AfricaFistula is key component of maternal health campaignpage 2

Women DeliverFistula survivors meet Danish Crown Princess

page 6

November 2010

T C E F

On 20 October

2010 high-ranking

national officials,

including ministers,

parliamentarians and

development partners,

brought good news

to women in the

Republic of Congo.

This happened when

they participated in

the national launch

of the Campaign on

Accelerated Reduction

of Maternal Mortality in Africa (CARMMA), attesting to the commitment to

improve maternal health in that country.

In the Republic of Congo, maternal death is above the regional average

at a dire rate of 580 deaths per 100,000 live births. This prompted the cam-

paign launch, which was presided over by Congo First Lady Ms. Antoinette

Sassou Nguesso, a champion for maternal health and CARMMA in the

country.

Speaking on behalf of the United Nations, UNFPA Regional Director Mr.

Bunmi Makinwa assured the Government of the UN’s support to acceler-

ate the improvement of maternal health in Africa. The Minister of Health,

Prof. Georges Moyen, reaffirmed the Government’s commitment to tackle

maternal death as a top priority in the country, and he is following up his

words with action.

“The Government has initiated a series of measures to reverse the

trend,” said Minister Moyen at the launch. “We have established a mater-

nal health observatory and we are promoting public awareness about the

importance of women and children’s health. Caesarean sections will be

carried out for free in the public health system and we are also committed

to the Campaign to End Fistula and the extension of the UNFPA programme

on this issue.”

With as many as 140 cases already identified in the country and poten-

tially many more likely to be found, obstetric fistula is considered a serious

public health issue in the Republic of Congo, a country in sub-Saharan

Africa with an estimated population of more than 4 million.

Since 2007, UNFPA has invested over $400,000 in the prevention and

treatment of this problem in the country, where precarious conditions and

poor access to maternal health services contribute to high rates of maternal

death and disability.

The extension of the fistula programme to two additional treatment

centers, one in Pointe Noire and the other in Owando, is a key part of

UNFPA’s contribution to CARMMA in Congo.

Fistula treatment is currently provided free of charge at two major

health centres in Brazzaville. With additional resources, the hope is that

more fistula centres will open in the coming months. The addition of these

new centres will significantly reduce the distance that women with fistula

need to travel for treatment.

Good news for women in AfricaBrazzaville, Republic of Congo

2

COVER PHOTO: After a successful fistula repair operation, Shamim, 26, is released from a hospital in Qatar. She developed fistula during her first pregnancy at the age of 16. Her difficult labour, assisted only by a traditional birth attendant, ended with a stillborn baby and a fistula. After two other unsuccessful pregnancies, she and her husband now have adopted a baby girl. Photo: Wendy Marijnissen, Campaign to End Fistula/UNFPA, Pakistan, 2009.

Senate’s First Secretary Ms. Philomène Fouty Soungou, designated by the Health Ministry and UNFPA as the Goodwill Ambassador for CARMMA in Congo. She will work with the First Lady to promote maternal health in the country. Photo: UNFPA, Congo-Brazzaville, 2010.

Filling the information gapLibreville, Gabon

A recent survey carried out in 55 health facilities in Gabon is helping

to fill the information gap about obstetric fistula in the country. It also

highlights that fistula is a public health problem and should be viewed as

a priority by Gabonese authorities. Although previous studies had already

highlighted the lack of emergency care for women with complications

during delivery, as well as early pregnancy and lack of skilled profession-

als as leading factors of disabilities, some experts denied the existence of

obstetric fistula in Gabon.

“There are many factors leading to the occurrence of obstetric fistula

in this country. Since the survey, we can name a few, from adolescent

pregnancy to the lack of access to health services. But we can’t ignore

structural issues like poverty and socio-cultural factors, including the

notion that real women should be brave and endure the pain when giving

birth,” explains UNFPA Country Director for Gabon, Mr. David Lawson.

