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May 2011

Tanzania

Mobile phones help fight fistula page 3

Global

Fistula initiatives will be mapped page 7


Editorial These are times of change for the Campaign to End Fistula.

Safe motherhood ambassador by Allison Shigo, Healing Hands of Joy

With new and reinvigorated partnerships, the Campaign will

According to a 2010 USAID report, in Ethiopia, 93 per cent of women

work even harder towards eliminating the devastating condition

deliver at home, in most cases without the assistance of a skilled attendant,

of obstetric fistula.

thus increasing their vulnerability to childbirth complications and disabilities, including obstetric fistula. The situation is dire, and experts believe that

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.

cultural birthing practices will only change from within communities. Berhidda Redda, 33, a fistula survivor from Adiweyane, a small village

Building on the excellent work done by other institutions, UNFPA

about one hour from the capital of the Tigray Region in Northern Ethiopia,

will be working closely with the Fistula Foundation, Direct

is living proof. Despite the many health-related challenges she faced, Ms.

Relief International and other partners to undertake a mapping

Redda is now helping bring positive changes to her own community.

exercise, compiling information on fistula centres, experts and activities globally.

“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

This is an ambitious and exciting project, and we hope it will

fistula during my first pregnancy. Everyone in my town knew me as the

provide valuable insight into what is happening with fistula across

woman who was ‘cursed’ with fistula.”

the world, as well as filling many information gaps.

For those working closely with fistula survivors, discrimination and divorce are familiar outcomes; it is extremely difficult to find purpose and

Another priority for 2011 is a more coordinated approach to the global response to fistula—prevention, quality treatment, social

means of subsistence even after being healed. Although Ms. Redda was able to get treatment, she continued to live with

reintegration, research, data and advocacy—to ensure that

the stigma and shame of this condition. But thanks to Healing Hands of Joy’s

the Campaign moves forward in a spirit of collaboration, with

Safe Motherhood Ambassador Training Program, a project that empowers

internationally agreed upon goals.

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.

In this and upcoming editions of Dispatch, the reader will find

“Before surgery, I was discriminated against by neighbors and even my

more and more articles highlighting the great achievements of our

family. Now, things are slowly getting better because I’ve learned fistula is

many partners in the field, as well as the difficulties they face and

not a disease caused by doing something outside of the law of God but is a

their plans for the future. These features will also portray the real

curable condition. I want to know more about it and help others,” she says.

faces and stories that make the work on fistula very challenging, yet extremely rewarding. Enjoy the reading!

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.

Gillian Slinger Coordinator, Campaign to End Fistula

“We had been giving birth at home. We had not been going to healthcare 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-

What is fistula?

riculum HHOJ designed in partnership with the Tigray Health Bureau,

Obstetric fistula is a childbirth injury caused by prolonged, obstructed

including maternal health lessons in the causes of fistula, prevention

labour, without timely medical intervention—typically a Caesarean

methods, and the benefits of institutional delivery.

section. During unassisted prolonged labour, the sustained pressure

Ms. Redda not only wanted to know more about the causes of fistula,

of the baby’s head on the mother’s pelvic bone damages soft tissues,

but also wanted to help prevent other women from suffering the same

creating a hole—or fistula—between the vagina and the bladder and/

fate. With her strength, determination and desire to learn, she can be an

or rectum. The pressure deprives blood flow to the tissue, leading to

agent of change in her community and fill an essential gap in providing

necrosis. Eventually, the dead tissue sloughs off, damaging the original

voluntary maternal health counseling.

structure of the vagina. The result is a constant leaking of urine and/or

Ms. Redda is now working in her community, monitoring pregnant

feces through the vagina. It’s estimated that over 2 million women live

women and confidently sharing her story to prevent other mothers from

with the condition in the world, with up to 100,000 new cases every year.

suffering as she had. She is also proud to be a business owner. With the

Fistula is both preventable and, in most cases, treatable.

