International Federation of Gynecology and Obstetrics

Background
Genital fistula is a distressing condition that can arise from a number of causes. The most common and most devastating type of genital fistula in developing countries is obstetric fistula, a hole in the birth canal usually caused by prolonged obstructed labour. Obstetric fistula is a totally preventable complication of labour which can largely be avoided by delaying the age of first pregnancy, stopping harmful traditional practices, and timely access to obstetric care. It results in nearly all cases in the death of the baby and leaves the woman suffering from health problems, including chronic incontinence, shame and social segregation.

According to the World Health Organization, each year between 50,000 to 100,000 women develop obstetric fistula. These figures are likely to be gross underestimates with many sufferers, often young women and adolescents, unwilling to seek treatment, unable to obtain treatment, and unaware that treatment is available. More than two million women live with untreated obstetric fistula in Asia and sub-Saharan Africa.

About the FIGO Initiative
In March 2011, FIGO signed an agreement with EngenderHealth  to collaborate on The Fistula Care Project, a project funded by USAID which focuses on the prevention and treatment of obstetric fistula in 11 African countries and one Asian country. 

Project Purpose
To ensure high quality clinical training for the care of women with obstetric fistula and to increase capacity of service sites and staff to provide comprehensive management and treatment of fistula through a programme of training of trainers and support to the training centres.

Project Objective
To implement structured fistula surgical training programmes in up to five countries in sub-Saharan Africa using a standardised training curriculum.

Global Competency-Based Fistula Surgery Training Manual (2011)
Current capacity to deliver care is grossly inadequate. Too few physicians are equipped with the knowledge and skills needed to repair genital fistulae and to care for patients following surgery. Most procedures are performed in Africa and Asia by local physicians, with technical support from surgeons from high-income countries where these fistulae are rarely seen.

Although the need for physicians trained in fistula repair has long been recognised, no standard training manual has existed. To meet this need, FIGO co-ordinated the production of a training manual, the Global Competency-Based Fistula Surgery Training Manual, aimed at healthcare providers from low- and middle-income countries involved in the prevention and management of fistula.

The purpose of the manual is to enable dedicated physicians to acquire the knowledge, skills and professionalism needed to prevent obstetric fistulae and provide proper surgical, medical and psychosocial care to women who have incurred fistulae, whether during childbirth or because of inflicted trauma.

The manual was produced with funding from the United Nations Population Fund (UNFPA) and with the collaboration of fistula surgeons, professional organisations and specialist health organisations, including the International Society of Obstetric Fistula Surgeons (ISOFS); UNFPA; EngenderHealth; and the Royal College of Obstetricians and Gynaecologists (RCOG). FIGO’s Fistula Committee played a pivotal role in the development of the manual.

The manual was pilot tested in several centres and is now ready for roll out.

Open Call for Fellowship Applications - Fistula Surgery Training

The International Federation of Gynecology and Obstetrics (FIGO) is pleased to announce an open call for fellowship applications for fistula surgery training. This is an opportunity for dedicated physicians to acquire the knowledge, skills and professionalism needed to prevent obstetric fistula and provide proper surgical, medical and psychosocial care to women who have incurred fistula, whether during childbirth or because of inflicted trauma.

Through this open call for fellows, FIGO is seeking to increase the number of fistula surgeons providing treatment for women living with obstetric fistula in countries where this condition is prevalent.  

Click here to access full details of the Open Call.   

(this Fellowship Programme was made possible with the support of the Fistula Foundation and Johnson & Johnson)  

Resources
FILM  The film 'Fistula Pilgrims' was written, produced and directed by Nancy Durrell McKenna for FIGO in collaboration with Safehands for Mothers, an organisation she founded. It tells the story of Telanish, a young girl in Ethiopia who was married at ten, pregnant at 11 and gave birth to a stillborn child at 12. As a result of a long and obstructed labour, she has a fistula and is left incontinent, an outcast from her community. With training, the complications that cause fistula can be avoided and spare young women like Telanish a lifetime of misery. To view the video, click here.

PUBLICATION   FIGO GLOBAL COMPETENCY-BASED FISTULA SURGERY TRAINING MANUAL

and FIGO GLOBAL COMPETENCY-BASED FISTULA SURGERY TRAINING MANUAL FRENCH TRANSLATION

FIGO COMMITTEE ON FISTULA

PRINT  An article, Pursuing a standard of care for training new fistula surgeons, written by Hamid Rushwan (FIGO’s Chief Executive) and Joseph Ruminjo (Clinical Director of EngenderHealth’s Fistula Care Project), was posted on the website RH Reality Check on 4 March 2011. It is part of a series of online articles on obstetric fistula which can be found here.