During the survey, which identified 90 fistula cases in the country, 15

women living with the condition were interviewed. In 50 per cent of the

interviews, the women were aged 15-24, the majority of whom had little

education. More than half of them live in remote rural areas difficult to

access by the most common means of transportation. Their main source of

income is agriculture.

“In these remote areas, it is only to produce the basics, just for subsis-

tence. That’s why these women are so vulnerable – most of them live under

the poverty line,” explains demographer Mr. Mbadu Muanda, the survey’s

lead consultant.

All the fistula survivors interviewed had their first pregnancy before

they had turned 19 and almost half of them even before they had turned

16. One out of every three fistula cases occurred after the first childbirth.

For most of the interviewed women it took more than 12 hours before

they arrived at a hospital after labour began and a complication was identi-

fied. Three of them spent almost 24 hours getting to a health facility. The

majority of them delivered a still-born baby.

“The fact that more than 50 per cent of the fistula cases occurred

after childbirth and the rest after a surgical intervention may reflect poor

emergency obstetric care. And since the majority of the women delivered in

a health facility, it leads us to think that more training is needed, as well as

more adequate equipment and supplies in case of complications,” says Mr.

Mbadu Muanda.

To help eradicate fistula in Gabon, the Campaign and its partners

advocate for the establishment of free delivery services and more skilled

care in the country, says Mr. David Lawson. “We are working to enhance the

capacity of health personnel and to improve the maternal health services

available to the population. This goes together with efforts to sensitize the

population about obstetric fistula and early pregnancy, as well as provide

better access to family planning and help empower women.”

dispatch3

Obstetric fistula, associated with incontinence and social isolation, is hardly

glamorous. But two African beauty queens – Miss Ghana@50 and Miss Liberia

2009 – are using their glamour and recognition to raise awareness about this

issue, which affects some of the most marginalized women in their countries.

Miss Frances Tekyi Mensah began talking about obstetric fistula through-

out 2007, the 50th anniversary

of her country’s independence,

and the year she reigned as

Miss Ghana@50. And she hasn’t

stopped talking about it since.

In view of the commitment

she demonstrated, the Ghana

Government nominated her as

an Ambassador for Obstetric Fistula. She accepted the mission with a strong

drive to make a difference across the country.

Initially Miss Tekyi Mensah selected obstetric fistula as the project to take

on during her reign because she realized that it affected the poorest, least

educated and most marginalized women in her country and elsewhere in

Africa and Asia. “They’ve got nothing except faith and hope and urine-soaked

clothes,” she said of the women who suffer the indignities of fistula. “Some

of them claim ‘even death would be better than this.’ If I could help just one

of these women, to me, it is literally, giving that woman her life back.”

Miss Tekyi Mensah spent most of her year as Miss Ghana@50 raising

awareness about obstetric fistula in the most remote parts of Ghana. She

met tribal chiefs, religious leaders, opinion leaders, men’s groups and several

community representatives spreading the message about the importance

of prevention and about the possibility of treatment. She also appealed to

women with the condition to get treatment and raised funds to support the

treatment of about 20

women in the regions

she visited.

In addition, she

encouraged 60 other

Ghanaians to become

local advocates. The

group includes fistula

survivors, community,

religious and traditional

leaders, as well as

men’s groups represen-

tatives and social workers. With the support of the Ghana Ministry of Health,

the advocates have drawn up action plans, which were implemented in 2010.

A compelling presentation by Miss Tekyi Mensah at the 2008 Miss World

beauty pageant convinced Shu-rina Wiah, who was crowned Miss Liberia

2009, to take on the issue as her project for the year. Throughout 2009, Miss

Wiah participated in outreach campaigns to prevent the injury, as well as in

projects aimed at empowering survivors.

After that, she has frequently spoken to fistula survivors, praising them

for their “resilience and courage” in seeking help, and paid tribute to UNFPA

for helping to restore respect and dignity to women affected by fistula.

Two beauty queens on a missionUNFPA Global Website

More global support needed

A report released in October by the United Nations Secretary

General, Mr. Ban Ki-moon, calls for intensified support for cost-

effective interventions to address the problem of obstetric fistula.

