Homecoming—about obstetric fistula in Sierra Leone, and listed EngenderHealth among organizations working on the issue (see the Links section). The 14-minute video focuses in part on Mercy Ships, one of the partners working with EngenderHealth on the global Fistula Care Project (managed by EngenderHealth).

For more information about this work, see the Sierra Leone country profiles at EngenderHealth.org and FistulaCare.org.

(Photo care of and copyrighted by WGBH/PBS.)

Video: Fistula Care Launches Activities at Fourth Guinean Hospital

(Video in French without subtitles.)

Every year, EngenderHealth organizes a national “Fistula Day” in Guinea to raise awareness of fistula among communities and key decision makers. Held this year on May 21, it marked the official launch of Fistula Care activities at a fourth site in Guinea, Labé Regional Hospital, the main hospital of the country’s central mountain region.

The opening ceremony, held at the amphitheater of the local training center, was well-attended by dignitaries from across the country, including the Governor and the Mayor of Labé, the Mayor of Kissidougou, officials from the Ministries of Health, Social Affairs, and Decentralization, and representatives of the U.S. Ambassador to Guinea and the Mission Director of the U.S. Agency for International Development (USAID), which supports Fistula Care. The Peace Corps, United Nations Population Fund, World Health Organization, OIC International, civil society organizations, the private sector, and the media were also represented.

To begin the proceedings, Labé Mayor El Hadj Amadou Thiam presented EngenderHealth with a key to the city. Accepting on behalf of the organization, the Vice President for Programs, Dr. Isaiah Ndong, later reflected that “this facility offers hope and the chance for a new life to women living with fistula throughout the Labé region.”

The Governor of Labé, the representative from USAID, and Ministry staff voiced their appreciation for the Fistula Care project. “One characteristic of the project is its big-picture consideration of all of fistula’s causes and its relevant strategy for sustainability, engaging technical departments from different partner Ministries and the community beneficiaries themselves,” said Dr. Cherif Sylla, General Secretary of the Ministry of Health and Public Hygiene.

A local youth group led a chant of the slogan “let’s fight together against fistula,” adding a spirited energy to the event. And three fistula survivors whose lives have been transformed by surgical repair shared emotional testimonies, including one who brought her infant, whom she gave birth to following a successful fistula repair.

Hundreds of peer educators invited the crowd to participate in a vibrant procession to the Labé Regional Hospital, where the General Secretary of the Ministry of Health and Dr. Ndong jointly cut the ribbon to celebrate the start of fistula repair services.

Fistula repairs at Labé began in early June. The hospital builds on the successful model Fistula Care developed at other sites in Guinea: Kissidougou District Hospital, Ignace Deen University Teaching Hospital, and Jean Paul II Hospital in Conakry. The Fistula Care project supports surgical repair, prevention, and reintegration into society for repaired women and creates partnerships between health facilities, communities, and local governments. Read more about Fistula Care’s activities in Guinea.

Reflections on Mother's Day and Obstetric Fistula

Carrie Ngongo is the Program Coordinator for the Fistula Care Project, which is managed by EngenderHealth.

This is my first Mother’s Day as a mother: I am blessed to have a delightful baby girl who is growing, learning, and thriving. Becoming a mother has certainly given me a great deal of appreciation for all mothers. I’ve also found myself thinking about women who have not been so fortunate on their road to motherhood and who instead have faced great difficulty and loss along the way.

In March I had the opportunity to meet a group of inspiring women in Niger who had all been through traumatic labors. Each of these women had been eager to bring a baby into the world. They felt the joy of kicking in their wombs, and they talked to their growing babies as they went about their days, just as I did. Yet while I was in the care of an experienced doctor and delivered at a hospital in a major city, most of these women were in rural areas without the help of a skilled health provider. They labored and labored, but something wasn’t right: Their babies were not passing through the birth canal. By the time they were brought to a hospital for emergency care, it was too late. Their babies were dead.

This would have been loss enough, yet it didn’t stop there: They soon discovered that they were leaking urine, the result of obstetric fistula. They couldn’t control the flow, even if they tried not to drink much or used cloth to soak up the mess.

For some, their husbands and family members stood by them in spite of their smell, but many experienced rejection and isolation from those closest to them. Not only had they lost their babies, but they’d lost their health and their personal relationships too.

Fortunately, each of these women had found out that there was hope for them. Fistula can be repaired in most cases, and the women heard that surgical repair is available at Lamordé Hospital in Niamey. Lamordé is one of the hospitals supported by the Fistula Care Project, which EngenderHealth leads with funding from the U.S. Agency for International Development.

	Fistula survivors in Niger

At Lamordé Hospital there were 17 women who were hoping for healing. Lamordé has a structure set aside for women awaiting fistula repair surgery. It’s a plain building jammed full of simple bed frames, without power for fans or air-conditioning in the sub-Saharan heat. There’s space just next to it for women to cook or find shade to rest. Some of the women have been here for more than a month, waiting to be hospitalized for the treatment.

