2. Obstetric Fistula in Kenya: A Holistic Model of Outreach, Treatment, and Reintegration

Author(s):  
Lindsay Pollaczek ◽  
Habiba Mohamed ◽  
Bwalya Chomba

In 2014, Fistula Foundation and partners launched Action on Fistula in Kenya, a comprehensive initiative focused on expanding access to fistula care and building the national capacity for fistula treatment, training, and community mobilization. Between  May 2014 - September 2018, over 4,000 fistula repair surgeries have been performed at six partner hospitals throughout the country, far surpassing the original targets and nearly doubling the treatment capacity in the country. This was accomplished through partnerships with the Ministry of Health, public and private hospitals, Federation of International Gynecology and Obstetrics for accreditation of the first FIGO obstetric fistula training center in the country, and community-based organizations responsible for patient identification, referral, and reintegration programs. This integrated and holistic model of delivering fistula care has resulted in over 4,100 fistula surgeries performed by 10 Kenyan surgeons, 8 new surgeons trained to the FIGO standard or intermediate competency level, 309 community health volunteers trained and deployed, over 12,000 community events conducted to improve knowledge and awareness of fistula, and over 300 women enrolled in support groups post repair to enhance social and psychological health and boost livelihood development opportunities. The success of the Kenya program prompted the launch of a new countrywide treatment network in Zambia in January 2017. In the first 20 months, the program supported over 375 additional surgeries at six hospitals (from a baseline of approximately 200 surgeries annually done across the country), trained three surgeons to FIGO standard competency level, trained 217 CHVs and Safe Motherhood Action Group Members, and conducted over 2,000 outreach activities for fistula awareness.


Author(s):  
Marcus Wiens ◽  
Sebastian Frahm ◽  
Philipp Thomas ◽  
Shoaib Kahn

AbstractRequirements for the design of wind turbines advance facing the challenges of a high content of renewable energy sources in the public grid. A high percentage of renewable energy weaken the grid and grid faults become more likely, which add additional loads on the wind turbine. Load calculations with aero-elastic models are standard for the design of wind turbines. Components of the electric system are usually roughly modeled in aero-elastic models and therefore the effect of detailed electrical models on the load calculations is unclear. A holistic wind turbine model is obtained, by combining an aero-elastic model and detailed electrical model into one co-simulation. The holistic model, representing a DFIG turbine is compared to a standard aero-elastic model for load calculations. It is shown that a detailed modelling of the electrical components e.g., generator, converter, and grid, have an influence on the results of load calculations. An analysis of low-voltage-ride-trough events during turbulent wind shows massive increase of loads on the drive train and effects the tower loads. Furthermore, the presented holistic model could be used to investigate different control approaches on the wind turbine dynamics and loads. This approach is applicable to the modelling of a holistic wind park to investigate interaction on the electrical level and simultaneously evaluate the loads on the wind turbine.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tilahun Fufa Debela ◽  
Zerihun Asefa Hordofa ◽  
Aster Berhe Aregawi ◽  
Demisew Amenu Sori

Abstract Background The consequences of obstetric fistula on affected women are more than the medical condition. It has extensive physical, psychological, social, and economic consequences on them. Obstetric fistula affects the entire health and entire life of women. Women suffering from obstetric fistula are often abandoned by her partner, relatives, and the community. This study aimed to determine the quality of life of obstetrics fistula patients before and after surgical repair. Methods Institutional-based prospective, before and after study design was conducted in the Jimma University Medical Center from November 1, 2019–October 30, 2020. A face-to-face interview was conducted with fistula patients who visited Jimma University Medical center, fistula clinic during the study period. All fistula patients were included in the study. Accordingly, 78 women who underwent surgical repair were interviewed. The means and the standard deviation were computed using conventional statistics formulas. The unpaired t-test was used to compare two independent means, and one-way analysis of variance (ANOVA) was used to compare the quality of life before repair and after a successful repair. Linear regression analysis was done for identifying determinants of quality of life. A P value of 0.05 will be considered statistical significance. Result The overall quality of life of women was 58.17 ± 7.2 before the surgical repair and 71.20 ± 10.79 after surgical repair. The result indicates there is a significant difference in the mean value of pre and post-operative (P < 0.001). The overall satisfaction of women with their health status before the surgical repair was 22.5 ± 1.30and it has increased to 53.0 ± .90after surgical repair. The physical health dimension score was 16.51 ± 5.27 before the surgical repair while it has increased to 21.77 ± 5.38 after the surgical repair. The score of the social domain before the surgical repair was 5.19 ± 1.34 and it has increased to 7.13 ± 3.67 after the surgical repair. The score of the environmental health domain was 17.41 ± 2.89 before the surgery while it also increased to 21.65 ± 4.04 after the surgical repair. The results have shown there was a significant difference in the mean values of pre and post-operatives in both social and environmental scores (P < 0.001). The score of the psychological health domain before the surgery was 19.06 ± 1.46 and it was increased to 19.84 ± 3.21 after the surgical repair. The result showed there is a significant difference in mean value pre and post-operative (P = 0.048), though it is a slight improvement compared to other domains. Conclusion The overall quality of life of the patient with fistula was improved after successful surgical repair. Although all domains of quality of life had shown significant improvement after successful surgical repair, the psychological domain showed slight improvement.


2021 ◽  
Vol 224 (2) ◽  
pp. S418
Author(s):  
Michael D. Jochum ◽  
Benjamin D. Belfort ◽  
Mary Stokes ◽  
Rachel Pope ◽  
Maxim Seferovic ◽  
...  

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Kevin Deschamps ◽  
Chris Nester ◽  
Veronica Newton ◽  
Gabriel Gijon-Nogueron ◽  
Engin Simsek ◽  
...  

AbstractFoot orthoses have been used for decades despite uncertainty surrunding their therapeutic efficacy. Orthoses have been used exclusively to affect neuro-biomechanical input and outcome variables, however, there is emerging evidence that therapeutic efficacy may be affected by a psychological stimulus. Critical appraisal of the literature highlights that there is no holistic model upon which foot orthosis practice is taught, practised nor investigated. This paper introduces a conceptual model of foot orthosis practice (Value Based Foot Orthosis Practice (VALUATOR) model) that embraces a broader range of factors that are pertinent to orthosis practice, incorporating contemporary health service behaviours and values into orthosis practice for the first time.Within the VALUATOR model, foot orthosis design and clinical value is considered along a bio-psycho-social-digital continuum that reflects the reality of foot orthosis practice. The model contextualises the variable outcomes that are observed in research and practice within 6 key areas: 1) value, 2) person-centered approach, 3) zone of optimal bio-psycho-social stress, 4) bio-psycho-social assessment, 5) monitoring, 6) primary and secondary clinical strategies.The VALUATOR model is targeted at students, lecturers, scientists and practitioners and includes carefully chosen terminology to support a robust basis for educational and scientific discussion. It is believed that it provides a contemporary viewpoint and a structured conceptual metaphor that builds on existing evidence from a wide range of sources, invites constructive intellectual debate, and is anchored in the experiences of practitioners too. Stress testing the VALUATOR model will help determine its model and support further developments and evolution of orthotic practice in a evidence based way.


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