The report Supporting Efforts to End Obstetric Fistula says that

considerable progress has been achieved in addressing obstetric

fistula. The document draws attention to the links between

poverty, income inequalities, gender disparities, discrimination

and poor education, as these factors contribute to poor health in

women and girls. It points out, however, that despite achieving

some positive developments, many serious challenges remain.

“Obstetric fistula is one of the most devastating consequences

of neglect during childbirth and a stark example of health inequity

in the world. Although the condition has been eliminated in the

developed world, obstetric fistula continues to afflict the most

impoverished women and girls, most of whom live in rural and

remote areas of the developing world,” the report states.

Thoraya Ahmed Obaid, Executive Director of UNFPA, the United

Nations Population Fund, has welcomed the new report. In a video

statement prepared for the recent summit on the Millennium

Development Goals, Ms. Obaid emphasized the importance of

tackling obstetric fistula in line with global agreements to improve

the health and rights of women.

“Every year millions of women suffer from pregnancy and

birth-related complications, as well as injuries. And one of them

is fistula, which is an injury that affects women and leaves

them incontinent and thus ostracized from their families and

communities. By working together we can ensure that fistula

is something of the past. And we have to restore the dignity of

millions of women,” said Ms. Obaid.

The struggle to improve health-care systems and reduce the

rate of maternal death and disability, including obstetric fistula,

must not only continue but intensify, as recently published

estimates show that the progress made in maternal mortality

reduction has been slow. Also, there is an urgent need to scale

up well-known, cost-effective interventions in order to reduce the

high number of avoidable maternal deaths and disabilities, the

report points out.

The report cites examples of successful interventions in various

countries and calls for specific actions to improve maternal health

and address the issue of obstetric fistula. It also highlights that

the condition can be prevented as part of broader efforts made to

achieve MDG 5, the one related to maternal health.

As part of its recommendations, the document points out that

funding should be predictable and sustained support should be

provided to countries’ national plans, United Nations entities,

and other global initiatives dedicated to tackling the problem,

including the Campaign to End Fistula.

Read more: www.endfistula.org/dispatch.html

Miss Ghana@50, Frances Teyki Mensah, and fistula survivors.

Miss Liberia 2009, Shu-rina Wiah, and fistula advocates.

The political crisis that

began in Madagascar

almost two years ago has

heavily impacted the imple-

mentation of assistance

programs in the country

and has now taken a toll

in the fight against fistula.

Without a formal national

strategy on the issue or

even the possibility of

carrying out major advocacy

projects, most of the activi-

ties are being implemented

by non-governmental

organizations and contacts

with the government are

restricted.

“We have faced some

technical problems, which hamper the smooth implementation of activi-

ties,” says UNFPA Maternal Health Technical Advisor, Dr. Eugene Kongnyuy.

“However, despite the crisis in the country, we continue to do our work. It

seems like a long time, but we only started the programme in 2008 and,

even with the crisis, we can see considerable progress.”

Before joining the Campaign to End Fistula in 2008, Madagascar con-

ducted a study to assess the magnitude of obstetric fistula in the country.

As part of the findings, the study revealed that knowledge about the

condition among health-care providers was low and that harmful traditional

practices contributed significantly to the occurrence of fistula.

Rural residence, poverty, lack of education, adolescent pregnancies, a

poor referral system and low quality of care during delivery were among

the determinants of fistula in Madagascar, the study pointed out.

Based on this a set of priorities was identified, including surgical repairs

and psychological care, together with social reintegration of fistula patients

and fistula prevention. To address these priorities, the programme designed

activities to empower women and mobilize community leaders.

Since joining the Campaign, the country has introduced the activities

in phases. Currently six reference hospitals are involved in surgical repair

while six NGOs are undertaking social reintegration of fistula survivors and

prevention of obstetric fistula using successfully repaired patients as role

models and advocates.

