A new set of priorities for the global fight against fistula is in focus this week in Maputo, Mozambique, as specialists from around the world gather for an expert meeting about this childbirth condition.
"This group has helped develop the first training strategy for fistula surgeons and this will help us face the lack of skilled professionals to address the demand for surgical repair in the country,” explained Patricia Guzman, UNFPA Representative in Mozambique, which is hosting this year’s International Obstetric Fistula Working Group meeting, from 10 to 12 October. The opening ceremony was attended by the country's Vice-Minister of Health, Ms. Nazira Abdul.
Obstetric fistula, a childbirth injury caused by obstructed, prolonged labour without timely medical intervention, has terrible consequences. The baby almost inevitably dies and the woman is left with chronic incontinence. Unable to control the flow of urine or faeces, or both, she may be abandoned by her family and ostracized by her community. Without treatment, her prospects for work and family life are virtually non-existent.
In most cases, however, fistula is treatable: $300 is usually enough to cover for surgery, post-operative care and rehabilitation support. Nevertheless, although reconstructive surgery can generally repair the injury, fistula treatment requires specialized and committed health professionals. Moreover, social reintegration initiatives must be in place so that fistula survivors can return to their lives and be accepted by their communities.
For the first time, the meeting counts on the participation of fistula survivors and advocates to help guide activities forward. Considered ground breaking, the initiative goes hand in hand with efforts to foster social reintegration and advocacy activities at global level. Fistula outreach manager for One By One in Kenya, Ms. Sarah Omega, and fistula advocate Ms. Norah Amisi shared their expertise with the group.
"After substantial efforts, we now have more representation of institutions working in social reintegration and advocacy," said Gillian Slinger, Coordinator of the Campaign to End Fistula, mentioning Healind Hands of Joy, Terrewode, the Fistula Foundation Nigeria, Women's Dignity and Health Poverty Action.
To also highlight the importance of social reintegration, UNFPA Mozambique and partners organized a photo exhibit with portraits of fistula survivors in the country. The exhibition, launched in the first day of the meeting, was attended by government officials, including the National Director for Medical Assistance, Mr. Antonio Mujovo, who was deeply touched by the photos by Gloria Santos. Partner NGOs and a vast audience also came to the Franco-Mozambican Cultural Center to learn more about the strong women portrayed and their stories of courage and hope.
According to Dr. Igor Vaz, one of the leading fistula surgeons in Mozambique, prevention is probably one of the best strategies to fight the condition. “The programme to fight fistula in the country targets mostly treatment,” he said, adding that the international group is very important since it brings many ideas in the areas of prevention and social reintegration of fistula survivors.
“If we have effective prevention, it will be like in many developed countries, where they were able to eliminate the condition as a public health issue,” explained the surgeon, who started his career as a fistula surgeon 25 years ago and still performs approximately 30 repairs per month at the Central Hospital, a reference center in the capital, Maputo.
Supplementing Dr. Vaz, Ms. Slinger, called for more integrated approaches. “Each year we have at least 100,000 new cases of fistula. Most of these can be prevented by giving women access to family planning, skilled birth attendance and, not least, emergency obstetric care –such as a Caesarean section– when needed,” she says.
The Campaign to End Fistula’s International Obstetric Fistula Working Group (IOFWG) works to ensure global collaboration and coordination of partner efforts for all issues relating to fistula, including prevention, treatment and social reintegration of fistula survivors.
The meeting in Maputo is held on a positive background. Never has the political focus on maternal health and fistula been higher, thanks in large part to the advocacy efforts made in recent years by the Campaign to End Fistula and its partners.
Considered a unique opportunity for health-care providers and experts from some of the world’s most affected nations to share key lessons from the work on the front lines of maternal health and obstetric fistula, the meeting in Mozambique will shed light on promising practices and priorities for the years to come.
Photos: Jessie Wingard (courtesy) and Etienne Franca.