unfpa dispatch may 2011
DESCRIPTION
UNFPA Dispatch, May 2011 editionTRANSCRIPT
May 2011
T C E F
GlobalFistula initiatives
will be mappedpage 7
TanzaniaMobile phoneshelp fightfistulapage 3
2
What is fistula?Obstetric fistula is a childbirth injury caused by prolonged, obstructed
labour, without timely medical intervention—typically a Caesarean
section. During unassisted prolonged labour, the sustained pressure
of the baby’s head on the mother’s pelvic bone damages soft tissues,
creating a hole—or fistula—between the vagina and the bladder and/
or rectum. The pressure deprives blood flow to the tissue, leading to
necrosis. Eventually, the dead tissue sloughs off, damaging the original
structure of the vagina. The result is a constant leaking of urine and/or
feces through the vagina. It’s estimated that over 2 million women live
with the condition in the world, with up to 100,000 new cases every year.
Fistula is both preventable and, in most cases, treatable.
COVER PHOTO: Mbathio LO, 43, goes home after a successful fistula repair at the Grand Yoff Hospital in Dakar. She lived with fistula for 25 years, not initially knowing that it was a treatable condition. Healed, she now wants to open a restaurant. Photo: Etienne Franca, Campaign to End Fistula, Senegal, 2010.
According to a 2010 USAID report, in Ethiopia, 93 per cent of women
deliver at home, in most cases without the assistance of a skilled attendant,
thus increasing their vulnerability to childbirth complications and disabilities,
including obstetric fistula. The situation is dire, and experts believe that
cultural birthing practices will only change from within communities.
Berhidda Redda, 33, a fistula survivor from Adiweyane, a small village
about one hour from the capital of the Tigray Region in Northern Ethiopia,
is living proof. Despite the many health-related challenges she faced, Ms.
Redda is now helping bring positive changes to her own community.
“I lived with my young daughter in a one-room house surviving off a
small plot of land that I farmed myself,” Ms. Redda says. “My husband
divorced me 18 years ago when he discovered that I had developed
fistula during my first pregnancy. Everyone in my town knew me as the
woman who was ‘cursed’ with fistula.”
For those working closely with fistula survivors, discrimination and
divorce are familiar outcomes; it is extremely difficult to find purpose and
means of subsistence even after being healed.
Although Ms. Redda was able to get treatment, she continued to live with
the stigma and shame of this condition. But thanks to Healing Hands of Joy’s
Safe Motherhood Ambassador Training Program, a project that empowers
fistula survivors and trains them as advocates for better maternal health, she
was able to regain confidence in herself and fight for respect in her village.
“Before surgery, I was discriminated against by neighbors and even my
family. Now, things are slowly getting better because I’ve learned fistula is
not a disease caused by doing something outside of the law of God but is a
curable condition. I want to know more about it and help others,” she says.
When Healing Hands of Joy established a new training centre for
fistula survivors in Mekelle, Ms. Redda was welcomed into the first class
of Safe Motherhood Ambassadors.
“We had been giving birth at home. We had not been going to health-
care facilities. We only went there when it was too late. My plans are to
ensure that women in my community become literate, and to discourage
underage marriage and home birthing,” she says.
For the next four weeks, Ms. Redda worked hard to learn the cur-
riculum HHOJ designed in partnership with the Tigray Health Bureau,
including maternal health lessons in the causes of fistula, prevention
methods, and the benefits of institutional delivery.
Ms. Redda not only wanted to know more about the causes of fistula,
but also wanted to help prevent other women from suffering the same
fate. With her strength, determination and desire to learn, she can be an
agent of change in her community and fill an essential gap in providing
voluntary maternal health counseling.
Ms. Redda is now working in her community, monitoring pregnant
women and confidently sharing her story to prevent other mothers from
suffering as she had. She is also proud to be a business owner. With the
training and a small start-up business fund that she’ll repay after one
year, she has opened a store in her home where she sells coffee, baskets,
scarves, biscuits, matches and other supplies.
Safe motherhood ambassadorby Allison Shigo, Healing Hands of Joy
These are times of change for the Campaign to End Fistula.
With new and reinvigorated partnerships, the Campaign will
work even harder towards eliminating the devastating condition
of obstetric fistula.