“We try to ensure that providers are able to properly handle emergen-

cies. This is another aspect of prevention that complements community

sensitization with former fistula patients.”

When asked if he believes that the Campaign will continue in

Madagascar, Dr. Kongnyuy is firm: “We have many accomplishments to

celebrate, including the de-stigmatization of fistula. We’ll just continue to

scale up our activities and develop a national obstetric fistula strategy as

soon as the socio-political situation improves. We are not adrift.”

Eritrea on the road to be ‘fistula free’Asmara, Eritrea

Efforts to end fistula go on despite crisis Antananarivo, Madagascar

A 17-year-old woman from Madagascar, recently operated upon for fistula, her mother and a fistula specialist. Photo: UNFPA Madagascar, 2009.

The government of Eritrea, in collaboration with partners, has embarked

on a project to make the country ‘fistula free’ by the end of 2011. An

intensive campaign to identify and treat women living with obstetric fistula

is being implemented in the country. To encourage women to come out for

treatment, the Ministry of Health is providing free services and reimbursing

related expenses, such as food and lodging. Also, transportation costs are

being paid for or refunded.

“It is a government priority to clear the waiting list of existing fistula

cases in the country, which means that Eritrea would be close to achieving

the national objective of eliminating fistula,” says the UNFPA Representative

in the country, Mr. Barnabas Yisa.

Although the number of existing cases in Eritrea is not yet known, teams

of international experts and national fistula surgeons are working hard to

clear the backlog. While the treatment is going on in several health facilities,

prevention measures are being put in place simultaneously in communities.

The ‘fistula free’

initiative is considered

rather advanced in a

country which has so

many challenges related

to the condition of

women, such as early

marriage, low social

status, fewer educa-

tion opportunities and

economic prospects

compared to men.

Besides the high

number of maternal

deaths —280 per 100,000

live births, according

to the most recent UN estimates— Eritrea also faces a high number of births

carried out without the support of a skilled health professional, reflecting

some reluctance to seek adequate health care during childbirth.

“Culture and tradition can explain this reluctance to deliver with

skilled birth attendants. Such practices increase the risk of complications,

maternal death and disability,” explains the Campaign Coordinator, Ms.

Gillian Slinger. “We also need to think very carefully about how to tackle

these challenging issues.”

Eritrea joined the Campaign to End Fistula in 2003, when a needs

assessment was carried out to detect the magnitude of the disability at

national level. Since then, obstetric fistula has been addressed as part of a

comprehensive package of interventions to overcome the serious reproduc-

tive health problems faced by the country, including an agreement with

Stanford University to provide technical assistance for on-the-job training of

local surgeons and midwives, specialized care for complicated cases, trainee

follow-up and community mobilization design, monitoring and evaluation.

4

Ms. Yirgalem Isaac, nurse midwife in charge of the fistula ward at the Mendefera hospital with a patient. Photo: UNFPA Eritrea, 2010.

Read more: www.endfistula.org/dispatch.html

Professionals trained to deal with fistula Karachi, Pakistan

Pioneer struggles to tackle fistulaConakry, Guinea

One of the first countries to join the Campaign to End Fistula in 2003, Guinea

is still struggling to tackle obstetric fistula. With a population of 10 million and

24 ethnic groups, the country faces one of the highest maternal death ratios in

the African continent —680 per 100,000 live births— and has not yet been able

to establish a coordinated response to disabilities such as fistula.

“This has been a long-lasting fight,” explains the chief of the Ministry of

Health Division for Reproductive Health in Guinea, Dr. Madina Rachid. Following

the International Conference on Population and Development held in 1994,

Guinea, as well as other developing countries, convened a national forum,

which defined the elements of reproductive health that should receive priority

in the country.

“Back then, obstetric fistula had been already identified as a central

component of maternal health in Guinea. However, despite the inclusion of

the condition in the national health policy and programs, little effort had

been made to tackle the problem in the country,” says Dr. Rachid.

