November 2010
Women Deliver Fistula survivors meet Danish Crown Princess page 6
Africa Fistula is key component of maternal health campaign page 2
Good news for women in Africa
Filling the information gap
Brazzaville, Republic of Congo
Libreville, Gabon On 20 October
A recent survey carried out in 55 health facilities in Gabon is helping
2010 high-ranking
to fill the information gap about obstetric fistula in the country. It also
national officials,
highlights that fistula is a public health problem and should be viewed as
including ministers,
a priority by Gabonese authorities. Although previous studies had already
parliamentarians and
highlighted the lack of emergency care for women with complications
development partners,
during delivery, as well as early pregnancy and lack of skilled profession-
brought good news
als as leading factors of disabilities, some experts denied the existence of
to women in the
obstetric fistula in Gabon.
Republic of Congo. Senate’s First Secretary Ms. Philomène Fouty Soungou, designated by the Health Ministry and UNFPA as the Goodwill Ambassador for CARMMA in Congo. She will work with the First Lady to promote maternal health in the country. Photo: UNFPA, Congo-Brazzaville, 2010.
“There are many factors leading to the occurrence of obstetric fistula
This happened when
in this country. Since the survey, we can name a few, from adolescent
they participated in
pregnancy to the lack of access to health services. But we can’t ignore
the national launch
structural issues like poverty and socio-cultural factors, including the
of the Campaign on
notion that real women should be brave and endure the pain when giving
Accelerated Reduction
birth,” explains UNFPA Country Director for Gabon, Mr. David Lawson.
of Maternal Mortality in Africa (CARMMA), attesting to the commitment to improve maternal health in that country. In the Republic of Congo, maternal death is above the regional average
During the survey, which identified 90 fistula cases in the country, 15 women living with the condition were interviewed. In 50 per cent of the interviews, the women were aged 15-24, the majority of whom had little
at a dire rate of 580 deaths per 100,000 live births. This prompted the cam-
education. More than half of them live in remote rural areas difficult to
paign launch, which was presided over by Congo First Lady Ms. Antoinette
access by the most common means of transportation. Their main source of
Sassou Nguesso, a champion for maternal health and CARMMA in the
income is agriculture.
country. Speaking on behalf of the United Nations, UNFPA Regional Director Mr.
“In these remote areas, it is only to produce the basics, just for subsistence. That’s why these women are so vulnerable – most of them live under
Bunmi Makinwa assured the Government of the UN’s support to acceler-
the poverty line,” explains demographer Mr. Mbadu Muanda, the survey’s
ate the improvement of maternal health in Africa. The Minister of Health,
lead consultant.
Prof. Georges Moyen, reaffirmed the Government’s commitment to tackle
All the fistula survivors interviewed had their first pregnancy before
maternal death as a top priority in the country, and he is following up his
they had turned 19 and almost half of them even before they had turned
words with action.
16. One out of every three fistula cases occurred after the first childbirth.
“The Government has initiated a series of measures to reverse the
For most of the interviewed women it took more than 12 hours before
trend,” said Minister Moyen at the launch. “We have established a mater-
they arrived at a hospital after labour began and a complication was identi-
nal health observatory and we are promoting public awareness about the
fied. Three of them spent almost 24 hours getting to a health facility. The
importance of women and children’s health. Caesarean sections will be
majority of them delivered a still-born baby.
carried out for free in the public health system and we are also committed
“The fact that more than 50 per cent of the fistula cases occurred
to the Campaign to End Fistula and the extension of the UNFPA programme
after childbirth and the rest after a surgical intervention may reflect poor
on this issue.”
emergency obstetric care. And since the majority of the women delivered in
With as many as 140 cases already identified in the country and poten-
a health facility, it leads us to think that more training is needed, as well as
tially many more likely to be found, obstetric fistula is considered a serious
more adequate equipment and supplies in case of complications,” says Mr.
public health issue in the Republic of Congo, a country in sub-Saharan
Mbadu Muanda.