A crucial step in the coming months and into the future will be
to develop a vision of the “who, what and where” for fistula.
Building on the excellent work done by other institutions, UNFPA
will be working closely with the Fistula Foundation, Direct
Relief International and other partners to undertake a mapping
exercise, compiling information on fistula centres, experts and
activities globally.
This is an ambitious and exciting project, and we hope it will
provide valuable insight into what is happening with fistula across
the world, as well as filling many information gaps.
Another priority for 2011 is a more coordinated approach to the
global response to fistula—prevention, quality treatment, social
reintegration, research, data and advocacy—to ensure that
the Campaign moves forward in a spirit of collaboration, with
internationally agreed upon goals.
In this and upcoming editions of Dispatch, the reader will find
more and more articles highlighting the great achievements of our
many partners in the field, as well as the difficulties they face and
their plans for the future. These features will also portray the real
faces and stories that make the work on fistula very challenging,
yet extremely rewarding. Enjoy the reading!
Gillian Slinger
Coordinator, Campaign to End Fistula
Editorial
Read more: www.endfistula.org
dispatch3
Using mobiles to fight fistulaDar es Salaam, Tanzania
Highlights
Spearheaded by UNFPA in collaboration with many partners and sup-
ported by numerous generous donors, the Campaign to End Fistula
has quadrupled in size during the last seven years. From its original 12
countries, the Campaign has now expanded to cover 49 countries in
Africa, Asia, the Arab States, Latin America and the Caribbean.
As a result of this growth, more and more women are able to access
the care they need to prevent and treat fistula, and to return to full and
productive lives after fistula treatment with the support of govern-
ments and partners.
UNFPA coordinates and serves as Secretariat for the Global
Campaign to End Fistula and for the International Obstetric Fistula
Working Group (IOFWG), which represents over 50 national and
international institutions.
Since the Campaign was launched in 2003: • Morethan20,000womenhavereceivedfistulatreatmentandcare
with support from UNFPA.
• OverhalfofallCampaigncountrieshaveincorporatedfistulain
national policies and plans.
• Additionalcountriesarerevisingtheirexistingreproductivehealth
national policies to ensure the full integration of obstetric fistula.
In 2010, with UNFPA support:• Morethan5,000womenandgirlsaccessedfistulatreatmentin
nearly 40 countries.
• Over1,800surgeonsandhealthworkersweretrained.
• Fistulasurvivorsin18countriesworkedtosensitizecommunities,
provide peer support and serve as advocates for fistula prevention
and improved maternal and newborn health at community and
national levels.
• TheUnitedNationsSecretary-GeneralReport,“Supporting Efforts
to End Obstetric Fistula,” released in October 2010, noted great
progress in addressing fistula, yet called for more support and
intensified action to end fistula.
• TheresolutionSupportingEffortstoEndObstetricFistula was
adopted by consensus at the United Nations General Assembly,
with 172 supporting countries, and called for renewed focus and
additional resources for fistula.
• Enhancedglobalandnationalmediacoverageandadvocacy
helped increase political focus on maternal health issues,
including fistula.
• TheCampaigntoEndFistulawasoneoffewinitiativesworldwide
featured in the MDGGoodPracticespublication.TheCampaign
was cited for its innovative and comprehensive approach,
combining programmatic, technical and advocacy intervention and
awareness-raising on how to prevent and treat fistula. A young fistula survivor who benefited from the project. “The Ambassador called the Hospital, received the money and then he got us the bus tickets. There were six of us so we took a bus from Mbeya up to Mbongo, and then a driver was waiting to pick us.” Photo: Lisa Russell, Tanzania, 2011.
Thecountry’slargestprovideroffistulasurgery,Comprehensive Community
BasedRehabilitationinTanzania(CCBRT), is revolutionizing the fight against
fistula through mobile phone technology to make services more available to
womenlivingwiththecondition.Thegoalistofacilitatetransportationfor
fistula patients seeking treatment, so that more women can access surgery.
According to UNFPA, an estimated 3,700 new cases of obstetric fistula
occurinTanzaniaeveryyear,butonlyabout1,000gettreated.“Sadly,
most women living with the condition do not know that treatment is avail-
ableortheyjustcan’taffordit,”explainsCCBRT’sChiefExecutiveOfficer,
ErwinTelemans,whoisalsoresponsibleforthemobilephoneinitiative.