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,

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.

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scarves, biscuits, matches and other supplies.

Read more:

www.endfistula.org


Using mobiles to fight fistula

Highlights

Dar es Salaam, Tanzania The country’s largest provider of fistula surgery, Comprehensive Community

Spearheaded by UNFPA in collaboration with many partners and sup-

Based Rehabilitation in Tanzania (CCBRT), is revolutionizing the fight against

ported by numerous generous donors, the Campaign to End Fistula

fistula through mobile phone technology to make services more available to

has quadrupled in size during the last seven years. From its original 12

women living with the condition. The goal is to facilitate transportation for

countries, the Campaign has now expanded to cover 49 countries in

fistula patients seeking treatment, so that more women can access surgery.

Africa, Asia, the Arab States, Latin America and the Caribbean.

According to UNFPA, an estimated 3,700 new cases of obstetric fistula occur in Tanzania every year, but only about 1,000 get treated. “Sadly,

As a result of this growth, more and more women are able to access

most women living with the condition do not know that treatment is avail-

the care they need to prevent and treat fistula, and to return to full and

able or they just can’t afford it,” explains CCBRT’s Chief Executive Officer,

productive lives after fistula treatment with the support of govern-

Erwin Telemans, who is also responsible for the mobile phone initiative.

ments and partners.

At their hospital in Dar es Salaam, CCBRT provides fistula surgery free of charge, but until recently, the high cost of transportation and accommo-

UNFPA coordinates and serves as Secretariat for the Global

dation prevented fistula survivors in remote villages from seeking treatment.

Campaign to End Fistula and for the International Obstetric Fistula

Since late 2009, however, the non-governmental organization began using

Working Group (IOFWG), which represents over 50 national and

Vodafone’s mobile banking system M-PESA—M for “mobile” and PESA for

international institutions.

“money” in Swahili—to help patients overcome transportation costs. Supported by UNFPA, the institution embarked on a pilot project, using M-PESA to send money to fistula survivors so that they can travel to the hospital in Dar es Salaam for their repair surgery. The money, which is provided by the project, is sent by CCBRT via SMS to fistula volunteer ambassadors, who may be former patients, health workers, or staff of non-governmental organizations, to identify and refer women suffering from fistula for treatment.

Since the Campaign was launched in 2003: • More than 20,000 women have received fistula treatment and care with support from UNFPA. • Over half of all Campaign countries have incorporated fistula in national policies and plans. • Additional countries are revising their existing reproductive health national policies to ensure the full integration of obstetric fistula.

The ambassadors can retrieve the money at the local Vodafone M-PESA agent and buy bus tickets for the patients. When the patient

In 2010, with UNFPA support:

arrives at the hospital, the ambassador receives a small incentive.

• More than 5,000 women and girls accessed fistula treatment in

Since the start of the project, the fistula ambassadors’ network has

nearly 40 countries.

expanded to all regions of the country and the number of women who

• Over 1,800 surgeons and health workers were trained.

have been able to access fistula surgery increased by 65 per cent. In

• Fistula survivors in 18 countries worked to sensitize communities,

2010, fifty-four ambassadors referred 129 women for fistula repair via

provide peer support and serve as advocates for fistula prevention

M-PESA. The project is profiled in a Fistula Care technical brief; to

and improved maternal and newborn health at community and

learn more, please visit http://www.fistulacare.org/pages/resources/ publications/technical-briefs.php.

national levels. • The United Nations Secretary-General Report , “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. • The resolution Supporting Efforts to End Obstetric Fistula was adopted by consensus at the United Nations General Assembly, with 172 supporting countries, and called for renewed focus and additional resources for fistula. • Enhanced global and national media coverage and advocacy helped increase political focus on maternal health issues, including fistula. • The Campaign to End Fistula was one of few initiatives worldwide featured in the MDG Good Practices publication. The Campaign was cited for its innovative and comprehensive approach, combining programmatic, technical and advocacy intervention and

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.

awareness-raising on how to prevent and treat fistula.