Africa with an estimated population of more than 4 million. Since 2007, UNFPA has invested over $400,000 in the prevention and
To help eradicate fistula in Gabon, the Campaign and its partners advocate for the establishment of free delivery services and more skilled
treatment of this problem in the country, where precarious conditions and
care in the country, says Mr. David Lawson. “We are working to enhance the
poor access to maternal health services contribute to high rates of maternal
capacity of health personnel and to improve the maternal health services
death and disability.
available to the population. This goes together with efforts to sensitize the
The extension of the fistula programme to two additional treatment centers, one in Pointe Noire and the other in Owando, is a key part of
population about obstetric fistula and early pregnancy, as well as provide better access to family planning and help empower women.”
UNFPA’s contribution to CARMMA in Congo. Fistula treatment is currently provided free of charge at two major health centres in Brazzaville. With additional resources, the hope is that more fistula centres will open in the coming months. The addition of these new centres will significantly reduce the distance that women with fistula need to travel for treatment.
2
COVER PHOTO: After a successful fistula repair operation, Shamim, 26, is released from a hospital in Karashi. She developed fistula during her first pregnancy at the age of 16. Her difficult labour, assisted only by a traditional birth attendant, ended with a stillborn baby and a fistula. After two other unsuccessful pregnancies, she and her husband now have adopted a baby girl. Photo: Wendy Marijnissen, Campaign to End Fistula/UNFPA, Pakistan, 2009.
Two beauty queens on a mission
More global support needed
UNFPA Global Website Obstetric fistula, associated with incontinence and social isolation, is hardly
A report released in October by the United Nations Secretary
glamorous. But two African beauty queens – Miss Ghana@50 and Miss Liberia
General, Mr. Ban Ki-moon, calls for intensified support for cost-
2009 – are using their glamour and recognition to raise awareness about this
effective interventions to address the problem of obstetric fistula.
issue, which affects some of the most marginalized women in their countries. Miss Frances Tekyi Mensah began talking about obstetric fistula through-
The report Supporting Efforts to End Obstetric Fistula says that considerable progress has been achieved in addressing obstetric
out 2007, the 50th anniversary
fistula. The document draws attention to the links between
of her country’s independence,
poverty, income inequalities, gender disparities, discrimination
and the year she reigned as
and poor education, as these factors contribute to poor health in
Miss Ghana@50. And she hasn’t
women and girls. It points out, however, that despite achieving
stopped talking about it since.
some positive developments, many serious challenges remain.
In view of the commitment she demonstrated, the Ghana Government nominated her as
“Obstetric fistula is one of the most devastating consequences Miss Ghana@50, Frances Teyki Mensah, and fistula survivors.
of neglect during childbirth and a stark example of health inequity in the world. Although the condition has been eliminated in the
an Ambassador for Obstetric Fistula. She accepted the mission with a strong
developed world, obstetric fistula continues to afflict the most
drive to make a difference across the country.
impoverished women and girls, most of whom live in rural and
Initially Miss Tekyi Mensah selected obstetric fistula as the project to take
remote areas of the developing world,” the report states.
on during her reign because she realized that it affected the poorest, least
Thoraya Ahmed Obaid, Executive Director of UNFPA, the United
educated and most marginalized women in her country and elsewhere in
Nations Population Fund, has welcomed the new report. In a video
Africa and Asia. “They’ve got nothing except faith and hope and urine-soaked
statement prepared for the recent summit on the Millennium
clothes,” she said of the women who suffer the indignities of fistula. “Some
Development Goals, Ms. Obaid emphasized the importance of
of them claim ‘even death would be better than this.’ If I could help just one
tackling obstetric fistula in line with global agreements to improve
of these women, to me, it is literally, giving that woman her life back.”
the health and rights of women.