AttheirhospitalinDaresSalaam,CCBRTprovidesfistulasurgeryfree
of charge, but until recently, the high cost of transportation and accommo-
dation prevented fistula survivors in remote villages from seeking treatment.
Since late 2009, however, the non-governmental organization began using
Vodafone’smobilebankingsystemM-PESA—Mfor“mobile”andPESAfor
“money” in Swahili—to help patients overcome transportation costs.
Supported by UNFPA, the institution embarked on a pilot project,
usingM-PESAtosendmoneytofistulasurvivorssothattheycantravel
tothehospitalinDaresSalaamfortheirrepairsurgery.Themoney,which
isprovidedbytheproject,issentbyCCBRTviaSMStofistulavolunteer
ambassadors, who may be former patients, health workers, or staff of
non-governmental organizations, to identify and refer women suffering
from fistula for treatment.
TheambassadorscanretrievethemoneyatthelocalVodafone
M-PESAagentandbuybusticketsforthepatients.Whenthepatient
arrives at the hospital, the ambassador receives a small incentive.
Sincethestartoftheproject,thefistulaambassadors’networkhas
expanded to all regions of the country and the number of women who
have been able to access fistula surgery increased by 65 per cent. In
2010, fifty-four ambassadors referred 129 women for fistula repair via
M-PESA.TheprojectisprofiledinaFistulaCaretechnicalbrief;to
learn more, please visit http://www.fistulacare.org/pages/resources/
publications/technical-briefs.php.
It is early morning, and my bed is dry!
We are very thankful.
We’ve been isolated.
We’ve been far away from this world.
Thank you doctor for bringing us back;
Back to the world of the living.
Two young women sang this poem in a farewell ceremony before
taking the plane back home. They were part of a group of 15 patients who
had travelled well over 1,000 km from South Somalia for fistula repair at
the Boroma Fistula Hospital in Somaliland. The majority of patients were
only in their mid-twenties, but some had already been living with obstetric
fistula for up to 12 years.
One of the patients, Rahimo Buno, 26, had developed a fistula and
lived with it for nine years. “I was in labour for seven days,” recalls Ms.
Buno. “My baby died. Then I noticed I was leaking urine. I didn’t know
what was wrong with me and it just didn’t stop…. I used to love going
out and seeing friends but that changed.… I no longer felt able to go to
weddings or the mosque; even going to the market was difficult. I was so
self-conscious of my smell, ashamed of spoiling my clothes, and aware
of what others thought of me.”
The ongoing armed conflict and instability in South and Central
Somalia make it very difficult to improve obstetric care or to provide
onsite fistula repair services. Yet this is an area with one of the highest
maternal death rates in the world, an indicator of high incidence of
post-partum complications, such as obstetric fistula. The relative stability
in Somaliland has allowed fistula treatment services to be provided in
several hospitals.
“For women coming from Southern and Central Somalia, the main
problem is transport,” explains Essam Elsayed, medical coordinator for
the Women and Health Alliance International (WAHA) in Somaliland.
“In the first fistula surgery initiative that we carried out in May 2010,
three women came all the way from Mogadishu to Somaliland by public
bus. It took them three days to arrive, travelling in difficult conditions.
One told us how she was thrown off the bus several times because the
passengers were upset by the smell of urine. Another one told us that she
was charged twice the ticket price for the same reason,” Dr. Elsayed says.
Following this experience, WAHA started financing and organiz-
ing transport for women from south and central Somalia to come to
Somaliland for the repair of obstetric fistula and other post-partum
injuries. Ms. Buno is part of the third group of patients brought to
Somaliland for surgery in 2010.
Patients are identified by midwives in Mogadishu and Kismayo and
then diagnosed by a Mogadishu-based doctor who organizes their trans-
port to Somaliland. WAHA covers all costs so that treatment and travel
are entirely free. In 2010, over 100 women from Somaliland and Southern
Somalia were operated with the support of WAHA in partnership with
Boroma Fistula Hospital and Edna Adan Maternity Hospital.
