“I feel myself incomplete, and I am inferior to people”: experiences of Sudanese women living with obstetric fistula in Khartoum, Sudan

Background Obstetric fistula is among the most devastating maternal morbidities that occur as a result of prolonged, obstructed labor. Usually, the child dies in a large number of the cases. Moreover, some of the women become infertile while the majority suffer physical, psychosocial and economic challenges. Approximately 5000 new cases of obstetric fistula occur in Sudan each year. However, their experiences are under documented. Therefore, this study aimed to shed light on their daily lives living with obstetric fistula and how they cope. Methods Using a qualitative study design, 19 women living with obstetric fistula were interviewed. The study took place in the fistula ward located in Khartoum hospital and the fistula re-integration center in Khartoum, Sudan. Thematic analysis approach was employed. Stigma and coping theories guided the data collection, analysis, and discussion of the findings. Findings Women in our study suffered a challenging physical life due to leakage of urine. In addition, they encountered all forms of stigmatization. Women used both emotion-focused and problem-focused coping techniques to mitigate the consequences of obstetric fistula. Conclusion The study findings underscore the importance of obstetric fistula prevention programs and the urgency of repair surgeries to alleviate women’s suffering. Community sensitization, rehabilitation and re-integration of women back to their communities are also important strategies on their journey to wholeness.

Epidemiology, etiology and prevention of postpneumonectomy pleural empyema

Background: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A broncho-pleural fistula is often detected. Despite various therapeutic options developed over the last five decades it remains a major surgical challenge. Materials and methods: A literature search in MEDLINE database was carried out (accessed through PubMed), by using a combination of the following key-words and MeSH terms: pneumonectomy, postoperative, complications, broncho-pleural fistula, empyema, prevention. The following areas of intervention were identified: epidemiology, etiology, prevention. Results: Pleural empyema in a post-pneumonectomy cavity occurs in up to 16% of patients with a mortality of more than 10%. It is associated with broncho-pleural fistula in up to 80% of them, usually in the early postoperative months. Operative mortality could reach 50% in case of broncho-pleural fistula. Unfavourable prognostic factors are: benign disease, COPD, right-sided surgery, neoadjuvant and adjuvant therapy, time of chest tube removal, long bronchial stump and mechanical ventilation. Bronchial stump protection with vascularised flaps is of utmost importance in the prevention of complications. Conclusion: Postpneumonectomy pleural empyema is a common complication with high mortality. The existing evidence confirms the role of bronchopleural fistula prevention in the prevention of life-threatening complications.

Fistula Prevention Awareness Activities of Community Volunteerism Niger: A way to improve Access to Information and Care

Aims: To assess the effects of community volunteer (CV) activities on use of maternal and reproductive health services in Niger. The USAID-funded Fistula Care Plus Project (FC+) strengthens fistula prevention, detection, treatment and reintegration. In Niger, FC+ engaged CVs to increase facility delivery, promote pre- and post-natal care and to improve access to family planning (FP) in Tahoua and Maradi health districts. Methods: FC+identified CVs and trained them to explain obstetric fistula, identify pregnancy danger signs, promote safe motherhood, and discuss male involvement. CVs provide community monitoring through household visits and awareness activities. CVs collect data on pregnant women, follow up on antenatal (ANC)/post-natal (PNC) visits, and provide counseling on all FP methods. We used routine facility data to summarize maternal health service usage in Tahoua and Maradi. Results: 774 CVs were trained between March 2015 and April 2016; they held 9,999 community outreach events, reaching 98,654 individuals. The number of women completing their first ANC visit increased from 13,041 in 2015 to 14,978 in 2016 (15%). 12% and 25% increases were documented, respectively, for fourth ANC visit and PNC visit completion in 2016 relative to 2015.A 48% increase in new acceptors of long-acting FP methods also occurred. Data require standardization against population changes and triangulation with qualitative data from community stakeholders. Conclusions: Engaging community volunteers may improve access to information and services, resulting in increased use of FP and maternal health care. A follow-up system to ensure continued engagement among stakeholders could promote sustainability.

