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Restore Dignity to Women in Mali

by IntraHealth International
Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Fousseyni Daou Hospital in Kayes
Fousseyni Daou Hospital in Kayes

In the five regions of Senegal where this project is focused there has been increased access to high-quality, sustainable, and resilient fistula treatment and prevention services. This is due to improved health systems, an increase in the capacity of health workers to diagnose and treat fistula, and an increased effort to prevent fistula. Women who would otherwise be unable to work, socialize, or contribute to society have found hope from fistula repair. I'll let Sidibe take it from here: 

"I was volunteering as a matron in the Kayes district and was expecting my first child. I was also selling ice in my neighborhood at this time and my life was very happy.

When my contractons started, I went to the health center where I received my pre-natal care to give birth. My labor was long and difficult and I eventually had to have a forceps delivery. My child lived. During the 40 days after the birth, I found that I started to leak. I though this must be something from childbirth and that it would pass. My fiancee and my mother, however, thought it must be related to an error by the health care worker and wanted to complain. I calmed them down and went back to see the doctor who volunteered to repair the leak.

I went through with the surgery but it wasn’t successful. I started to despair and at the same time I felt shame. I had to stop working because I was afraid that others would discover that I was suffering from this condition. I also stopped selling ice. Secluded at home I only left if absoulutely necessary.

Several months after the unsuccessful surgery, I decided to go to Fousseyni Daou Hospital in Kayes. There I learned about a project that would provide support to women with my same condition. After screening by a doctor, I was operated on again by a surgeon at the hospital and it was a success.

I just want to thank them because I am very happy to be finally free of this condition that was ruining my life. I can now finally resume my normal routine and devote myself back to my family and my work!"

Sidibe, 26 years old

Loading up medical supplies bound for Norther Mali
Loading up medical supplies bound for Norther Mali

The IntraHealth Mali Fistula program has made great strides in recruiting and training medical personnel to provide emergency and obstetric fistula surgery. To date, 25 surgical teams have been trained across the country and members of the teams have held 186 community conversations, made 96 home visits, hosted 89 counseling sessions, and diffused 740 health related messages on 10 local radio stations.

While training medical professionals to diagnose and treat fistula, reducing stigma surrounding fistula, and addressing the social and physiological consequences of fistula remain project priorities, attention can now be drawn to addressing specific needs of hospitals in the remote norther regions of Gao, Kayes, Sikasso, Koulikoro, and Bamako. By ensuring the hospitals and medical facilities in these regions are properly equipped to provide quality care, the project can expand the breadth and depth of fistula services.

A partnership with Project C.U.R.E has enabled IntraHealth to secure and disseminate donated hospital and surgical equipment and supplies that will strengthen the hospitals ability to provide care.

Twenty stethoscopes, 20 folding walkers, 3 monitors for vital signs, 14 IV poles, 2 centrifuges, exam lights and EKG electrodes, feminine pads and diapers, linens, and towels. That’s just some of the equipment and supplies packed into a shipping container earlier this summer by colleagues at Project C.U.R.E. The container was bound for target regions in northern Mali where hospital workers and patients eagerly awaited them.

The estimated value of all the equipment and supplies volunteers managed to squeeze into the container topped $180,000—all donated or purchased through donations.

The goal of the supplies is to alleviate the severe shortage and in some cases even complete dearth of essential equipment available at health facilities. Along with the equipment comes a sense of relief to the health workers who have been limping by with old, broken, or missing equipment. Now these hospitals can continue to restore dignity to women suffering from fistula by not only providing a life-changing medical procedure, but also by providing them with high quality care in adequately equipped facilities.

While the supplies are a welcome site and essential for quality care and increased capacity, more supplies are necessary. One hospital in the region, l’Hopital du Point G, is desperately awaiting a shipment of new hospital beds. With your help this can become a reality.  