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dispatch


Extending fistula care in Somalia

Fighting fistula in East Africa

by Kate de Rivero, WAHA International

Kamuli, Uganda Childbirth Injury Fund

It is early morning, and my bed is dry!

When asked about the progress made in the fight against fistula, Brian

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.

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

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

comments, quoting recent UN statistics. A leading cause of maternal death, obstructed labour can only be

had travelled well over 1,000 km from South Somalia for fistula repair at

relieved by timely medical intervention, usually a Caesarean section,

the Boroma Fistula Hospital in Somaliland. The majority of patients were

without which the woman usually dies. If “lucky,” she will survive after

only in their mid-twenties, but some had already been living with obstetric

days of agony, often resulting in a dead baby and injuries that can have a

fistula for up to 12 years.

devastating effect on her life.

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

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

what was wrong with me and it just didn’t stop…. I used to love going

Fund, prevention must be the main goal, closely followed by education and

out and seeing friends but that changed.… I no longer felt able to go to

improved transport options and hospital facilities. “But the problem will be

weddings or the mosque; even going to the market was difficult. I was so

with us for a long time. There will be a need to train many more surgeons,”

self-conscious of my smell, ashamed of spoiling my clothes, and aware

he asserts.

of what others thought of me.” The ongoing armed conflict and instability in South and Central

Having done more than 1,300 fistula repairs during his career, Dr. Hancock knows about the real situation in many countries where fistula

Somalia make it very difficult to improve obstetric care or to provide

is prevalent. He usually spends three months a year abroad, partnering

onsite fistula repair services. Yet this is an area with one of the highest

with other institutions and rural hospitals in several East and West African

maternal death rates in the world, an indicator of high incidence of

countries to both perform surgery and train new professionals.

post-partum complications, such as obstetric fistula. The relative stability

“I rarely operate without at least one trainee present,” Dr. Hancock says,

in Somaliland has allowed fistula treatment services to be provided in

explaining that, according to his experience, although the necessary equip-

several hospitals.

ment is usually minimal, fistula surgery is highly demanding, encompassing

“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

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.

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 organizing 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 transport 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.

4

Fistula surgery at Kamuli. Photo: Gillian Slinger, Uganda, 2010.


A vision in white

Survivors get back on their feet

Lusaka, Zambia

DRC/ Liberia/ Republic of the Congo

Sarah Sukwa, 18, got married before turning 15. She left her father’s

It takes more than an operation to get fistula survivors on their feet. First,

home and went to live next to her mother-in-law in a village nearby. Ms.

there’s a recovery period, two weeks on average, so that the patients can

Sukwa was very happy with her new husband, who worked in a small

heal after surgery. But it’s often a job or a livelihood that really helps them

farm. When she got pregnant right after her marriage, he would even help

reclaim their lives.

her with the heavier domestic tasks.

Because so many fistula survivors have been abandoned, excluded

When she realized that her labour had started, she informed her

or shunned—often for years—a job or a business opportunity can mean

mother-in-law, who then sent for the traditional birth attendant. Her

renewed social connections and a sense of purpose, as well as a much-

mother-in-law told Ms. Sukwa that she should deliver at home as most

needed livelihood.

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.

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

However, it was too late—her baby was dead.

of the fistula survivors who benefited from the programme in Liberia after

Two days later, her husband took her back home on his bicycle. Ms.

living with the

Sukwa noticed that she was leaking urine uncontrollably, but she was

condition for

too weak to return to the hospital. She didn’t know then that she had

almost 20 years.

developed fistula. Unfortunately, there are many other stories like this in Zambia.