After an awareness campaign launched in 2003, the Ministry of Health

conducted a situation analysis in collaboration with UNFPA, leading to the

establishment of a project for the prevention and treatment of obstetric fistula

in Kankan, Guinea’s largest city.

Since then, the project has allowed for the training of health professionals

and community workers and the promotion of public awareness on how to

prevent fistula, including messages disseminated through public and private

radio stations in urban and rural areas, as well as through peer educators.

More than 110 surgical repairs have been successfully carried out thus far

and 29 fistula survivors have received training on income-generating activities

in the country. However, despite the results achieved and lessons learned,

many challenges remain, including the lack of skilled human resources,

insufficient treatment services and low utilization of health services by the

community.

“Most of all, we need a strong national leadership to establish a coordi-

nated response and to strengthen partnerships. With that we can perhaps

foster changes in society and promote the de-stigmatization of fistula,” says

the UNFPA Representative in Guinea, Dr. Marcelle Chevallier.

dispatch

A new programme initiated by UNFPA in Pakistan is providing a 30-week

training course for community midwives on fistula prevention and treat-

ment. The programme, which already benefited more than 70 midwives,

has been developed to train trainers, help prevent obstructed labour and

provide quick referral when emergency obstetric care is needed.

According to experts, having more midwives in the communities will

also help raise awareness among women about the importance of spacing

births, seeking skilled attendants at the time of delivery and providing

proper nutrition for pregnant girls and women.

One of the lead fistula surgeons in the country, Dr. Shershah Syed

believes that more health professionals should be trained to help

improve maternal health. “We don’t have enough skilled birth at-

tendants. Moreover, some of the existing attendants are improperly

trained,” says Dr. Syed.

The initiative to train community midwives complements a broader

strategy to build capacity to treat fistula, developed and implemented

since January 2006, when the Campaign to End Fistula was launched in

Pakistan. As part of the strategy, Pakistani doctors have been encour-

aged to exchange knowledge and share experiences with internationally

renowned surgeons in the field of obstetric fistula.

“Our surgeons are having more opportunities to learn about cost-

effective surgical interventions that can be used to repair fistula patients,”

tells Dr. Faaria Ahsan, UNFPA’s Reproductive Health and Fistula specialist in

Pakistan.

Since the launch of the Campaign in the country, more than 38 surgeons

have been trained on fistula repair surgeries, and an estimated 78 com-

munity midwives and nurses have been trained on pre- and post-operative

management of obstetric fistula. Currently, seven regional and six referral

centres are providing free services to women in need; more than 2,000

fistula cases have been repaired with a success rate of 90 per cent.

5

Students from the Nursing and Midwifery Tutor Training course during their graduation ceremony. They completed a 30-week course that aims to ensure more qualified midwives and nurses, who can then teach other professionals and thus provide better care. Photo: Wendy Marijnissen, Campaign to End Fistula/UNFPA, Karachi, Pakistan, 2009.

Women gathering at the village of Bate Nafadji to hear an educational talk on fistula organized by a local NGO, the African Family Support. Photo: UNFPA Guinea, 2010.

Read more: www.endfistula.org/dispatch.html

One of the highlights of the Women Deliver

Conference in Washington D.C. in June

2010 was the meeting between Her Royal

Highness Crown Princess Mary of Denmark,

and two fistula survivors and advocates.

The Crown Princess, who was accompanied

by the Danish Minister for Development

Cooperation Søren Pind, was deeply moved

by their stories.

One of the women the Crown Princess

met was Ms. Sarah Omega, a fistula survivor from Kenya, who became

pregnant in her late teens. After hours of obstructed labour and losing her

baby in the process, she developed a fistula —a condition she then lived

with for 12 years before receiving treatment. Since 2007 Ms. Omega has

traveled Kenya and the world as a maternal health advocate. She wants to

ensure that other women with fistula know that treatment is available.

“In Kenya, it is estimated that we have 3,000 new fistula occurrences

each year, but only 7 per cent of these women get treatment, leaving us

with a huge backlog of cases. For this reason,

I have been going to the communities, getting

women who are suffering in silence and refer-

ring them to a health facility where they can

receive treatment,” Ms. Omega explained.

