Camps to treat fistulas

In their operations worldwide, MSF doctors have always been faced with women suffering from fistula. In 2003, MSF organized its first fistula camps in Ivory Coast and Chad, then, in subsequent years, in Sierra Leone, Somalia, Democratic Republic of Congo (DRC), CAR or Mali. These ad hoc interventions are continuing today in DRC and CAR.

Women relax in one of the tents at the MSF fistula camp in Boguila, CAR. 65 women had their fistulas repaired during the six week-long camp in 2010.[? Sarah ELLIOTT for MSF]

"MSF usually works in insecure or war-torn countries. That is why we chose to set-up short projects," explained Michiel Lekkerkerker, medical advisor for MSF in Amsterdam. "Fistula camps, as we call them, are installed for two months next to existing hospitals. Before we set up the camp, the population is informed so that women with fistula come for consultation. Then we hire additional employees and we prepare between 40 and 80 beds, usually in tents. The surgeon stays about one month on site and operates on several women a day. This method has the advantage of flexibility and it is easier to find a specialised surgeon for a short period. "

Three permanent centres in Burundi Chad and Nigeria

Today, MSF treats obstetric fistula in three permanent centres in Burundi, Chad and Nigeria.

The latest location to open its doors is the Urumuri centre, backed by the regional hospital in Gitega, in the heart of Burundi, and opened its doors in July 2010. This is the first centre specialising in fistula in Burundi, able to treat women seven days a week and MSF has built four houses to accommodate the patients before surgery and during rehabilitation.

"This kind of project ensures a better monitoring of patients and it is possible to do research to improve treatment," said Geert Morren, surgeon and fistula specialist at MSF in Brussels and who operated on many of the women in Gitega. "The objective is to operate on 350 women per year over three years. This time frame should allow us to train three Burundi surgeons and to transfer our activities to the Ministry of Health."

In Burundi, in addition to the specialised centre in Gitega, MSF built a maternity unit in another region of the country. The plan is to prevent the occurrence of fistulas by improving the obstetrical care available in Burundi.

In Abeche, eastern Chad, the project "butterfly" started in 2008. The butterfly symbolises the transformation of women who lived secluded lives and can begin a fresh start after their operation. En 2009, MSF built a "village of women" to accommodate patients with fistula during their weeks long stay. During the first consultations, a preoperative evaluation is done to screen malnutrition cases that will be taken care of before the surgical intervention. After their operation. Counselling and rehabilitation sessions allow them to regain a place in society.

MSF works with a Chadian surgeon. Dr. Valentin Valandi, who graduated in Dakar, is specialising himself in fistulas thanks to the visit of international experts. "Each case is different, I learn every day," he said. "In Chad, too many women have already been operated upon inappropriately, which further complicates the procedure."

In Abeche, MSF also supports the regional maternity hospital, next to its "butterfly" centre.The objective is to improve obstetric care in order to prevent new cases of fistula occurring because of poor management of difficult deliveries.

In Nigeria, finally, MSF works with the staff of the Ministry of Health at a hospital in Jahun in the north of the country. The teams provide obstetric and neonatal care to the local population. The objective is not only to reduce maternal and infant mortality but also to prevent and treat fistula. In 2010, the MSF team carried out 400 fistula repair surgeries. Upon discharge from the hospital, women receive six months of outpatient follow-up care to ensure the fistula has healed and that continence is maintained.

In 2010, MSF teams have operated and treated about 1000 women suffering from obstetric fistula.