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• W317005172 abstract "Zainab Jabati (not her real name) gave birth for the first time at sixteen. Not unusual for a teenager in rural Sierra Leone. Growing up in a tiny village on the remote tip of a mangrove-ringed island off Sierra Leone's southern coast, Zainab was two days by boat from the nearest clinic. she went into labour, her mother was away visiting a sick relative and local women took her to a 'sacred bush' to give birth. She was there for three days while the women tried to induce labour by sitting on her belly and pulling at the baby with their hands. Perhaps not surprisingly, the procedure failed. When it came out, my baby was dead, Zainab remembers. As terrible as the experience was, losing the baby was just the beginning of Zainab's problems; she suffered an obstetric fistula--a communication between the vagina and the urethra and/ or the large intestine. This can result in chronic incontinence. Obstetric fistula often follows prolonged, obstructed labour and typically affects the poorest of the poor--uneducated women living in rural areas in countries where obstetric care is poor and women tend to give birth at home. Without proper treatment, women with an obstetric fistula can face a lifetime of suffering, unable to control the discharge of urine or fecal matter. Often abandoned by their husbands and families, they find themselves effectively ostracized from society. Girls drop out of school, women cannot work and simple things--like getting on a bus--become an ordeal because of the way the sufferer smells. People didn't greet me, Zainab remembers. Men didn't want me. It was very difficult--I didn't have any friends. [ILLUSTRATION OMITTED] Reliable incidence and prevalence data on obstetric fistula are lacking, but the United Nations Population Fund (UNFPA) estimates between 2 and 4 million women suffer from obstetric fistula in low-income countries in Africa, south-east Asia and the Middle East, with another 50 000 to 100 000 women and girls developing the condition each year. Mariana Widmer from the department of Reproductive Health and Research at the World Health Organization (WHO), says the social stigma and misunderstanding that it inspires has led to significant under-reporting, making it a largely hidden condition. The UNFPA steers the Campaign to End Fistula, as well as the International Obstetric Fistula Working Group - the decision-making body of the campaign--which comprises over 60 national and international agencies collaborating on all aspects of fistula, including prevention, treatment, social reintegration and rehabilitation. The campaign started in 2003, and according to Gillian Slinger, the campaign's coordinator at UNFPA, it has done much to raise awareness about the condition. Our understanding of obstetric fistula is also set to improve with the completion of a number of studies, including a literature review of worldwide fistula prevalence and incidence that is under way at the London School of Hygiene and Tropical Medicine. Meanwhile, the Johns Hopkins Bloomberg School of Public Health is leading a multi-country study to examine post-op prognosis and long-term outcomes of obstetric fistula cases following surgery. The clinical picture is also improving. US-based reproductive health non-profit, EngenderHealth, and WHO are currently coordinating a randomized controlled trial studying catheter management in post-operative fistula patients. WHO also recently developed clinical management guidelines for obstetric fistula, while the International Federation of Gynecology and Obstetrics (FIGO), the International Society of Obstetric Fistula Surgeons (ISOFS), and other partners have published the first guidelines on obstetric fistula repair surgery. At the Aberdeen Women's Center in Freetown, Alyona Lewis, Sierra Leone's only national full-time fistula surgeon, is currently using the new Training Manual for Fistula Surgeons to train a second Sierra Leonean surgeon in obstetric fistula repair surgery and treatment. …" @default.
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• W317005172 date "2012-02-01" @default.
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• W317005172 title "Fixing Fistula: While New Clinical Management Guidelines Promise Better Treatment Outcomes for Women with Obstetric Fistula, More Needs to Be Done to Prevent This Debilitating Condition in the First Place. Felicity Thompson Reports from Sierra Leone" @default.
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