Ms. Awatif Altayib, the other advocate

who met the Crown Princess, came from

Furbaranga, West Darfur State, Sudan, where

she works as the village midwife. Also a

fistula survivor, she was married and pregnant

with her first child at the age of 16. Sadly, her baby did not survive an

obstructed labour, from which she developed obstetric fistula. Determined

to ensure that other women do not suffer as she had, Ms. Altayib decided

to become a midwife. She now recruits women living with fistula and

helps them access the care they need.

“It was an important opportunity for me to learn more about the

maternal health challenges that persist in the developing world. Sarah and

Awatif lent a face to all women who have suffered due to the lack of access

to skilled attendants during pregnancy and childbirth. This is something

industrialized nations take for granted but is still very much a luxury in

many countries in the developing world,”

said the Crown Princess of Denmark.

During the meeting, Ms. Thoraya Obaid,

UNFPA Executive Director, expressed her

sincere appreciation that the Crown Princess

accepted to be patron of UNFPA. The

announcement made in June 2010 called

attention to Denmark’s support of UNFPA’s

efforts to promote maternal health and safer

motherhood in developing nations.

6

As part of the fistula-related events during

the Women Deliver conference, UNFPA and

Family Care International (FCI) launched

a new advocacy publication and interac-

tive CD-ROM Toolkit – Living Testimony:

Obstetric Fistula and Inequities in Maternal

Health. The publication aims to contrib-

ute to broader efforts to reduce maternal

mortality and morbidity, to bring obstetric

fistula to the fore, and to highlight specific actions to reduce its

incidence and prevalence.

The main objectives of the CD-ROM Toolkit are to:

• Provide guidance and tools to carry out advocacy for improv-

ing maternal health, and to highlight how attitudes about

pregnancy and delivery affect maternal death and disabilities,

including obstetric fistula.

• Present new strategies for addressing the social norms and

cultural practices that impede access to sexual and reproduc-

tive health-care services in order to increase their availability.

Fistula survivors meet the Danish Crown Princess Washington, D.C., U.S.A.

Toolkit promotes advocacy on fistula

During the same week the Women Deliver Conference was held, fis-

tula survivor and advocate Sarah Omega had the opportunity to brief

members of the U.S. Congress on issues related to obstetric fistula.

The briefing was organized in coordination with the offices of U.S.

Representatives Carolyn Maloney, from New York, and Mike Castle,

from Delaware, sponsors of a bipartisan legislation on fistula: The

Obstetric Fistula Prevention, Treatment, Hope and Dignity Restora-

tion Act of 2010, H.R. 5441.

Earlier in the same week,

Sarah Omega also participated

in an advocacy effort on Capi-

tol Hill, aimed at encouraging

U.S. funding and support for

maternal health and MDG 5.

Ms. Omega, who was joined

by television and film star

Ms. Jennifer Beals, shared her

personal story with several

representatives.

Congressional briefing discusses fistula

UN Foundation representative Tamara Kreinen, fistula survivor and advocate Sarah Omega, Rep. Mark Kirk and television and film star Jennifer Beals. Photo: Sam Hurd, Women Deliver, Washington, D.C., 2010.

Read more: www.endfistula.org/dispatch.html

H.R.H. The Crown Princess of Denmark. Photo: Steen Evald, 2010.

Ms. Sarah Omega. Photo: Moises Saman/Panos, 2010.

Ms. Awatif Altayib. Photo: Moises Saman/Panos, 2010.

For additional information or to obtain copies of the CD-ROM Toolkit, contact: publications@fcimail.org or fistulacampaign@unfpa.org

dispatch7

Gillian Slinger, a British-trained nurse and midwife with a BSc Degree

in Health Management and an MSc Degree in Public Health, recently

joined UNFPA to coordinate the global Campaign to End Fistula.

