Restore Dignity to Women in Mali

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:

• Malian Women with Fistula Find Compassion and Solidarity

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.