A working ICU monitor in l
A working ICU monitor in l'Hopital du Point G Mali

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Bed in a public hospital in Mali
Bed in a public hospital in Mali

Can you imagine walking into a hospital room pregnant and vulnerable and seeing broken medical monitors, stained beds, and sticks being used as IV poles? This would be an upsetting shock for those accustomed to high-quality, fully equipped medical facilities, but for many women in rural Mali, a medical center, no matter how ill-equipped, is preferable to suffering at home. However, in order for a facility to operate effectively, it must be equipped with not only a trained staff who can help treat and repair fistula, but also with medical equipment and supplies to ensure a comfortable (and sanitary) visit.

In Mali, high fertility, low use of modern contraceptive methods, early marriage, and low rates of facility births place an estimated 2,400 women at high risk of fistula each year. The majority of these women live in rural areas, often over 15 kilometers from a health facility. Recent progress has been made to open new facilities and, over the last several years, 25 obstetric fistula teams have been trained to work in regional hospitals and health centers. The next priority is to outfit these centers with fistula-specific supplies and equipment which will strengthen the facilities ability to provide care, as well as their capacity to expand the breadth and depth of fistula services.

A recent survey of facilities in Mali found that some housed entire rooms and wards devoid of equipment and supplies and many more were limping by with broken beds, unsanitized utensils, and/or a dearth of equipment tailored to the predominant patient caseload. For example, the pediatric ICU in Koulikoro hospital lacks infant-specific equipment and supplies, although the predominant caseload is pregnant mothers and infants.

The survey also developed a priorities list of supplies and equipment specifically related to fistula treatment and prevention. The top three items requested include oxygen concentrators, surgical kits, and beds with new, clean mattresses and linens.

As the ultimate goal of the project is to increase access to high quality, sustainable, and resilient fistula treatment and prevention services, it is imperative to have both trained and equipped staff. The physical and mental toll fistula can have on a women is severe enough without the indignity of recovering in a broken bed with unclean sheets. Supporting this project will help ensure that women who suffer from fistula have not only the personnel available to aid with recovery, but also the simple provisions that many take for granted: anesthesia, exam lights, a clean towel. 

Patient in an ill-equipped public hospital
Patient in an ill-equipped public hospital
Business management training
Business management training

Each year in Mali, up to 2,400 women are in danger of developing obstetric fistula, a devastating but largely curable condition. Women living with untreated fistula are often shamed, isolated from their communities, and left to live in poverty.

That’s why IntraHealth’s Fistula Mali Project has provided successful repair surgeries for over 1,000 women. As part of our comprehensive treatment plan, we’ve helped many of these women to harness their own earning potential so they can rejoin their communities and begin making a living.  

Recently, 46 women completed our week-long business management training and received coaching and financial support to establish their businesses. Their ideas range from sheep-raising and hair styling to selling spices, soap, wood, or doughnuts. 

After presenting their business plans at the end of the training, each woman received 40,000 CFA(West African francs) to start their businesses and will receive another 10,000 CFA after demonstrating success. This money—which amounts to about US$100—is a life-changing gift for the women we help.

Hard to imagine that you can, quite literally, change a life for $100. And when you change a woman's economic future, you change her family's future. When you change families, you change communities. Regions. Nations. This investment will transform her life from one of despair and isolation into one of independence and hope. A victim of circumstance no longer - now these women can become business owners in charge of their own futures and empowered to invest in themselves and their families.  

Your participation in the Fistula Project will not only transform the physical and communal lives of women in Mali, but will help them take the next step back into the world—putting them in charge of their own futures and empowering them to change not just their own lives, but those of their communities and beyond.

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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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Organization Information

IntraHealth International

Location: Chapel Hill, NC - USA
Website:
Facebook: Facebook Page
Project Leader:
Nola Paterni
Development Officer
Chapel Hill, NC United States

Funded Project!

Combined with other sources of funding, this project raised enough money to fund the outlined activities and is no longer accepting donations.
   

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