As a midwife, Ms. Slinger has always been deeply moved by the

many obstetric fistula cases she has cared for in the field. Since

starting her MSF post in Geneva in 2007, her involvement in fistula

work has increased enormously, fueling her commitment to address

global maternal death and disability.

Asked about her plans for the future, Ms. Slinger talks about a new

vision for the Campaign.

“There will be a gradual scaling up of training and treatment

services in response to the significant number of existing cases, with

a shift away from ‘vertical’ fistula campaigns organized as occasional

interventions, and towards more permanent fistula services,” explains

Ms. Slinger.

According to Ms. Slinger, the idea is to promote a more holistic

approach to services, as they will be incorporated into existing health

structures and firmly anchored in sustainable health programmes at

the national level. “There will also be greater emphasis on prevention,

including the work with maternal health partners and looking at

preventive measures immediately after prolonged labour and for new

fistula cases,” she complements.

As part of the new vision that is emerging, a greater focus on

quality, more research —including on the reintegration of recovering

fistula patients after treatment— and improved communication

channels will also be integral to the Campaign, Ms. Slinger says.

“One of the expected outcomes is a greater information flow from

global to project level and vice versa, and between key practitioners

and organizations working together to move this agenda forward as

part of the well-established partnership spirit of the Campaign.”

Dispatch: How did obstetric

fistula come to be a priority

health issue in Cameroon?

Dr. Fouda: In 2004, Cameroon

recorded particularly alarming

indicators of maternal health.

It was thus legitimate to think

that, despite the absence of

data, obstetric fistula was a

reality in Cameroon. A few

years ago, UNFPA supported the

Ministry of Public Health to evaluate the situation in two provinces (North

and Far-North). This study allowed us to gain basic knowledge of the fistula

situation in that part of the country, to learn that there are a lot of cases in

these regions and to realize that the existing health facilities did not have

the capacity to deal with the problem.

Dispatch: Can you share with us some of the challenges related to obstetric

fistula that you have faced in the country?

Dr. Fouda: There are many. To begin with, how can we eliminate stigmatiza-

tion? You can see these women abandoned by everybody, and rejected by

the community because their condition is seen as a “curse” or result of

infidelity. They are considered shameful and forced to live apart from the

community, all the while mourning their babies who have died. Raising

funds is another challenge. Women usually cannot pay for the services

because they are extremely poor. The exclusion of the community is not

only social and cultural, but also economic. And since we don’t have the

means and resources for everybody yet, their treatment is not possible

without foreign support. There are also the difficulties involved in following

the patients who have been operated on once they return to their villages,

since most of them are from remote areas where even motorbikes cannot

get to, especially during the raining season.

Another issue is the social reintegration of the patients into their communi-

ties. We also need to improve our health system, and the occurrence of ob-

stetric fistula is an indicator of that. It means training health professionals

in the management of obstetric fistula, which is another challenge. Finally,

treating obstetric fistula is good, but prevention is even better. Sensitiza-

tion has to continue, but it also needs to be improved. It should never be

forgotten that it is the man who makes decisions in African society, and

that he is generally under the influence of his community when he makes

his decisions. Read the full interview online.

A fistula champion and a pioneerYaoundé, Cameroon

Dispatch interviewed Dr. Pierre Fouda, one of the pioneers of fistula

treatment in Cameroon. A urologist and long-term partner in the country,

Dr. Fouda talks about the challenges of fighting fistula.

Gillian Slinger, the new Coordinator of the Campaign to End Fistula, with a fistula survivor in the market close to the Kamuli Mission Hospital in Uganda. Photo: Brian Hancock, FRCS, founder Uganda Childbirth Injury Fund, 2010.

Dr. Pierre Fouda. Photo: UNFPA Cameroon, 2010.

Read more: www.endfistula.org/dispatch.html

Campaign has new coordinator

UNFPACampaign to End Fistula605 Third Avenue, New York, NY 10158email: fistulacampaign@unfpa.org

dispatch is a biannual newsletter highlighingdevelopments in the Campaign to End Fistula

Why the Campaign?