Fighting fistula in East AfricaKamuli, Uganda Childbirth Injury Fund
Extending fistula care in Somaliaby Kate de Rivero, WAHA International
When asked about the progress made in the fight against fistula, Brian
Hancock, a British surgeon who has been working in Africa for more than 40
years, is blunt: “There is no sign of reduction either in the new cases, or in
the enormous backlog that we can’t really address with the human resources
available now.”
Obstetric fistula has been eliminated in countries where good obstetric
care is available. “It is a tragic fact that a woman in sub-Saharan Africa is
about 100 times more likely to die in labour than in developed countries,” he
comments, quoting recent UN statistics.
A leading cause of maternal death, obstructed labour can only be
relieved by timely medical intervention, usually a Caesarean section,
without which the woman usually dies. If “lucky,” she will survive after
days of agony, often resulting in a dead baby and injuries that can have a
devastating effect on her life.
Even the smallest fistulas cause incontinence, which in turn can lead to
social isolation, depression and the breakdown of family and community life.
For Dr. Hancock, who is also the chairman of the Uganda Childbirth Injury
Fund, prevention must be the main goal, closely followed by education and
improved transport options and hospital facilities. “But the problem will be
with us for a long time. There will be a need to train many more surgeons,”
he asserts.
Having done more than 1,300 fistula repairs during his career, Dr.
Hancock knows about the real situation in many countries where fistula
is prevalent. He usually spends three months a year abroad, partnering
with other institutions and rural hospitals in several East and West African
countries to both perform surgery and train new professionals.
“I rarely operate without at least one trainee present,” Dr. Hancock says,
explaining that, according to his experience, although the necessary equip-
ment is usually minimal, fistula surgery is highly demanding, encompassing
different techniques and specialized training.
“Only a quarter of the cases are suitable for beginners. Another quarter
are extremely complex and it takes a long time to build up experience—I
would say at least 100 surgeries before a professional feels comfortable
attempting most repairs,” he estimates.
4
Fistula surgery at Kamuli. Photo: Gillian Slinger, Uganda, 2010.
A vision in whiteLusaka, Zambia
Survivors get back on their feetDRC/ Liberia/ Republic of the Congo
It takes more than an operation to get fistula survivors on their feet. First,
there’s a recovery period, two weeks on average, so that the patients can
heal after surgery. But it’s often a job or a livelihood that really helps them
reclaim their lives.
Because so many fistula survivors have been abandoned, excluded
or shunned—often for years—a job or a business opportunity can mean
renewed social connections and a sense of purpose, as well as a much-
needed livelihood.
In the Democratic Republic of the Congo, former fistula patients are
becoming skilled beauticians and dress makers. In Liberia, fistula survivors
are making and selling soap, flowers, baked goods, dresses and fabric. In
the Republic of Congo, there’s an individualized approach with a focus on
business and management skills.
In all three countries, the women also receive coaching on the life skills
that can help them become successful and overcome their tragic pasts.
“I lost all hope. I was abandoned by every member of my family. Now,
some of them are beginning to relate to me,” says Nyamah Kollie, 39, one
of the fistula survivors who benefited from the programme in Liberia after
living with the
condition for
almost 20 years.
The change
in Rebecca
Mambweni’s
life is striking.
She was just 23
when she went
through days of
agonizing labour
before a dead
fetus was pulled
from her uterus.
The trauma
to her birth
canal left her
incontinent.
“I lived for a
year with fistula. I just stayed at home with my mum. Sometimes I could
see her crying. No one wanted to be around me. My in-laws abandoned
me,” she says. “They didn’t want to pay for an operation to fix me. All I
could do was stay home. I couldn’t go outside just in case I urinated on
myself. When I went outside people would laugh at me, pointing. It was
like a prison. I sometimes felt it would just be better if I died and just be
quiet somewhere else.”
Now, following her surgery and training as a beautician in the DRC,
she is employed and optimistic about her future: “I work in this salon, the
Salon of Hope. One day I’d really like to have a salon of my own. I’d really
like all those people that laughed at me to see me now. I just want to live a
normal life,” Ms. Mambweni says.
dispatch
Sarah Sukwa, 18, got married before turning 15. She left her father’s
home and went to live next to her mother-in-law in a village nearby. Ms.
Sukwa was very happy with her new husband, who worked in a small
farm. When she got pregnant right after her marriage, he would even help
her with the heavier domestic tasks.