At first glance, providing fistula repair surgery seems straightforward. A trained surgical team in an equipped hospital is all you need—but it’s not so simple. In much of Africa, there are too few doctors to serve large, dispersed populations. Motivated surgeons need time to be trained and to advance their skills, especially because of the complexity of repair and the reality that no two fistulas are the same. One fistula surgeon in a hospital is often not enough, because that doctor may be called away. Moreover, fistula repair is never an emergency, and understaffed and overburdened hospitals can easily prioritize a thousand other important things.

As I talked with the women, I was amazed by their patience and endurance. These women have already been through plenty. How can we reduce the time they wait for surgery?

This was one of the subjects I discussed with the hospital staff who make fistula repair possible, including social workers, nurses, record keepers, and surgeons. We agreed that the Fistula Care Project will continue to train surgical teams and equip the hospital, so that client backlogs diminish over time. Together, we’re working on innovative solutions like supporting field trips for trained surgeons to travel between hospitals in order to pool their efforts, and encouraging hospitals to improve communication and record keeping in order to improve the quality of their services.

All 17 women whom I met in Niger have now had their lives transformed by fistula repair surgery. They are recovering, looking forward to returning to their homes and rebuilding their lives. Many hope to try to have a child again. Thanks to fistula repair surgery, they too may be mothers celebrating healthy babies on a Mother’s Day in the future.

Ten Thousand Women with Fistula Receive Life-Changing Surgery

Dear colleagues and friends,

EngenderHealth and the U.S. Agency for International Development (USAID) today celebrate a milestone in global maternal health: A total of 10,000 women have received fistula repair surgery with U.S. support since 2005. Fistula, a devastating childbirth injury affecting millions of women in developing countries, can be surgically repaired up to 90% of the time, but most of those with the condition lack access to a skilled surgeon or health center, making treatment out of reach.

Four years ago, USAID launched a global effort to both treat and prevent fistula. To date, through initiatives such as the EngenderHealth-led Fistula Care Project, and in collaboration with local governments, regional health care organizations, and faith-based organizations, medical teams in 12 countries and 25 health facilities across Africa and Asia have been trained and equipped to provide surgery for fistula.

It is these trained medical professionals, as well as their supporting institutions, whose dedication has made it possible for 10,000 women to regain dignity and hope through fistula repair surgery. We honor the tireless efforts of the surgical teams as we mark this maternal health milestone.

Obstetric fistula is an injury caused by prolonged obstructed labor, when the head of the baby cannot pass safely through the woman's birth canal. The baby often dies as a result, and the woman is left with an abnormal opening in the birth canal and chronic incontinence. If left untreated, fistula can lead to skin ulcerations and infections, kidney disease, social isolation, and even death.

The hopeful part of the story is that in addition to most cases being reparable, fistula is almost entirely preventable. This is why the Fistula Care Project is working to improve access to emergency obstetric care and cesarean section for women who develop complications during delivery. Together with skilled attendance at all births and the availability of voluntary family planning, this could make fistula as rare in the developing world as it is in the industrialized world. The Fistula Care Project is working to engage all levels of society to raise awareness about fistula and its underlying causes, including early pregnancy, poverty, and a lack of education and empowerment for women and girls.

As the largest USAID-supported effort to both treat and prevent fistula, the Fistula Care Project will keep you apprised of our work to transform the lives of thousands more women and girls around the world--work that is possible thanks to your partnership. To learn more, please visit our web site at www.fistulacare.org.



Gratefully yours,

Karen J. Beattie
Project Director
Fistula Care Project





The Fistula Care Project is a five-year cooperative agreement funded by USAID and managed by EngenderHealth. The project works to address the enormous backlog of women awaiting life-altering fistula repair, ensuring that they receive timely and quality care from trained providers. At the same time, it works to remove barriers to emergency obstetric care that lead to fistula in the first place, so that women in labor get to the right place with the right services at the right time. The project is supporting a network of facilities offering a continuum of services, from emergency obstetric care, referrals, and family planning to complex fistula repairs and advanced surgical training. Visit www.fistulacare.org for more information or contact fistulacare@engenderhealth.org.

The American people, through USAID, have provided economic and humanitarian assistance worldwide for nearly 50 years. For more information about USAID and its programs, visit www.usaid.gov.

New York Times: A Preventable Trauma

The New York Times has published a letter from Karen J. Beattie, director of the Fistula Care Project (managed by EngenderHealth), in response to a recent story about obstetric fistula:

"While increasing access to fistula repair surgery restores hope and improves lives, there is no way to stem the rising backlog of fistula cases unless we prevent the injury from occurring in the first place.

"We know what works: increasing access to quality emergency obstetric services and meaningful prenatal care, ensuring the availability of contraception, delaying early marriage and childbirth, and improving education and nutrition to help girls grow and thrive. These actions, combined with stepped-up political will and community engagement, would improve countless lives."

Karen J. Beattie
New York