10–15 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 or to learn how you can help, please visit: endfistula.org.

Editorial Process: Etienne FrancaDesign and Printing: Prographics, Inc.

Contributors: Faaria Ahsan, Yves Bergevin, Luc de Bernis, Nicole Carta, Marcelle Chevallier, Cheikh Tidiane Cissé, Sarah Craven, Akinyele Eric Dairo, Apollinaire Delamou, Triana Dorazio, Nicole Eteki, Pernille Fenger, Calixte Hessou, Sennen Hounton, Esther Huerta, Katja Iversen, Patricia Keba, Hugues Kone, Eugene Kongnyuy, David Lawson, Bunmi Makinwa, Emilie Maurice, Elsabeth Mengsteab, Robert Mensah, Aline Piedecocq, Shafia Rashid, William Ryan, Cecilia Schubert, Alain Sibenaler, Klaus SimoniPedersen, Sandy Singer, Gillian Slinger, Kadiatou Sy, Etta Tadese, Margherita Tinti, Barnabas Yisa.

Campaign Donors (since 2003)

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

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

ISOFS started from the recognition among prominent fistula surgeons working in Africa

and Asia that there are more than two million obstetric fistula survivors in the world,

yet there are not enough skilled surgeons to operate on them. According to specialists,

surgical attempts by inexperienced surgeons can lead to further damage to the women

living with fistula.

The previous conference, held in Nairobi, Kenya, in 2009, covered topics ranging from the

role of community midwives to the effectiveness of social reintegration and community

partnerships. Organized in collaboration with the African Medical and Research

Foundation (AMREF), the event hosted a diverse assembly of government ministers,

medical professionals, and delegates from charitable and aid organizations and academic

institutions. In 2010, the organizing institutions expect an even larger participation.

Immediately prior to the conference, on 5-6 December, obstetric fistula specialists

from various countries will gather in Dakar for the International Obstetric Fistula

Working Group (IOFWG)* annual meeting. They will discuss priorities and exchange

experiences in the field of obstetric fistula.

What: Third Annual Conference of

the International Society of

Obstetric Fistula Surgeons

(ISOFS)

Annual Meeting of the

International Obstetric Fistula

Working Group (IOFWG)

Where:Both the IOFWG meeting (5-6

Dec) and the ISOFS conference

(7-9 Dec) will be held at the

Hotel Des Almadies in Dakar,

Senegal.

Campaign to End Fistula countries

Mauritania

SenegalGambiaGuineaBissau Guinea

Mali

GhanaTogo

Benin

Nigeria

Niger Chad

Congo

Sudan Yemen

India

Nepal

Bangladesh

Pakistan

Afghanistan

Djibouti

Eritrea

Somalia

Kenya

BurundiRwanda

Uganda

Ethiopia

AngolaZambia Malawi

MozambiqueMadagascarZimbabwe

SouthAfrica

Lesotho

Swaziland

DemocraticRepublicof Congo

UnitedRepublic ofTanzania

CameroonCentral African

Republic

Gabon

SierraLeone

EquatorialGuinea

Liberia

Côted’Ivoire

BurkinaFaso

Haiti

CARIBBEAN

The Third Annual

Conference of the

International Society

of Obstetric Fistula

Surgeons (ISOFS) will take

place in Dakar, Senegal,

from 7-9 December 2010.

As an annual summit of

health-care providers and

activists from some of

the world’s most affected

nations, ISOFS provides a

valuable forum to share

key lessons from the

work on the front lines of

obstetric fistula.

*Among its many partners at international, national, regional and local levels, the Campaign to End Fistula also counts on the support of the many institutions and practitioners who are part of the International Obstetric Fistula Working Group (IOFWG). The group aims to ensure global collaboration and coordination of efforts for all issues relating to fistula, including prevention and management, and to guide the secretariat of the global Campaign. Learn more online.

Disclaimer: The opinions expressed by the persons interviewed do not necessarily reflect the newsletter editorial position or the official position of UNFPA.