The change in Rebecca

According to national authorities, at least 500 new cases of obstetric

Mambweni’s

fistula occur in the country every year, a rough estimate based on the

life is striking.

number of women seeking treatment at various health centres across

She was just 23

the country. However, most hospitals keep no documentation, and only

when she went

a few have complete records. So the figures reflect health personnel

through days of

estimates and claims that “…there are many women living with fistula in

agonizing labour

the country.”

before a dead

Besides the lack of data, fistula survivors receive little help from district

fetus was pulled

and provincial health facilities due to the limited capacity to provide com-

from her uterus.

prehensive care. The people have to travel long distances on poor roads

The trauma

to reach health facilities, and rural centres are few and understaffed.

to her birth

“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

canal left her incontinent.

Rebecca Mambweni benefited from a programme that teaches fistula survivors and employs them as beauticians and dressmakers. Photo Robin Hammond, Panos/Campaign to End Fistula, DR Congo, 2010.

“I lived for a

prevention and integration of obstetric fistula within the larger maternal

year with fistula. I just stayed at home with my mum. Sometimes I could

health initiatives in the country,” she explains.

see her crying. No one wanted to be around me. My in-laws abandoned

To raise public awareness about the problem, some safe motherhood

me,” she says. “They didn’t want to pay for an operation to fix me. All I

action groups supported by the government have been engaged to educate

could do was stay home. I couldn’t go outside just in case I urinated on

communities in reproductive health matters, including fistula prevention.

myself. When I went outside people would laugh at me, pointing. It was

The members, who are identified by the community, encourage women

like a prison. I sometimes felt it would just be better if I died and just be

to seek skilled attendance during delivery, use modern family planning

quiet somewhere else.”

methods to space their children, and avoid unplanned pregnancies. Nevertheless, government plans to scale up the initiative are being

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

hampered due to the lack of resources. Another challenge is the insuf-

Salon of Hope. One day I’d really like to have a salon of my own. I’d really

ficient mobilization of community leaders around the importance

like all those people that laughed at me to see me now. I just want to live a

of preventing fistula.

normal life,” Ms. Mambweni says.

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dispatch


Restoring hope

Nouakchott, Mauritania

My journey as a doctor by Aleida Marroquin

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.

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.

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

It all started in my home country, El Salvador. As a doctor, I was assigned

national authorities are committed to scaling up the efforts to eliminate fistula

to one of the main national maternity hospitals. Because of the hospital’s

that have been carried out in the country since 2005, many challenges remain.

many resources, all the complicated cases were sent there. This gave

“One of the priorities is to raise awareness about the condition,”

me the opportunity to learn how to respect all patients and discover the

explains the chairwoman of the Midwives Association of Mauritania,

joys of helping women deliver their babies. For me, every single one of the

Addellah Fatimetou. To break the silence surrounding fistula, UNFPA has

approximately 35 daily deliveries we handled was unique.

established a partnership with the Midwives Association, a network of

Now I am facing another side of medical practice: I’m working in a

non-governmental organizations working to eliminate fistula in the country

small clinic in the heart of Athens, Greece. Here, we provide free medical

as well as journalists interested in population and development.

consultation for migrants—something they can’t get elsewhere. But we

“They have helped pass the message on to communities, health workers and society in general,” says former UNFPA Representative in

don’t have surgical facilities. I am astonished by the huge differences between countries, especially

Mauritania, Diene Keita. A video telling the story of a fistula survivor is

regarding complications. According to the UN, every day in 2008 about

used during awareness campaigns and social mobilization.

1,000 women died of complications during pregnancy and childbirth.

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

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

theatres have received support to strengthen prevention efforts,” says the

baby can’t come out, a surgical intervention is the only way to save the

head of the National Reproductive Health Program, Mahfoud Ould Boye.

lives of the mother and the baby, and to prevent injuries. If the head of

Since 2008, 150 health workers, including doctors, midwives and nurses

the baby stays for too long in the vagina, the pressure starts to block the

with obstetric skills, have received training on how to manage fistula cases.

blood vessels, so no oxygen is received, and the tissue lacking oxygen

Although there are three fistula centres in the country, they are not fully operational. In 2010, 178 patients were treated. Twenty fistula survivors

develops necrosis and eventually sloughs off. If we consider the number of new cases of fistula every year, knowing

benefited from social reintegration support after surgery and follow-up to

that each fistula is almost always preventable, we can see how limited the

develop income-generating activities.

access is to maternal health care in our world.