Contribution of Ad-din Micro-credit program in Fistula Prevention, Case identification and Referral

Aims: The objective of this presentation is to describe the practice of fistula case identification, referral and rehabilitation of patients under the Ad-din microcredit program and to share performance data and program experience in this field. Methods: Using a 4 question checklists developed through the Fistula Care Plus project, Ad-din field workers identify fistula clients from community. Ad-din does a customized rehabilitation need assessment of individual fistula cases then and supports them accordingly. Results: During this period, 358 cases have been identified with probable fistula symptoms. Diagnosis was confirmed among 169 cases through community fistula diagnosis events. Ad-din facilitated treatment of 153 cases. The program has provided rehabilitation training to 46 cases and livelihood support to 59 cases. Conclusion: Microcredit networks can be used for community-based fistula case identification, treatment facilitation, case referral and case rehabilitation. If the networks of microcredit systems in many settings are utilized in fistula prevention and care, they could be useful partners to address fistula in any community.

Experience of using Community Radio for Fistula Communication in Bangladesh

Aims: To share the experience of using community radio networks for female genital fistula communication in Bangladesh. Methods: We selected 11 community radio stations from remote areas in Bangladesh. Four hours orientation training was provided to manager and fistula focal person per radio station. We provided pre-recorded education and advocacy materials for fistula prevention and communication. Station staffs were provided with a manual for fistula communication. Results: 32 key staff members of community radios were trained. At least 33 episodes were broad casted focusing on prevention of early marriage, care of obstructed labor, treatment and rehabilitation of fistula. Information about fistula prevention, case identification, repair center and rehabilitation were provided to an estimated number 660,000 people living in hard to reach places through community radio stations. They incorporated fistula messages song, dramas and talk shows on fistula throughout the year. Conclusions: Community radio is a low cost, effective media for fistula communication in hard to reach areas. It is capable of linking a range of stakeholders and can be a strong force for facilitation of social movement for fistula free communities.

Fistula Prevention Awareness

Aim: Genital tract fistula is a known tragedy in Pakistan. We know the causes of this tragedy and we also know the methods to eradicate this curse from the community. Despite the initiative from UNFPA, Islamic Development Bank and other concerned stake holders the government of Pakistan has failed to address the issue and an organized system is not developed to reduced maternal death rate and maternal morbidity in Pakistan. It’s a common practice to exploit the sad situation of victims of fistula and run ghost campaigns to eradicate genital tract fistula from the community. Methods:In depth analysis on intersections of social inequities in health, polices in Pakistan. The review carried out on the available literature / reports around the theme of women health & rights responsiveness in health systems. This analysis also includes the role and support of the donor agencies working on maternal health in Pakistan. Results: An overall unfairness prevailing in the healthcare system which is affecting women health resulting a very high maternal mortality ratio (MMR) maternal morbidity like fistula. The health policy is a highly complex phenomenon needs a multi-disciplinary approach to develop public policy that aims to explain the interaction between institutions, interests and ideas in the policy process. Health policies must reflect the specific steps to address the issue of gender based discrimination. Conclusion: The politics of fistula is serving people to become rich in vested interest group, its providing platform to governments to make their image in front of donor countries. It’s also providing opportunity to people working in donor agencies to get involve in corruption at the cost of poor patients of fistula. Prevention of fistula is ultimate goal to get rid of this morbidity need department of health for provision of basic health facilities specially availability of SBA BUT there is no such policy intervention to produce competent midwives local community level. The existing fistula cases are not treated at district level due to lack of skill of local gynecologists to repair the fistula at district level.

Nuanced Reporting of Fistulas in Laryngectomy Studies

Pharyngocutaneous fistula is an important complication of laryngectomy and can vary significantly in severity. Many authors have advocated for the use of vascularized flaps (eg, pectoralis major) to reduce the risk of fistula. Prevention of small, self-limited fistulas may not be worth the morbidity of a vascularized flap in some cases. More nuanced analysis of fistula outcomes, stratified by severity, may enable better surgeon-patient decision making regarding the use of vascularized flaps in laryngectomy.