Bangladesh National Fistula Programme

1
Bangladesh National Fistula Programme

• Prof. Kohinoor Begum
• Head, Dept.of Obstetrics Gynecology,
• Dhaka Medical College Hospital,
• Dhaka, Bangladesh

2
Causes of Fistula Bangladesh Perspective

• Low status of women girl child
• Typically girls marry by 16 years and have first
  child by 18
• Low nutritional status
• 13 Deliveries by skilled attendants
• 90 Deliveries at home
• Poor referrals

3
How rights of the girl child are violated

• When born
• Gloomy faces in the family
• When growing up
• Discrimination in opportunity resources
• When to marry and become pregnant
• Choice is not of her own
• When pregnant
• When Pregnant
• No ANC, No rest
• When in labor
• Attended by untrained attendants
• Prolonged labour often results
• Consequence are stillbirth and fistula
• She suffers through no fault of her own

4
Magnitude of the Problem

• Bangladesh
• Incidence/ Prevalence, exact figures unknown
• Prevalence estimates vary between 71,000 and
  400,000

• Global
• Estimated incidence of 0.3 of deliveries in
  areas without EmOC
• Prevalence estimated at more than 2 million

5
Fistula Services before Government and UNFPA
Initiative

• Institution - Government Hospital
• Private Hospital
• Few surgeries mostly self-trained and personal
  initiative
• Little interest in fistula surgeries among
  gynecologists/ urologists

6
National Fistula Programme

• Major impetus UNFPAs launch of Global Campaign
  to end Fistula in 2003
• Series of workshops cadre of master trainers at
  Dhaka Medical College Hospital created in 2003/04
  
• Experts from Ethiopia and Australia provide
  trainings 25 doctors and 18 nurses trained

7
A Successful Advocacy Programme
Capacity Building - Training
GOB Donor Initiative Commitment
Cooperation and Networking
Involvement of NGOs
Team approach
Dedication of Doctors and Nurses
Involvement of Womens Groups
Poor and social welfare funds
8
Results of Advocacy

• National Fistula Programme launched Oct. 2003
• The Government provided
• Pre and post-operative wards, operation theatre
• Skilled doctors and nurses
• Space for training
• Beds and food for the patients
• Free diagnosis, essential medicines and drugs to
  start a Temporary Fistula Centre in Dhaka
• UNFPA provided
• Financial, technical, logistical support

9
National Fistula Centre at DMCH

• GoB Facility established Oct. 2003 separate
  ward, pre and post operative operating theater
• Capacity Development through training (166
  Doctors Nurses trained to date)
• Curriculum on fistula surgery and management
• Rehabilitation Centre
• Financial, technical logistical support, incl.
  equipment and supplies through UNFPA

10
Decentralization of fistula services

• Facilities renovated and equipped
• DMCH doctors and nurses selected as trainers
• 8 peripheral medical college hospitals nationwide
  
• Provide services
• 659 doctors and nurses oriented

• Nationwide (to date)
• 1208 surgeries performed
• 673 at DMCH

11
Profile of the Treated Fistula PatientCause of
the fistula
83.33
16.67
Obstructed
Gynecological
labor
Operations
12
Profile of the Treated Fistula Patient
Age at Marriage
51.33
40.67
8
Under 15
16-20
20
13
Age at fistula onset
Profile of the Treated Fistula Patient
36
18.66
18
16.66
10.66
Under 15
16-20
21-25
26-30
30
14
Success Rates (First time operation)

• In some cases, complete
• physical repair not possible

15
Rehabilitation

• Training and Rehabilitation Center est. Nov 2006
• 53 admissions
• Waiting home
• Income generation activities
• Literacy training
• Health and Hygiene

16
Maternal Mortality and Morbidity Reduction

• Socio-economic development
• Female education free to grade 12
• Microcredit
• Roads and communication networks
• Advocacy of safe motherhood
• Expansion of Community-based SBA and EmOC

17
Future Vision

• Centre of Excellence at DMCH
• Regional capacity-building through South-South
• Further decentralization and institutionalisation
• Training surgeons, nurses
• Rehabilitation Programme
• Involve local community leaders, womens groups,
  media, policy makers

18
Challenges

• Data
• Awareness
• Quality of Care
• Ministerial Coordination
• Civil society involvement
• Status of women
• Resources

19

• Countless women continue to suffer in silence-
• No woman should have to endure the misery of
  fistula.
• Let us work together to make the world
• fistula-free.