From Despair to Dignity Prevention and treatment of
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From Despair to Dignity Prevention and treatment of post-partum complications (fistulae) in Pakistan Dr. Sajjad Ahmed Siddiqui PNFW H
Millennium Development Goal no. 5: Reduce, by 75%, between 1990 and 2015, the maternal mortality ratio
We have ”a culture of irresponsible commitments” • Rome 1975 (FAO): No child will go to bed hungry by the year 2000 • Alma Ata 1978 (WHO): Health for all by the year 2000
We have ”a culture of irresponsible commitments” • • New York 1990 (World Summit for Children): Maternal mortality ratio down by 50% by the year 2000 Cairo 1994 (UN/ICPD): Maternal mortality ratio down by 50% by the year 2000
We have ”a culture of irresponsible commitments” • Copenhagen 1995 (World Summit for Social development): Maternal mortality ratio down by 50% by the year 2000 • Beijing 1995 (Fourth World conference on Women): Maternal mortality ratio down by 50% by the year 2000
We have ”a culture of irresponsible commitments” • New York 2000 (UN): Maternal mortality ratio down by 75% by the year 2015
The world is NOT on track to reach the 5 th Millennium Development Goal
A maternal death is a family disaster: studies indicate that around 90% of infants to mothers dying a maternal death are themselves dead at 5 years of age
DEATHS & MORBIDITIES ARE ASSOCIATED WITH POOR MATERNAL CARE DURING PREGNANCY AND AT DELIVERY
Obstetric fistula, a devastating maternal morbidity
Women in Pakistan
Underage Marriages in Pakistan
Genital Tract Fistula
• started in Nov 2005 IN PAKISTAN PNFWH
Fistula Centers Larkana
Global campaign - End Fistula • Obstetric fistula was eliminated in Europe and the United States more than 100 years ago • It's unacceptable that women and girls in developing countries are still suffering from this entirely preventable and treatable condition • The Campaign is now working in 47 countries in Africa, Asia and the Arab region urged to make fistula a thing of the past. • Our target date for fistula elimination is 2015, in line with MDG targets to improve maternal health
Ending the Silence, Easing the Suffering Social support is an essential component for comprehensive treatment of obstetric fistula it includes • Basic education, • Training in income generating skills, • Health education • Psychosocial support,
The Project’s Aim Basic strategies of this project are § To strengthen seven regional Fistula centers in Pakistan § To improve the technical skills of surgeons § Enhancing the accessibility of patient to quality surgery through community out reach, surgical camps § Raising awareness and promotion of safe delivery through community sensitization workshops and seminars
Programmatic directions for campaign • Build capacity and develop mechanisms to identify & Treat obstetric fistula cases routinely • Identify strategies to generate demand for services • Design a sustained and field-based communication & advocacy strategy • Strengthen the health system to address obstetric fistula • Integrate obstetric fistula within the reproductive health agenda
Achievements: • 56 doctors including gynaecologist, urologist & general surgeons were trained for providing services for fistula management. Doctors Trained (Year wise)
Achievements: • 450 nurses & midwives being trained on fistula prevention and post-operative care. Nurses & Midwives Trained (Year wise)
Achievements: • A total of 3678 patients were treated from Jan 2006 to June 2013. • Twenty one (21) out-reach camps for fistula patients were held from 2006 to 2012 in which about Three hundred (300) fistulas were treated.
Prevention 1. Obstetric fistula 2. Iatrogenic Fistula
Preventing Obstetric Fistula Prevention is the key, it is possible ONLY WHEN • accessibility for all women to a continuum of quality maternal health care services • Empowerment of women and girls • Increases in their life opportunities and delaying of first births and marriage
Prevention-Obstetric fistula-CMW
Prevention-Obstetric fistula-LHW
Prevention-Obstetric fistula-CW
Prevention • Training of Midwives • Health Workers • Activation of BHU / RHC • Task Shifting ü Surgeries ü Anesthesia
Early catheterization for all prolong labour
Prevention - Iatrogenic • Post Graduate training Fistula • OBGY • Surgery • Training & Trainee
Way forward • Strategies to increasing awareness on its causes, consequences and access to OF-related services • OF program should incorporate rehabilitation and social reintegration activities • Integration, OF into existing RH services at all levels specially- MNCH. • Media and community leaders need to be involved in prevention as well as in rehabilitation & social reintegration. • Holistic prevention strategies for RH-FP. • Surveillance of OF at community level through LHWs. • Family practitioner sensitized about the importance of notifying health authorities • Referral to nearest HF for confirmation & treatment • Every month submission of zero reporting at HF
Purpose: To provide adequate and accessible facilities for the treatment of fistula and to prevent the incidence of Fistula in future 1. Strengthening of Seven Fistula Regional Centers. 2. Enhancing Treatment Technical Capacity. 3. Enhancing Accessibility of Patient to Quality Surgery. 4. Rehabilitation 5. Awareness and Promotion of Safe Delivery. 6. Policy Advocacy
Surveillance of fistula through LHWs & midwives • • Bangladesh & Nepal- model to eradicate fistula Early identification of women living with fistula Pilot project in selected districts Collection of data at community level for continuous dribbling of urine Family practitioner sensitized about the importance of notifying health authorities Referral to nearest HF for confirmation & treatment Every month submission of zero reporting at HF This system will use LHWs, community midwives and primary health care workers to establish a vital link between the public health sector and private practitioners, including obstetricians, gynecologists and urologists.
Out reach Camps
Dr. John Kelly's
If we can ensure safe delivery and safe motherhood, one day obstetric fistula will be history. ” “ Thanks PNFWH
- Primary prevention secondary prevention tertiary prevention
- Initiative vs guilt stage
- Macduff's reaction to his family's death
- Hope despair and memory
- Who wrote hope despair and memory
- Despair
- Color of despair
- Integrity vs despair
- B. f. skinner theory child development
- 심연/despair scan
- Pit of despair meaning
- But tis strange and oftentimes to win us to our harm
- Anger despair acceptance
- Generativity
- Despair definition bible
- Dignity and privacy
- Romeo and juliet balcony scene translated to modern english
- What is a constructive feedback
- Proverbs 31 10-31 niv
- Proverbs 31 1
- Visual design principles and elements matrix
- Dignity and discipline
- Curwin and mendler discipline with dignity theory
- St john pledge
- Example of human rights
- Curwin and mendler
- Dignity of risk
- Examples of dignity
- In fair verona where we lay our scene meaning
- Questions about human dignity
- Two households, both alike in dignity
- National dignity council
- Lasting legacy meaning
- Examples of dignity
- Examples of dignity
- Why is dignity important
- Catholic dignity
- Dignity example
- Social justice definiton
- Two households, both alike in dignity.