Miss Tekyi Mensah spent most of her year as Miss Ghana@50 raising
“Every year millions of women suffer from pregnancy and
awareness about obstetric fistula in the most remote parts of Ghana. She
birth-related complications, as well as injuries. And one of them
met tribal chiefs, religious leaders, opinion leaders, men’s groups and several
is fistula, which is an injury that affects women and leaves
community representatives spreading the message about the importance
them incontinent and thus ostracized from their families and
of prevention and about the possibility of treatment. She also appealed to
communities. By working together we can ensure that fistula
women with the condition to get treatment and raised funds to support the
is something of the past. And we have to restore the dignity of
treatment of about 20 women in the regions she visited. In addition, she
The struggle to improve health-care systems and reduce the rate of maternal death and disability, including obstetric fistula, must not only continue but intensify, as recently published
encouraged 60 other
estimates show that the progress made in maternal mortality
Ghanaians to become
reduction has been slow. Also, there is an urgent need to scale
local advocates. The
up well-known, cost-effective interventions in order to reduce the
group includes fistula
high number of avoidable maternal deaths and disabilities, the
survivors, community,
report points out.
religious and traditional Miss Liberia 2009, Shu-rina Wiah, and fistula advocates.
millions of women,” said Ms. Obaid.
The report cites examples of successful interventions in various
leaders, as well as
countries and calls for specific actions to improve maternal health
men’s groups represen-
and address the issue of obstetric fistula. It also highlights that
tatives and social workers. With the support of the Ghana Ministry of Health,
the condition can be prevented as part of broader efforts made to
the advocates have drawn up action plans, which were implemented in 2010.
achieve MDG 5, the one related to maternal health.
A compelling presentation by Miss Tekyi Mensah at the 2008 Miss World
As part of its recommendations, the document points out that
beauty pageant convinced Shu-rina Wiah, who was crowned Miss Liberia
funding should be predictable and sustained support should be
2009, to take on the issue as her project for the year. Throughout 2009, Miss
provided to countries’ national plans, United Nations entities,
Wiah participated in outreach campaigns to prevent the injury, as well as in
and other global initiatives dedicated to tackling the problem,
projects aimed at empowering survivors.
including the Campaign to End Fistula.
After that, she has frequently spoken to fistula survivors, praising them for their “resilience and courage” in seeking help, and paid tribute to UNFPA for helping to restore respect and dignity to women affected by fistula.
Read more:
www.endfistula.org 3
dispatch
Efforts to end fistula go on despite crisis
Eritrea on the road to be ‘fistula free’
Antananarivo, Madagascar
Asmara, Eritrea The political crisis that
The government of Eritrea, in collaboration with partners, has embarked
began in Madagascar
on a project to make the country ‘fistula free’ by the end of 2011. An
almost two years ago has
intensive campaign to identify and treat women living with obstetric fistula
heavily impacted the imple-
is being implemented in the country. To encourage women to come out for
mentation of assistance
treatment, the Ministry of Health is providing free services and reimbursing
programs in the country
related expenses, such as food and lodging. Also, transportation costs are
and has now taken a toll
being paid for or refunded.
in the fight against fistula.
“It is a government priority to clear the waiting list of existing fistula
Without a formal national
cases in the country, which means that Eritrea would be close to achieving
strategy on the issue or
the national objective of eliminating fistula,” says the UNFPA Representative
even the possibility of
in the country, Mr. Barnabas Yisa.
carrying out major advocacy
Although the number of existing cases in Eritrea is not yet known, teams
projects, most of the activi-
of international experts and national fistula surgeons are working hard to
ties are being implemented
clear the backlog. While the treatment is going on in several health facilities,
by non-governmental
prevention measures are being put in place simultaneously in communities.
organizations and contacts A 17-year-old woman from Madagascar, recently operated upon for fistula, her mother and a fistula specialist. Photo: UNFPA Madagascar, 2009.
The ‘fistula free’
with the government are
initiative is considered
restricted.
rather advanced in a
“We have faced some
country which has so
technical problems, which hamper the smooth implementation of activi-
many challenges related
ties,” says UNFPA Maternal Health Technical Advisor, Dr. Eugene Kongnyuy.
to the condition of
“However, despite the crisis in the country, we continue to do our work. It
women, such as early
seems like a long time, but we only started the programme in 2008 and,
marriage, low social
even with the crisis, we can see considerable progress.”
status, fewer educa-
Before joining the Campaign to End Fistula in 2008, Madagascar con-
tion opportunities and
ducted a study to assess the magnitude of obstetric fistula in the country.