When she realized that her labour had started, she informed her
mother-in-law, who then sent for the traditional birth attendant. Her
mother-in-law told Ms. Sukwa that she should deliver at home as most
girls in the village do, assuring her that even women as young as 14 did so
without a problem.
Ms. Sukwa was in labour for two days, without food or water. No sign
of the baby. Then her mother was sent for.
On the third day of labour, when her mother arrived, Ms. Sukwa
demanded that they take her to the nearby health centre, 15 kilometres
away. She was weak and scared that she and the baby might die. Her
husband took a bicycle and went to the health centre to seek advice.
They rang for an ambulance, which took Ms. Sukwa to the hospital.
However, it was too late—her baby was dead.
Two days later, her husband took her back home on his bicycle. Ms.
Sukwa noticed that she was leaking urine uncontrollably, but she was
too weak to return to the hospital. She didn’t know then that she had
developed fistula.
Unfortunately, there are many other stories like this in Zambia.
According to national authorities, at least 500 new cases of obstetric
fistula occur in the country every year, a rough estimate based on the
number of women seeking treatment at various health centres across
the country. However, most hospitals keep no documentation, and only
a few have complete records. So the figures reflect health personnel
estimates and claims that “…there are many women living with fistula in
the country.”
Besides the lack of data, fistula survivors receive little help from district
and provincial health facilities due to the limited capacity to provide com-
prehensive care. The people have to travel long distances on poor roads
to reach health facilities, and rural centres are few and understaffed.
“We depend entirely on donors’ assistance to sustain the fistula
programme,” says Mary Nambao, Reproductive Health specialist at
the Ministry of Health. “At the moment, there is inadequate funding for
prevention and integration of obstetric fistula within the larger maternal
health initiatives in the country,” she explains.
To raise public awareness about the problem, some safe motherhood
action groups supported by the government have been engaged to educate
communities in reproductive health matters, including fistula prevention.
The members, who are identified by the community, encourage women
to seek skilled attendance during delivery, use modern family planning
methods to space their children, and avoid unplanned pregnancies.
Nevertheless, government plans to scale up the initiative are being
hampered due to the lack of resources. Another challenge is the insuf-
ficient mobilization of community leaders around the importance
of preventing fistula.
5
Rebecca Mambweni benefited from a programme that teaches fistula survivors and employs them as beauticians and dressmak-ers. Photo Robin Hammond, Panos/Campaign to End Fistula, DR Congo, 2010.
Small and quite slim, M.* turns her eyes away when asked about the
nightmare she experienced just a year ago. Before even turning 13, she
was raped and got pregnant. She did not understand what had happened
to her. Suddenly, instead of the usual tenderness of her family, M. was
treated with harshness and confined to her house.
In shame, the family kept the secret about the rape and pregnancy. M.
could not go out with her friends anymore, and she was forced to drop out
of school. She saw her body changing and suffered in silence. One day she
had terrible convulsions and, without medical assistance, she delivered a
stillborn baby at home. Weak and traumatized, M. survived through the pain
of the almost unbearable experience. But her ordeal was just beginning.
Shortly after labour, she realized with horror that she was leaking
urine and feces. Her clothes constantly soiled, she was rejected by her
extended family. Her parents tried to help her, but they didn’t know that
her condition could most probably be cured.
M.’s story is not uncommon in Mauritania, where it’s estimated that up to
10,000 untreated cases of fistula exist, according to local experts. Although the
national authorities are committed to scaling up the efforts to eliminate fistula
that have been carried out in the country since 2005, many challenges remain.
“One of the priorities is to raise awareness about the condition,”
explains the chairwoman of the Midwives Association of Mauritania,
Addellah Fatimetou. To break the silence surrounding fistula, UNFPA has
established a partnership with the Midwives Association, a network of
non-governmental organizations working to eliminate fistula in the country
as well as journalists interested in population and development.
“They have helped pass the message on to communities, health
workers and society in general,” says former UNFPA Representative in
Mauritania, Diene Keita. A video telling the story of a fistula survivor is
used during awareness campaigns and social mobilization.
Another goal is to improve access to emergency obstetric and
newborn care in the country, in particular emergency obstetric care,
including additional equipment and human resources.
