The World Health Organisation (WHO) has described fistula as “the single most dramatic aftermath of neglected childbirth."
The word "fistula" is a collective medical term for any abnormal connection between two bodily organs. In the case of obstetric fistula it is the result of pressure exerted by the head of the foetus on the pelvis during obstructed labour, a force that interrupts the blood flow to nearby tissues in the mother's pelvis, resulting in two classifications Vesicovaginal Fistula and Rectovaginal Fistula.
Vesicovaginal Fistula (VVF) |
Patients who have VVF or RVF uncontrollably and continuously leak urine or stool or both. They smell of urine or stool all the time. In addition to the physical discomfort of the fistulas, they often have a profound effect on the patient's emotional well-being as most of these women are shunned by their communities and some forced to move away from home.
| Rectovaginal Fistula (RVF) RVF occurs in a similar way to VVF however, holes form between the tissues of the vagina and rectum, leading to uncontrollable leakage of faeces. RVF is also sometimes referred to as Recto-vaginal Fistula and Recto Vaginal Fistula. |
VVF and RVF occur commonly in areas where the culture encourages marriage and conception at a young age, often before full pelvic growth has been achieved. Chronic malnutrition further limits pelvic dimensions. Few women are attended to by qualified health care professionals or have access to medical facilities during childbirth; their obstructed labour may be protracted for days or weeks.
Aim
The AMREF National Fistula Program works in 20 regions of mainland Tanzania to build an effective, comprehensive strategy to address fistula in the context of maternal mortality and morbidity.
Objectives
- To build capacity of local health care providers to be able to effectively treat and prevent fistula.
- To ensure girls and women are able to access high quality fistula care in an effective manner and return to a life of dignity following treatment.
- To significantly increase public awareness and understanding of fistula and maternal mortality and morbidity in order to mobilise action for prevention and treatment.
- To build a partnership among government, non-government actors, professionals, and the media to address fistula.
Achievements
- 34 doctors have been trained in fistula surgery and provide fistula treatment in 30 hospitals in Tanzania. The service is also linked to AMREF Flying Doctors Clinical Outreach Service.
- 84 nurses have been trained in fistula post-operative care and prevention through life saving skills for emergency obstetric care.
- 30 hospitals now provide fistula repair services carried out by resident fistula surgeons or visiting fistula doctors (outreach services).
- 2640 women with fistula have been treated (94% of projection).The cost for each fistula repair is subsidised by AMREF by refunding the hospitals.
- 10 hospitals have been supplied with fistula repair instruments, operating table, operating lamps and consumables.