economic prospects
As part of the findings, the study revealed that knowledge about the
compared to men.
condition among health-care providers was low and that harmful traditional practices contributed significantly to the occurrence of fistula. Rural residence, poverty, lack of education, adolescent pregnancies, a poor referral system and low quality of care during delivery were among the determinants of fistula in Madagascar, the study pointed out. Based on this a set of priorities was identified, including surgical repairs and psychological care, together with social reintegration of fistula patients and fistula prevention. To address these priorities, the programme designed activities to empower women and mobilize community leaders. Since joining the Campaign, the country has introduced the activities
Besides the high Ms. Yirgalem Isaac, nurse midwife in charge of the fistula ward at the Mendefera hospital with a patient. Photo: UNFPA Eritrea, 2010.
number of maternal deaths —280 per 100,000 live births, according
to the most recent UN estimates— Eritrea also faces a high number of births carried out without the support of a skilled health professional, reflecting some reluctance to seek adequate health care during childbirth. “Culture and tradition can explain this reluctance to deliver with skilled birth attendants. Such practices increase the risk of complications, maternal death and disability,” explains the Campaign Coordinator, Ms.
in phases. Currently six reference hospitals are involved in surgical repair
Gillian Slinger. “We also need to think very carefully about how to tackle
while six NGOs are undertaking social reintegration of fistula survivors and
these challenging issues.”
prevention of obstetric fistula using successfully repaired patients as role models and advocates. “We try to ensure that providers are able to properly handle emergen-
Eritrea joined the Campaign to End Fistula in 2003, when a needs assessment was carried out to detect the magnitude of the disability at national level. Since then, obstetric fistula has been addressed as part of a
cies. This is another aspect of prevention that complements community
comprehensive package of interventions to overcome the serious reproduc-
sensitization with former fistula patients.”
tive health problems faced by the country, including an agreement with
When asked if he believes that the Campaign will continue in
Stanford University to provide technical assistance for on-the-job training of
Madagascar, Dr. Kongnyuy is firm: “We have many accomplishments to
local surgeons and midwives, specialized care for complicated cases, trainee
celebrate, including the de-stigmatization of fistula. We’ll just continue to
follow-up and community mobilization design, monitoring and evaluation.
scale up our activities and develop a national obstetric fistula strategy as soon as the socio-political situation improves. We are not adrift.”
4
Read more:
www.endfistula.org
Professionals trained to deal with fistula
Pioneer struggles to tackle fistula
Karachi, Pakistan
Conakry, Guinea
A new programme initiated by UNFPA in Pakistan is providing a 30-week training course for community midwives on fistula prevention and treatment. The programme, which already benefited more than 70 midwives, has been developed to train trainers, help prevent obstructed labour and provide quick referral when emergency obstetric care is needed. According to experts, having more midwives in the communities will also help raise awareness among women about the importance of spacing births, seeking skilled attendants at the time of delivery and providing proper nutrition for pregnant girls and women. One of the lead fistula surgeons in the country, Dr. Shershah Syed believes that more health professionals should be trained to help improve maternal health. “We don’t have enough skilled birth attendants. Moreover, some of the existing attendants are improperly trained,” says Dr. Syed. The initiative to train community midwives complements a broader
Women gathering at the village of Bate Nafadji to hear an educational talk on fistula organized by a local NGO, the African Family Support. Photo: UNFPA Guinea, 2010.
One of the first countries to join the Campaign to End Fistula in 2003, Guinea
strategy to build capacity to treat fistula, developed and implemented
is still struggling to tackle obstetric fistula. With a population of 10 million and
since January 2006, when the Campaign to End Fistula was launched in
24 ethnic groups, the country faces one of the highest maternal death ratios in
Pakistan. As part of the strategy, Pakistani doctors have been encour-
the African continent —680 per 100,000 live births— and has not yet been able
aged to exchange knowledge and share experiences with internationally
to establish a coordinated response to disabilities such as fistula.