“So far, eight maternity clinics have been equipped and two operating
theatres have received support to strengthen prevention efforts,” says the
head of the National Reproductive Health Program, Mahfoud Ould Boye.
Since 2008, 150 health workers, including doctors, midwives and nurses
with obstetric skills, have received training on how to manage fistula cases.
Although there are three fistula centres in the country, they are not fully
operational. In 2010, 178 patients were treated. Twenty fistula survivors
benefited from social reintegration support after surgery and follow-up to
develop income-generating activities.
M. was among them. When she was identified by the fistula pro-
gramme, she was in a hopeless condition. After a successful surgery, she
received the support she needed to go back to her family and community.
She resumed her studies and now makes periodic visits to the boarding
centre of Sebkha, where she was treated and cared for until she recovered. Her
shy smile is a source of hope for other patients and a strong motivation for staff.
*Real name has been omitted by request.
6
Restoring hopeNouakchott, Mauritania
It all started in my home country, El Salvador. As a doctor, I was assigned
to one of the main national maternity hospitals. Because of the hospital’s
many resources, all the complicated cases were sent there. This gave
me the opportunity to learn how to respect all patients and discover the
joys of helping women deliver their babies. For me, every single one of the
approximately 35 daily deliveries we handled was unique.
Now I am facing another side of medical practice: I’m working in a
small clinic in the heart of Athens, Greece. Here, we provide free medical
consultation for migrants—something they can’t get elsewhere. But we
don’t have surgical facilities.
I am astonished by the huge differences between countries, especially
regarding complications. According to the UN, every day in 2008 about
1,000 women died of complications during pregnancy and childbirth.
Some 570 of those deaths occurred in sub-Saharan Africa and 300 of
them in South Asia, compared to only five in high-income countries.
But there are other sad outcomes. Sometimes, the woman is too small
to allow the baby to pass. The fact is that when the delivery starts and the
baby can’t come out, a surgical intervention is the only way to save the
lives of the mother and the baby, and to prevent injuries. If the head of
the baby stays for too long in the vagina, the pressure starts to block the
blood vessels, so no oxygen is received, and the tissue lacking oxygen
develops necrosis and eventually sloughs off.
If we consider the number of new cases of fistula every year, knowing
that each fistula is almost always preventable, we can see how limited the
access is to maternal health care in our world.
My desire is to continue working so that every pregnant woman can
choose to have a delivery in a safe environment, no matter what part of
the world they are from, and regardless of whether they are single, who
they are married to, or where they live. This is something worth striving for.
Aleida Marroquin is an obstetrician-gynecologist from El Salvador. She worked with Médecins Sans Frontières in maternity projects in Jahun, Nigeria and South Sudan, and with Medecins du Monde in a clinic for migrants in Athens, Greece. Aleida will start fistula surgery training this year in Ethiopia.
My journey as a doctorby Aleida Marroquin
Patients’ relatives waiting outside the maternity ward. Ahuk (in red, next to Dr. Marroquin), developed a severe infection after obstructed labor. Both her sister (in blue, also pregnant) and her mother stayed with her while she was in the hospital. Photo: Janine Issa, South Sudan, 2009.
dispatch7
MappingUNFPA will be working closely with the Fistula Foundation, Direct
Relief International and other partners to undertake a mapping exercise,
compiling information on fistula centers, experts and activities globally.
The idea is to develop “the big picture” on current activities, needs
and gaps relating to fistula in the world. A testing round of sample
questionnaires was already circulated among key partners in the
Campaign.
According to Lindsey Pollaczek, who is leading the mapping effort at
Direct Relief International, the survey will provide a more comprehensive
understanding of where women are currently going for fistula care
and how many are currently being treated. The information, which will
be updated continuously, will also guide strategic planning for fistula
initiatives in the future and will further connect key people and agencies
working in the field. EngenderHealth, Women and Health Alliance
International (WAHA) and the International Society of Obstetric Fistula
Surgeons (ISOFS) are key partners in the initiative, which will add to
the excellent work done by others, such as the Geneva Foundation for
Medical Education and Research (GFMER).
Regional Conference“The government will establish a National Task Force on Fistula to
move from a campaign-based to a permanent service-based approach
for the management of this stark health challenge,” said Assad Hafeez,
Director-General in the Ministry of Health, during a regional fistula
conference in Karachi from 4-6 March 2011.
