IntraHealth International

Our commitment: IntraHealth is a global champion for health workers. We have pledged to double our impact between 2011 and 2015 to ensure that more health workers are present, ready, connected, and safe. Mission: IntraHealth empowers health workers to better serve communities in need around the world. We foster local solutions to health care challenges by improving health worker performance, strengthening health systems, harnessing technology, and leveraging partnerships. ...
Jan 6, 2017

Fistula and Mental Health

Mariam
Mariam

It is well documented that the women who suffer from obstetric fistula suffer not only physically, but also psychologically. Due to the social isolation and stigma associated with fistula, patients often suffer from depression and other mental health dysfunctions.

The team of health workers at the Koulikoro referral health center in Mali has seen enough patients and witnessed sufficient behavior patterns to understand there is a clear link between physical and mental trauma associated with fistula.

To better assess the need for mental health services among the women who receive care through this project, IntraHealth International and the Duke Global Health Institute have introduced an adapted version of the Patient Health Questioner (PHQ-9), a multipurpose instrument for screening, diagnosing, monitoring, and measuring the severity of depression. The team is using this accredited tool, along with some additional questions specific to the effects of fistula on mental health, to learn more about the connection so they are better equipped to treat and counsel patients.

Mariam, a recipient of fistula repair surgery at the center, suffers from an undiagnosed mental health disorder, which most likely stems from and is exacerbated by the stress of being isolated from her community, unable to contribute to her family, and in constant physical discomfort.  

Mariam is quiet unless spoken to, her demeanor proud—almost stoic. She has a slow, shy smile that only occasionally breaks through. She attended a previous fistula repair campaign, accompanied by her mother, and experienced episodes of severe agitation. This time Mariam is at the hospital alone because the rest of her family needed to work in the fields.

The results of the PHQ-9 survey will help the project explore options to address the psychological issues these women struggle with. Women like Mariam.

When these women return home after surgery, they will continue to receive follow-up support from the community health agents, who have been trained in fistula counseling, including psychosocial care, postsurgery guidelines, and family planning. The agents make more than a dozen house calls throughout the region in any given month and provide emotional support through countless phone calls.

Now that Mariam has begun her postsurgery recovery, she spends much of her day sitting under a shade tree with the community health agents and the other fistula patients. There is a lot of talking and sharing. The camaraderie is contagious. These women stick together. “She’s going to be okay,” says Coulibaly, a community health facilitator, “She’s already improved so much since she’s been here, and I’m going to make sure her family understands that.”

 

* A version of this report written by Ingrid Marzoula was orginally published on Vital, IntraHealth's blog

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Oct 11, 2016

Collaboration is Key for Successful Healing

Patients at the health center
Patients at the health center

The women at the Koulikoro referral health center in Mali each have their own personal obstetric health histories which have affected their lives. Each comes to the facility hoping to undergo a successful repair surgery to heal her fistula. Their accounts reveal some unmistakable parallels:

Sali is 27 years old and developed obstetric fistula during her second pregnancy. After laboring for three days, she received an emergency cesarean to remove her stillborn child. She’s lived with a fistula for nine years and has lingering incontinence after receiving two previous fistula repair operations. Of two total pregnancies, she has only one living child.

Korotimi is 43 years old and developed obstetric fistula after 24 hours of labor during her third pregnancy. She’s lived with a fistula for 10 years and has lingering incontinence after two previous repair operations. Of seven total pregnancies, she has two living children.

Doussouba is 61 years old and developed obstetric fistula during her eighth pregnancy after laboring at home for three days. She’s lived with incontinence for more than 20 years. Of eight total pregnancies, she has three living children.

Their stories reflect a health system that offers inadequate access to high-quality perinatal care. But their narratives also uncovered a much larger systemic problem: how to provide the multifaceted support necessary for these women who have fallen through the cracks of a struggling health system and been left to endure the debilitating consequences.

Their most obvious and immediate need is for physical healing. But many different levels of health providers are needed to addresses the physical and psychosocial needs of these women. And, although each cadre provides a different specialization, collaboration is the key underlying factor for successful healing. Each member of the fistula repair team—nurses, surgical aids, anesthetists, surgeons—has an official role, but also understands the imperative need for cooperation and collaboration. Surgical aids calm anxious clients. Anesthetists help clean patients. Nurses chase mosquitoes out of bed nets.

These health workers are united in their goal of serving women and playing their part in the holistic model that has made this project successful. This multidisciplinary and multilayered approach of the health care team offers a glimpse of the solidarity and dedication required not just to perform successful repair surgeries, but to fully and wholly cure a women suffering from obstetric fistula.

* A version of this report written by Ingrid Marzoula was orginally published on Vital, IntraHealth's blog

Links:

Aug 9, 2016

What's the Cure for Stigma?

Welcome center for victims of fistula
Welcome center for victims of fistula

The stigma surrounding fistula is a challenge to overcome in its own right. Education and awareness campaigns are essential to overcoming the stigma that surrounds this devastating birth injury. Stigma is often the culprit that prevents women from seeking the medical help they need to heal. The Restore Dignity project seeks to counter stigma in a variety of ways, from radio messages and TV ads, to working with community health workers to identify those in need of treatment. Women who have undergone fistula repair surgery are often key ambassadors in helping identify and contact other women in the community who are in need of treatment but do not feel comfortable or safe seeking it out.

The Restore Dignity project takes into account the suite of barriers that prevent women from seeking care and undergoing surgery – a simple surgery that will change their life for the better and allow them to reintegrate into society. The project and its partners seek to advance the global community’s understanding of the physical, social, and financial needs of women who have suffered, or continue to suffer, the scourge of fistula, and to augment the innovations and resources aimed at ending fistula and restoring women’s dignity.

This holistic approach this project takes to fistula treatment and prevention has yielded impressive results. The training and recruitment of health workers at all levels has resulted in 609 women receiving surgical fistula repair and 78% of eligible women repaired are now using a family planning method. The increase use of family planning is a result of the education and awareness campaigns which are interwoven into the care package. In addition, treatment addresses women’s physical and psychosocial needs.

During the World Fistula Day celebration on May 23, two IntraHealth staff members – the Mali Country Director and the International Program Director for West Africa – received awards from the Mali Ministry of Health and Public Hygiene for the project’s dedication to restoring the dignity of women suffering from fistula. These leaders and their teams have overseen the opening of a new welcome center for fistula clients at Sikasso Hospital, distributed 280 dignity kits to women undergoing repair, expanded the availability of repair services into two additional districts, implemented income generating opportunities for 50 women, and planned mental health interventions for all affected women.

Despite these achievements, the need is still great. Every year more women and girls develop fistula. It is imperative that the treatment approach include an understanding of societal norms in Mali and address not only physical needs, but also the deep-seeded societal stigmas that played a leading role in creating the problems to begin with. 

Health workers receiving certificates
Health workers receiving certificates
 
   

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