renowned surgeons in the field of obstetric fistula. “Our surgeons are having more opportunities to learn about cost-
“This has been a long-lasting fight,” explains the chief of the Ministry of Health Division for Reproductive Health in Guinea, Dr. Madina Rachid. Following
effective surgical interventions that can be used to repair fistula patients,”
the International Conference on Population and Development held in 1994,
tells Dr. Faaria Ahsan, UNFPA’s Reproductive Health and Fistula specialist in
Guinea, as well as other developing countries, convened a national forum,
Pakistan.
which defined the elements of reproductive health that should receive priority
Since the launch of the Campaign in the country, more than 38 surgeons have been trained on fistula repair surgeries, and an estimated 78 com-
in the country. “Back then, obstetric fistula had been already identified as a central
munity midwives and nurses have been trained on pre- and post-operative
component of maternal health in Guinea. However, despite the inclusion of
management of obstetric fistula. Currently, seven regional and six referral
the condition in the national health policy and programs, little effort had
centres are providing free services to women in need; more than 2,000
been made to tackle the problem in the country,” says Dr. Rachid.
fistula cases have been repaired with a success rate of 90 per cent.
After an awareness campaign launched in 2003, the Ministry of Health conducted a situation analysis in collaboration with UNFPA, leading to the establishment of a project for the prevention and treatment of obstetric fistula in Kankan, Guinea’s largest city. Since then, the project has allowed for the training of health professionals and community workers and the promotion of public awareness on how to prevent fistula, including messages disseminated through public and private radio stations in urban and rural areas, as well as through peer educators. More than 110 surgical repairs have been successfully carried out thus far and 29 fistula survivors have received training on income-generating activities in the country. However, despite the results achieved and lessons learned, many challenges remain, including the lack of skilled human resources, insufficient treatment services and low utilization of health services by the community. “Most of all, we need a strong national leadership to establish a coordinated response and to strengthen partnerships. With that we can perhaps
Students from the Nursing and Midwifery Tutor Training course during their graduation ceremony. They completed a 30-week course that aims to ensure more qualified midwives and nurses, who can then teach other professionals and thus provide better care. Photo: Wendy Marijnissen, Campaign to End Fistula/UNFPA, Karachi, Pakistan, 2009.
foster changes in society and promote the de-stigmatization of fistula,” says the UNFPA Representative in Guinea, Dr. Marcelle Chevallier.
Read more:
www.endfistula.org
5
dispatch
Fistula survivors meet the Danish Crown Princess
Congressional briefing discusses fistula
Washington, D.C., U.S.A.
During the same week the Women Deliver Conference was held, fistula survivor and advocate Sarah Omega had the opportunity to brief
One of the highlights of the Women Deliver
members of the U.S. Congress on issues related to obstetric fistula.
Conference in Washington D.C. in June 2010 was the meeting between Her Royal
The briefing was organized in coordination with the offices of U.S.
Highness Crown Princess Mary of Denmark,
Representatives Carolyn Maloney, from New York, and Mike Castle,
and two fistula survivors and advocates.
from Delaware, sponsors of a bipartisan legislation on fistula: The
The Crown Princess, who was accompanied
Obstetric Fistula Prevention, Treatment, Hope and Dignity Restora-
by the Danish Minister for Development
tion Act of 2010, H.R. 5441.
Cooperation Søren Pind, was deeply moved by their stories.
Ms. Awatif Altayib. Photo: Moises Saman/Panos, 2010.
One of the women the Crown Princess
Earlier in the same week, Sarah Omega also participated
met was Ms. Sarah Omega, a fistula survivor from Kenya, who became
in an advocacy effort on Capi-
pregnant in her late teens. After hours of obstructed labour and losing her
tol Hill, aimed at encouraging
baby in the process, she developed a fistula —a condition she then lived
U.S. funding and support for
with for 12 years before receiving treatment. Since 2007 Ms. Omega has
maternal health and MDG 5.
traveled Kenya and the world as a maternal health advocate. She wants to
Ms. Omega, who was joined
ensure that other women with fistula know that treatment is available.
by television and film star
“In Kenya, it is estimated that we have 3,000 new fistula occurrences each year, but only 7 per cent of these women get treatment, leaving us with a huge backlog of cases. For this reason,
Ms. Jennifer Beals, shared her personal story with several representatives.