M. was among them. When she was identified by the fistula pro-

My desire is to continue working so that every pregnant woman can

gramme, she was in a hopeless condition. After a successful surgery, she

choose to have a delivery in a safe environment, no matter what part of

received the support she needed to go back to her family and community.

the world they are from, and regardless of whether they are single, who

She resumed her studies and now makes periodic visits to the boarding

they are married to, or where they live. This is something worth striving for.

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

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.


Working Group meeting

NEWS

Dakar, Senegal A new set of priorities for the global fight against obstetric fistula was the

Mapping

focus of the 2010 meeting of the International Obstetric Fistula Working

UNFPA will be working closely with the Fistula Foundation, Direct

Group (IOFWG). Specialists from around the world gathered in Dakar,

Relief International and other partners to undertake a mapping exercise,

Senegal, last December to discuss ways to move the fistula agenda forward

compiling information on fistula centers, experts and activities globally.

and eliminate the condition. The meeting was held immediately before the

The idea is to develop “the big picture” on current activities, needs

International Society of Obstetric Fistula Surgeons (ISOFS) Conference.

and gaps relating to fistula in the world. A testing round of sample

New initiatives on prevention, treatment and research were highlighted by

questionnaires was already circulated among key partners in the

the group, which works to ensure global coordination of partner efforts for all

Campaign.

issues relating to fistula. Updates on fistula activities included a session led

According to Lindsey Pollaczek, who is leading the mapping effort at

by EngenderHealth on current fistula research, and the formulation of a list of

Direct Relief International, the survey will provide a more comprehensive

research recommendations to overcome research gaps and strengthen data

understanding of where women are currently going for fistula care

base on fistula. Findings of the mid-term evaluation and the new three-year

and how many are currently being treated. The information, which will

vision for the Campaign were shared with working group members.

be updated continuously, will also guide strategic planning for fistula

While there was a strong presence of medical and surgical organizations,

initiatives in the future and will further connect key people and agencies

participants recognized the urgent need for engaging with more advocacy

working in the field. EngenderHealth, Women and Health Alliance

and social reintegration partners in the future. This will include human rights

International (WAHA) and the International Society of Obstetric Fistula

groups, as it was the recognition of fistula as a neglected medical and human

Surgeons (ISOFS) are key partners in the initiative, which will add to

rights issue that initially gave rise to the global Campaign to End Fistula.

the excellent work done by others, such as the Geneva Foundation for

The meeting was held on a positive high note. Never has the political

Medical Education and Research (GFMER).

focus on maternal health and fistula been higher, thanks in large part to the

Regional Conference

advocacy efforts made in recent years by the Campaign to End Fistula and

“The government will establish a National Task Force on Fistula to

its partners.

move from a campaign-based to a permanent service-based approach

“It was an excellent opportunity for health-care providers and experts

for the management of this stark health challenge,” said Assad Hafeez,

from some of the world’s most affected nations to share key lessons

Director-General in the Ministry of Health, during a regional fistula

from the work on the front lines of maternal health and obstetric fistula,”

conference in Karachi from 4-6 March 2011.

explained the Campaign coordinator, Gillian Slinger. The Dakar meeting also

The conference brought together 3,000 experts in the field of obstetric

shed light on promising practices that are being carried out by the many

fistula, including 11 international fistula surgeons. It covered a range of

partners of the Campaign.

issues, from safe motherhood to social reintegration of fistula survivors,

One of the hosts of the meeting, Professor Serigne Gueye, a leading

providing an opportunity to reach consensus on priorities and draw

fistula expert and also one of the organizers of the ISOFS Third Annual

attention to the linkages between fistula and poverty, inequality, gender

Conference, highlighted the increased collaboration among partners

disparity and poor education. The participating surgeons also operated

and specialists from different backgrounds.

on complex fistula cases while they were in Pakistan.

