Worldwide Fistula Fund

After several days of travel (and a couple of misplaced bags), our team has arrived at the new Danja Fistula Center in Niger and the news is good! There are about 20 surgeries scheduled for this week as well as a number of post-operative check-ins with our past patients. While some of the women who have shown up at the facility can’t be fit into the schedule for this trip, they either will be operated on during the next trip in November or as soon as the hospital commences year-round care (January 2012). The mood is hopeful and everyone is very excited to get the procedures underway and bring some measure of hope and healing to these ladies.

Our lovely intern, Kim, who is down in Niger learning about obstetric fistula and the Hausa culture, sent along a few pictures of patients who will be treated on this trip:

Yesterday, The New York Times published an interesting piece, In Sierra Leone, New Hope for Children and Pregnant Women, exploring the effects of the country’s new policy providing free health care for pregnant women and children. The Times writes, “By waiving the requirement for payments — which sometimes amount to hundreds of dollars and clearly represent the main barrier to using health facilities — the government here appears to have sharply cut into mortality rates for pregnant women and deaths from malaria for small children.”

All this clearly rang some bells for us at the Worldwide Fistula Fund. Our work is in Niger, which is ranked beneath Sierra Leone on the Human Development Index, and shares many of the same problems — and the same hopes. While the government of Niger currently provides free health care for pregnant women at its hospitals, which are scattered around the country and typically quite far from the remote outlying villages, it does not provide free obstetric fistula repair surgery. Nor does it have the trained doctors and nurses on hand to deal with the vast number of women in need. The Worldwide Fistula Fund does. And we are able to provide the highest quality medical care at no price because of private donors and foundations who recognize the value of a woman’s life, the unmitigated horror of living with a traumatic childbirth injury such as obstetric fistula, and the importance of surgical training and staffing to address the problem. We are so very honored to be able to offer this service to the women of Niger, Nigeria, Cameroon (and anyone else that shows up at our doors), and are unbelievably excited to open our free fistula hospital in January.

But the good news is somewhat tempered by the fact that the health care is, for the time-being, heavily subsidized by international donors and not Sierra Leone itself. There also are only four gynecologists and two pediatricians in the entire country so, although health care might be free, there are no guarantees that a patient could get an appointment in time.  A third point, though rather vague, hinges on the fact that the scholarly correlation between better health care access and better health are not as crystal-clear as might be expected. Clearly, programs such as this need to be studied further before conclusions can be drawn.

One point of note about “free” health care: while we in the fistula community often bandy about $400 or $450 as a typical cost for a fistula surgery, the truth of the matter is that costs vary with each patient. A woman whose bladder has been completely destroyed or one whose legs have palsied from nerve damage typically requires more care (and financial commitment) than a woman with a “simple” obstetric fistula. We, too, average costs at $450 per surgery but some may cost many times that amount.

To serve women who need more care or time to heal, the Danja Fistula Center has a 24-bed long-term care hostel on its grounds. Because we take full responsibility for each of our patients, they will be allowed to stay for as long as they need — at no cost. Offering free services is the only way to function in a country as destitute as Niger, but it is another piece of the subsidized health care puzzle that must be figured out — how long is long-term? For us, there are no limits. And for that, we thank you. We could not do this without you.

Findings from the United Nations’ recently released report The State of World’s Midwifery 2011: Delivering Health, Saving Lives are as sobering as might be expected: to fully meet the needs of women around the world, we need 350,000 more skilled midwives (112,000 in the neediest 38 countries surveyed). The report’s analysis of the maternal health situation in Niger, home to the Worldwide Fistula Fund’s new fistula hospital, is equally upsetting:

• Average life expectancy is 51 years and 63% of the population live below the poverty line.
• The country has a high fertility rate (7.8 births and 7.1 children per woman), high child mortality rates (198 per 1,000), high infant malnutrition and an insufficient number of skilled workers.
• Nearly 83% of deliveries occur outside health facilities. While large urban-rural discrepancies exist, 81% of these women receive no postpartum care. Only 18% give birth with a skilled birth attendant present (0.5% with a physician), and 53% receive no antenatal care.
• Access to health care is highly correlated to women’s wealth.
• There is one midwife per 1,000 life births.

There is good news, however. While still incredibly high, maternal mortality rates have lessened rather dramatically in the last 20 years:

Further, a recognized definition of a professional midwife exists, a government body regulates midwifery practice and a licence is required to practice midwifery — all of which helps spread the practice and profession of midwifery and help ensure women receive qualified, professional care.

How to Help

While the report shows that some progress has been made in Niger (and other sub-Saharan African countries), there is still an enormous amount of work to be done to provide all women with maternal health services before, during and after giving birth. In coordination with the opening of our new fistula hospital, the Worldwide Fistula Fund is developing a full-scale fistula prevention campaign to educate women in rural villages about the warning signs of obstructed labor and how to seek help. Among other outreach initiatives, our prevention campaign will also fund bush taxi service to deliver expectant mothers to hospitals as well as pay for the medical treatment the women receive at the hospitals.

Please help prevent the formation of fistula and lessen the rates of infant and maternal death by giving what you canto the Worldwide Fistula Fund. If you’d like to donate specifically to our prevention campaign, please visit our new giving catalog and choose “Fistula Prevention Outreach” from the options given.