UN Foundation representative Tamara Kreinen, fistula survivor and advocate Sarah Omega, Rep. Mark Kirk and television and film star Jennifer Beals. Photo: Sam Hurd, Women Deliver, Washington, D.C., 2010.
I have been going to the communities, getting women who are suffering in silence and refer-
Read more:
www.endfistula.org/
ring them to a health facility where they can receive treatment,” Ms. Omega explained. Ms. Awatif Altayib, the other advocate who met the Crown Princess, came from Ms. Sarah Omega. Photo: Moises Saman/Panos, 2010.
Toolkit promotes advocacy on fistula
Furbaranga, West Darfur State, Sudan, where
As part of the fistula-related events during
she works as the village midwife. Also a
the Women Deliver conference, UNFPA and
fistula survivor, she was married and pregnant
Family Care International (FCI) launched
with her first child at the age of 16. Sadly, her baby did not survive an
a new advocacy publication and interac-
obstructed labour, from which she developed obstetric fistula. Determined
tive CD-ROM Toolkit – Living Testimony:
to ensure that other women do not suffer as she had, Ms. Altayib decided
Obstetric Fistula and Inequities in Maternal
to become a midwife. She now recruits women living with fistula and
Health. The publication aims to contrib-
helps them access the care they need.
ute to broader efforts to reduce maternal
“It was an important opportunity for me to learn more about the
mortality and morbidity, to bring obstetric
maternal health challenges that persist in the developing world. Sarah and
fistula to the fore, and to highlight specific actions to reduce its
Awatif lent a face to all women who have suffered due to the lack of access
incidence and prevalence.
to skilled attendants during pregnancy and childbirth. This is something industrialized nations take for granted but is still very much a luxury in many countries in the developing world,”
The main objectives of the CD-ROM Toolkit are to: •
said the Crown Princess of Denmark.
Provide guidance and tools to carry out advocacy for improving maternal health, and to highlight how attitudes about
During the meeting, Ms. Thoraya Obaid,
pregnancy and delivery affect maternal death and disabilities,
UNFPA Executive Director, expressed her
including obstetric fistula.
sincere appreciation that the Crown Princess
•
Present new strategies for addressing the social norms and
accepted to be patron of UNFPA. The
cultural practices that impede access to sexual and reproduc-
announcement made in June 2010 called
tive health-care services in order to increase their availability.
attention to Denmark’s support of UNFPA’s efforts to promote maternal health and safer motherhood in developing nations.
6
H.R.H. The Crown Princess of Denmark. Photo: Steen Evald, 2010.
For additional information or to obtain copies of the CD-ROM Toolkit, contact: publications@fcimail.org or fistulacampaign@unfpa.org
A fistula champion and a pioneer
Campaign has new coordinator
Yaoundé, Cameroon Dispatch interviewed Dr. Pierre Fouda, one of the pioneers of fistula treatment in Cameroon. A urologist and long-term partner in the country, Dr. Fouda talks about the challenges of fighting fistula.
Gillian Slinger, a British-trained nurse and midwife with a BSc Degree in Health Management and an MSc Degree in Public Health, recently joined UNFPA to coordinate the global Campaign to End Fistula. As a midwife, Ms. Slinger has always been deeply moved by the
Dispatch: How did obstetric fistula come to be a priority health issue in Cameroon? Dr. Fouda: In 2004, Cameroon recorded particularly alarming indicators of maternal health.