The UNFPA Representative in Senegal, Rose Gakuba, was delighted

Women’s Day

with the initiative to have back–to-back obstetric fistula meetings, which

On International Women’s Day, singer and actress Natalie Imbruglia,

gave the opportunity to share lessons learned and experiences, and to

spokesperson for the Campaign to End Fistula, raised her voice to draw

bring coherence to the global efforts in this area.

attention to the many women who still suffer with obstetric fistula. In

Nine new partner organizations joined the group during the meeting: the

an emotional video testimony, she talked about her missions during the

Bangladesh Medical Association, Fistula Foundation Nigeria, Health and

past five years and the many special women she has met in her fight

Development International, Human Rights Watch, Médecins Sans Frontières

against this terrible condition.

(Belgium), Obstetrical and Gynecological Society of Bangladesh, the

Reality Check

Uganda Childbirth Injury Fund, Women and Health Alliance International, and Women’s Hope International. More than 20 journalists from national, regional and international

The 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,

media attended a press conference with fistula experts at the meeting and

the International Women’s Health Coalition, the Fistula Foundation

followed the stories of fistula survivors as they underwent treatment and

and UNFPA. The series, which highlighted the importance of more

returned to their communities. Their coverage helped raise visibility about

comprehensive approaches to fight fistula, was published in conjunction

the importance of expanding treatment. The next IOFWG meeting will be in

with renewed efforts to increase support to address obstetric fistula.

October 2011.

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dispatch


New report highlights midwifery THE STATE OF THE

WORLD’S MIDWIFERY 2011

DELIVERING

HEALTH, SAVING

LIVES

A major effort by over 20 partners—includ-

The report, which will be launched on June 20th at the Congress of

ing United Nations agencies, donors and

the International Confederation of Midwives in Durban, South Africa,

non-governmental organizations—will

is considered a key advocacy tool for human resources for health,

produce the first ever State of the World’s

particularly midwifery, providing new information, global analysis and

Midwifery Report, which is expected to

data on midwifery in 60 countries with high maternal mortality.

shed light on critical resource gaps.

“The health of women and their newborns has increasingly taken

Although it is widely recognized that the

centre stage in global development discussions since the launch of

role of midwives and others with mid-

the United Nations Secretary General’s Strategy on Women’s and

wifery competencies is crucial in promoting

Children’s Health, in September 2010,” says the chief of the Sexual

women’s and children’s health, an overview of midwifery in the world has

and Reproductive Health Branch at UNFPA, Laura Laski. “The new

thus far been lacking.

midwifery report will provide new evidence about midwifery in the

“This strong global partnership is calling unprecedented attention to the critical importance of optimizing the practice of midwives, thus ensuring

priority countries identified by the strategy and will guide our work,” Dr. Laski adds.

their ability to provide a host of integrated preventative and treatment

Furthermore, midwives have a key role in monitoring the progress

services that are essential to maternal health, including sexual and

of labour, recognizing when it is obstructed and referring pregnant

reproductive health issues like fistula prevention,” says Peter Johnson,

women to emergency obstetric care in time, which helps reduce the

Director of Global Learning for Jhpiego, an international non-profit health

incidence of obstetric fistula while safeguarding the well-being of

organization affiliated with Johns Hopkins University and UNFPA partner

both mother and baby.

in midwifery training initiatives.

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.

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 Liberia Cameroon Republic 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.

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.

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 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 numerous partners and individual donors for their collaboration and support to the Campaign to End Fistula since its inception.

UNFPA Dispatch May 2011  

UNFPA Dispatch, May 2011 edition

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