Obstetric fistula is a neglected public health and human rights issue. A devastating childbirth injury that leaves women permanently incontinent unless they receive treatment by a trained, competent fistula surgeon.  

The FIGO Fistula Surgery Training Initiative is a globally recognised, pioneering programme training fistula surgeons and care teams in countries where fistula occurs. Our 64 trainee surgeons - FIGO Fellows - provide life-transforming care in some of the world’s most underserved regions and are working hard to close the fistula treatment gap.  

This month, we spoke to FIGO Fellow Dr Shuvechchha Dewa Shrestha from Fistula Centre Surkhet, Province Hospital, Nepal about her experience as a fistula surgeon and FIGO Fellow.   

Raising awareness and training surgeons: improving obstetric fistula treatment in Nepal

At the Fistula Centre Surkhet, we have seen cases of women being mistreated due to a lack of adequate fistula treatment training for health workers. People travel to neighbouring countries for treatment due to their lack of knowledge about the condition and the low number of fistula surgeons in Nepal.  

The woman on whom I performed my first fistula surgery was 74 years old. After fistula repair surgery, she was dry for the first time in 50 years. She said that if only she had known earlier about the treatment and come here sooner, she would not have suffered for so long. People not knowing about the availability of fistula treatment options is causing them so much suffering. 

In addition, COVID-19 has had a huge impact on our work, and created more barriers to helping women living with obstetric fistula. The lockdown put in place to respond to the pandemic led to transport issues, and people became afraid to travel away from their homes. Our outreach team also faced difficulties in delivering fistula awareness programmes in different areas of the country. All this has resulted in fewer patients for the centre.  

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Training as a FIGO Fellow to provide quality fistula care 

Being a FIGO Fellow, I learn not only about how to treat fistulas, but also about how to prevent them as well as about the physical and mental wellbeing of patients. When I joined the FIGO Fistula Surgery Training Initiative earlier this year, I was placed in Hamlin Fistula Centre in Ethiopia, under FIGO Trainer, Dr Yeshineh. The training lasted from 14 February to 12 March. I learnt many things about fistula management, including surgery for complicated cases. The hospital team and staff were very cooperative and helpful and we went to visit Desta Mender, the rehabilitation centre for fistula patients.  

My experience with the FIGO Fistula Surgery Training Initiative made me see how FIGO trains fistula surgeons and care teams from different parts of the world where obstetric fistula is prevalent. This helps in creating a more broadly trained workforce in the fight to end fistula globally. 

23 May marks the annual International Day to End Obstetric Fistula. Help FIGO to end obstetric fistula by spreading the message on social media using our resources.