Dr. Pierre Fouda. Photo: UNFPA Cameroon, 2010.
many obstetric fistula cases she has cared for in the field. Since starting her MSF post in Geneva in 2007, her involvement in fistula work has increased enormously, fueling her commitment to address global maternal death and disability. Asked about her plans for the future, Ms. Slinger talks about a new vision for the Campaign. “There will be a gradual scaling up of training and treatment
It was thus legitimate to think
services in response to the significant number of existing cases, with
that, despite the absence of
a shift away from ‘vertical’ fistula campaigns organized as occasional
data, obstetric fistula was a
interventions, and towards more permanent fistula services,” explains
reality in Cameroon. A few
Ms. Slinger.
years ago, UNFPA supported the
According to Ms. Slinger, the idea is to promote a more holistic
Ministry of Public Health to evaluate the situation in two provinces (North
approach to services, as they will be incorporated into existing health
and Far-North). This study allowed us to gain basic knowledge of the fistula
structures and firmly anchored in sustainable health programmes at
situation in that part of the country, to learn that there are a lot of cases in
the national level. “There will also be greater emphasis on prevention,
these regions and to realize that the existing health facilities did not have
including the work with maternal health partners and looking at
the capacity to deal with the problem.
preventive measures immediately after prolonged labour and for new fistula cases,” she complements.
Dispatch: Can you share with us some of the challenges related to obstetric fistula that you have faced in the country? Dr. Fouda: There are many. To begin with, how can we eliminate stigmatization? You can see these women abandoned by everybody, and rejected by the community because their condition is seen as a “curse” or result of infidelity. They are considered shameful and forced to live apart from the community, all the while mourning their babies who have died. Raising funds is another challenge. Women usually cannot pay for the services
As part of the new vision that is emerging, a greater focus on quality, more research —including on the reintegration of recovering fistula patients after treatment— and improved communication channels will also be integral to the Campaign, Ms. Slinger says. “One of the expected outcomes is a greater information flow from global to project level and vice versa, and between key practitioners and organizations working together to move this agenda forward as part of the well-established partnership spirit of the Campaign.”
because they are extremely poor. The exclusion of the community is not only social and cultural, but also economic. And since we don’t have the means and resources for everybody yet, their treatment is not possible without foreign support. There are also the difficulties involved in following the patients who have been operated on once they return to their villages, since most of them are from remote areas where even motorbikes cannot get to, especially during the raining season. Another issue is the social reintegration of the patients into their communities. We also need to improve our health system, and the occurrence of obstetric fistula is an indicator of that. It means training health professionals in the management of obstetric fistula, which is another challenge. Finally, treating obstetric fistula is good, but prevention is even better. Sensitization has to continue, but it also needs to be improved. It should never be forgotten that it is the man who makes decisions in African society, and that he is generally under the influence of his community when he makes his decisions. Read the full interview online.
Read more:
Gillian Slinger, the new Coordinator of the Campaign to End Fistula, with a fistula survivor in the market close to the Kamuli Mission Hospital in Uganda. Photo: Brian Hancock, FRCS, founder Uganda Childbirth Injury Fund, 2010.
www.endfistula.org
7
dispatch
The Third Annual
ISOFS started from the recognition among prominent fistula surgeons working in Africa
Conference of the
and Asia that there are more than two million obstetric fistula survivors in the world,
International Society
yet there are not enough skilled surgeons to operate on them. According to specialists,
of Obstetric Fistula
surgical attempts by inexperienced surgeons can lead to further damage to the women
Surgeons (ISOFS) will take
living with fistula.
What:
place in Dakar, Senegal, from 7-9 December 2010.
The previous conference, held in Nairobi, Kenya, in 2009, covered topics ranging from the
As an annual summit of
role of community midwives to the effectiveness of social reintegration and community
health-care providers and
partnerships. Organized in collaboration with the African Medical and Research
activists from some of
Foundation (AMREF), the event hosted a diverse assembly of government ministers,
the world’s most affected
medical professionals, and delegates from charitable and aid organizations and academic
nations, ISOFS provides a
institutions. In 2010, the organizing institutions expect an even larger participation.
valuable forum to share
Third Annual Conference of the International Society of Obstetric Fistula Surgeons (ISOFS) Annual Meeting of the International Obstetric Fistula Working Group (IOFWG)
key lessons from the
Immediately prior to the conference, on 5-6 December, obstetric fistula specialists
work on the front lines of
from various countries will gather in Dakar for the International Obstetric Fistula
Where:
obstetric fistula.