The conference brought together 3,000 experts in the field of obstetric
fistula, including 11 international fistula surgeons. It covered a range of
issues, from safe motherhood to social reintegration of fistula survivors,
providing an opportunity to reach consensus on priorities and draw
attention to the linkages between fistula and poverty, inequality, gender
disparity and poor education. The participating surgeons also operated
on complex fistula cases while they were in Pakistan.
Women’s DayOn International Women’s Day, singer and actress Natalie Imbruglia,
spokesperson for the Campaign to End Fistula, raised her voice to draw
attention to the many women who still suffer with obstetric fistula. In
an emotional video testimony, she talked about her missions during the
past five years and the many special women she has met in her fight
against this terrible condition.
Reality CheckThe RH Reality Check blog ran a series on prevention, care and
treatment of obstetric fistula, with contributions from various institutions,
including EngenderHealth, Guttmacher Institute, Human Rights Watch,
the International Women’s Health Coalition, the Fistula Foundation
and UNFPA. The series, which highlighted the importance of more
comprehensive approaches to fight fistula, was published in conjunction
with renewed efforts to increase support to address obstetric fistula.
NEWS
A new set of priorities for the global fight against obstetric fistula was the
focus of the 2010 meeting of the International Obstetric Fistula Working
Group (IOFWG). Specialists from around the world gathered in Dakar,
Senegal, last December to discuss ways to move the fistula agenda forward
and eliminate the condition. The meeting was held immediately before the
International Society of Obstetric Fistula Surgeons (ISOFS) Conference.
New initiatives on prevention, treatment and research were highlighted by
the group, which works to ensure global coordination of partner efforts for all
issues relating to fistula. Updates on fistula activities included a session led
by EngenderHealth on current fistula research, and the formulation of a list of
research recommendations to overcome research gaps and strengthen data
base on fistula. Findings of the mid-term evaluation and the new three-year
vision for the Campaign were shared with working group members.
While there was a strong presence of medical and surgical organizations,
participants recognized the urgent need for engaging with more advocacy
and social reintegration partners in the future. This will include human rights
groups, as it was the recognition of fistula as a neglected medical and human
rights issue that initially gave rise to the global Campaign to End Fistula.
The meeting was held on a positive high note. 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.
“It was an excellent 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,”
explained the Campaign coordinator, Gillian Slinger. The Dakar meeting also
shed light on promising practices that are being carried out by the many
partners of the Campaign.
One of the hosts of the meeting, Professor Serigne Gueye, a leading
fistula expert and also one of the organizers of the ISOFS Third Annual
Conference, highlighted the increased collaboration among partners
and specialists from different backgrounds.
The UNFPA Representative in Senegal, Rose Gakuba, was delighted
with the initiative to have back–to-back obstetric fistula meetings, which
gave the opportunity to share lessons learned and experiences, and to
bring coherence to the global efforts in this area.
Nine new partner organizations joined the group during the meeting: the
Bangladesh Medical Association, Fistula Foundation Nigeria, Health and
Development International, Human Rights Watch, Médecins Sans Frontières
(Belgium), Obstetrical and Gynecological Society of Bangladesh, the
Uganda Childbirth Injury Fund, Women and Health Alliance International,
and Women’s Hope International.
More than 20 journalists from national, regional and international
media attended a press conference with fistula experts at the meeting and
followed the stories of fistula survivors as they underwent treatment and
returned to their communities. Their coverage helped raise visibility about
the importance of expanding treatment. The next IOFWG meeting will be in
October 2011.
Working Group meetingDakar, Senegal
UNFPACampaign to End Fistula605 Third Avenue, New York, NY 10158email: [email protected]
dispatch is a biannual newsletter highlighingdevelopments in the Campaign to End Fistula
Why the Campaign?Every year, 7-10 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, please visit: endfistula.org.
Editorial Process: Etienne FrancaDesign and Printing: Prographics, Inc.