Working Group (IOFWG)* annual meeting. They will discuss priorities and exchange
Both the IOFWG meeting (5-6 Dec) and the ISOFS conference (7-9 Dec) will be held at the Hotel Des Almadies in Dakar, Senegal.
experiences in the field of obstetric fistula. *Among its many partners at international, national, regional and local levels, the Campaign to End Fistula also counts on the support of the many institutions and practitioners who are part of the International Obstetric Fistula Working Group (IOFWG). The group aims to ensure global collaboration and coordination of efforts for all issues relating to fistula, including prevention and management, and to guide the secretariat of the global Campaign. Learn more online.
Why the Campaign? 10–15 million women suffer severe or long-lasting illnesses or disabilities caused by complications during pregnancy or childbirth, including obstetric fistula. Obstetric fistula is a preventable and, in most cases, treatable childbirth injury that leaves women incontinent, ashamed and often isolated from their communities. There are at least 2 million women living with obstetric fistula in the developing world and up to 100,000 new cases occur each year. In 2003, UNFPA and its global partners united to launch the Campaign to End Fistula. The Campaign is now present in 49 countries, having raised over $40 million toward the goal of eliminating fistula. The Campaign, with its many partners around the world, focuses on three key areas: preventing fistula, treating affected women, and supporting women as they recover from surgery and rebuild their lives.
For more information or to learn how you can help, please visit: endfistula.org. Afghanistan Pakistan
Nepal Bangladesh India
Mauritania Mali Niger Chad Eritrea Senegal Yemen Sudan Burkina Gambia Faso Djibouti Guinea Bissau Guinea Nigeria Côte Sierra Ethiopia Central African d’Ivoire Leone Republic Liberia Cameroon Ghana Benin Somalia Uganda Togo Congo Kenya Equatorial Gabon Democratic Guinea Rwanda Republic Burundi of Congo United Republic of Tanzania Angola
Zambia Malawi Zimbabwe
Mozambique
Madagascar
Swaziland CARIBBEAN
Haiti
South Africa
Lesotho
Campaign to End Fistula countries
UNFPA Campaign to End Fistula
605 Third Avenue, New York, NY 10158 email: fistulacampaign@unfpa.org dispatch is a biannual newsletter highlighing developments in the Campaign to End Fistula Editorial Process: Etienne Franca Design and Printing: Prographics, Inc.
Disclaimer: The opinions expressed by the persons interviewed do not necessarily reflect the newsletter editorial position or the official position of UNFPA.
Contributors: Faaria Ahsan, Yves Bergevin, Luc de Bernis, Nicole Carta, Marcelle Chevallier, Cheikh Tidiane Cissé, Sarah Craven, Akinyele Eric Dairo, Apollinaire Delamou, Triana Dorazio, Nicole Eteki, Pernille Fenger, Calixte Hessou, Sennen Hounton, Esther Huerta, Katja Iversen, Patricia Keba, Hugues Kone, Eugene Kongnyuy, David Lawson, Bunmi Makinwa, Emilie Maurice, Elsabeth Mengsteab, Robert Mensah, Aline Piedecocq, Shafia Rashid, William Ryan, Cecilia Schubert, Alain Sibenaler, Klaus SimoniPedersen, Sandy Singer, Gillian Slinger, Kadiatou Sy, Etta Tadese, Margherita Tinti, Barnabas Yisa. Campaign Donors (since 2003) Americans for UNFPA Arab Gulf Programme for UN Development Organizations Bill & Melinda Gates Foundation through EngenderHealth European Voice Government of Australia Government of Austria Government of Canada Government of Finland Government of Iceland Government of Ireland Government of Japan (through the UN Trust Fund for Human Security) Government of Luxembourg Government of New Zealand
Government of Norway Government of Poland Government of the Republic of Korea Government of Spain Government of Sweden Government of Switzerland Johnson & Johnson Kingdom of Spain, Autonomous Community of Catalunya One by One United Nations Foundation Virgin Unite Women's Missionary Society of the African Methodist Episcopal Church Zonta International
UNFPA wishes to acknowledge with gratitude the multi-donor support generated towards strengthening and improving Maternal Health in the world. Our appreciation is also extended to the many partners and individual donors for their collaboration and support to the Campaign to End Fistula since its inception.