Contributors:Muhammad Ajmal, Erin Anastasi, Assane Ba,Yves Bergevin, Luc de Bernis, Joséphine Kawende Bora, Emily Dally, Triana D’Orazio, Abubakar Dungus, Vincent Fauveau, Neil Ford, Esperance Fundira, Omar Gharzeddine, Kate Grant, Serigne Gueye, Brian Hancock, Calixte Hessou, Sennen Hounton, Katja Iversen, Janet Jensen, Peter Johnson, Diene Keita, Richard Kollodge, Jeannette Biboussi Kouangha, Laura Laski, Geeta Lal, Amar Ould Mohamed Lemine, Jenipher Mijere, Julita Onabanjo, Duah Owusu-Sarfo, Aleida Marroquin Parducci, Friedrike Paul, Lindsey Pollaczek, Kate De Rivero, Allison Shigo, Sandy Singer, Gillian Slinger, Sawiche Wamunza.
Campaign Donors (since 2003)Americans for UNFPAArab Gulf Programme for UN Development Organizations Bill & Melinda Gates Foundation through EngenderHealth European Voice Government of AustraliaGovernment of AustriaGovernment of Canada Government of FinlandGovernment of IcelandGovernment of Ireland Government of Japan (through the UN Trust Fund for Human Security) Government of LuxembourgGovernment of New Zealand Government of Norway Government of Poland Government of the Republic of Korea Government of Spain Government of SwedenGovernment of SwitzerlandJohnson & Johnson Kingdom of Spain, Autonomous Community of CatalunyaOne by One United Nations FoundationVirgin UniteWomen's Missionary Society of the African Methodist Episcopal ChurchZonta 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 numerous partners and individual donors for their collaboration and support to the Campaign to End Fistula since its inception.
Campaign to End Fistula countries
Mauritania
SenegalGambiaGuineaBissau Guinea
Mali
GhanaTogo
Benin
Nigeria
Niger Chad
Congo
Sudan Yemen
India
Nepal
Bangladesh
Pakistan
Afghanistan
Djibouti
Eritrea
Somalia
Kenya
BurundiRwanda
Uganda
Ethiopia
AngolaZambia Malawi
MozambiqueMadagascarZimbabwe
SouthAfrica
Lesotho
Swaziland
DemocraticRepublicof Congo
UnitedRepublic ofTanzania
CameroonCentral African
Republic
Gabon
SierraLeone
EquatorialGuinea
Liberia
Côted’Ivoire
BurkinaFaso
Haiti
CARIBBEAN
The opinions expressed by the persons interviewed and original authors do not necessarily reflect the newsletter editorial position, the official position of UNFPA, or recognition of geographic boundaries or countries.
A major effort by over 20 partners—includ-
ing United Nations agencies, donors and
non-governmental organizations—will
produce the first ever State of the World’s
Midwifery Report, which is expected to
shed light on critical resource gaps.
Although it is widely recognized that the
role of midwives and others with mid-
wifery competencies is crucial in promoting
women’s and children’s health, an overview of midwifery in the world has
thus far been lacking.
“This strong global partnership is calling unprecedented attention to the
critical importance of optimizing the practice of midwives, thus ensuring
their ability to provide a host of integrated preventative and treatment
services that are essential to maternal health, including sexual and
reproductive health issues like fistula prevention,” says Peter Johnson,
Director of Global Learning for Jhpiego, an international non-profit health
organization affiliated with Johns Hopkins University and UNFPA partner
in midwifery training initiatives.
The report, which will be launched on June 20th at the Congress of
the International Confederation of Midwives in Durban, South Africa,
is considered a key advocacy tool for human resources for health,
particularly midwifery, providing new information, global analysis and
data on midwifery in 60 countries with high maternal mortality.
“The health of women and their newborns has increasingly taken
centre stage in global development discussions since the launch of
the United Nations Secretary General’s Strategy on Women’s and
Children’s Health, in September 2010,” says the chief of the Sexual
and Reproductive Health Branch at UNFPA, Laura Laski. “The new
midwifery report will provide new evidence about midwifery in the
priority countries identified by the strategy and will guide our work,”
Dr. Laski adds.
Furthermore, midwives have a key role in monitoring the progress
of labour, recognizing when it is obstructed and referring pregnant
women to emergency obstetric care in time, which helps reduce the
incidence of obstetric fistula while safeguarding the well-being of
both mother and baby.
New report highlights midwifery
THE STATE OF THE
WORLD’S MIDWIFERY2011
DELIVERINGHEALTH,
SAVINGLIVES