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.

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

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

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

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

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

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

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

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

DEATHS & MORBIDITIES ARE ASSOCIATED WITH POOR MATERNAL CARE DURING PREGNANCY AND AT DELIVERY

Obstetric fistula, a devastating maternal morbidity

Obstetric fistula, a devastating maternal morbidity

Women in Pakistan

Women in Pakistan

Underage Marriages in Pakistan

Underage Marriages in Pakistan

Genital Tract Fistula

Genital Tract Fistula

 • started in Nov 2005 IN PAKISTAN PNFWH

• started in Nov 2005 IN PAKISTAN PNFWH

Fistula Centers Larkana

Fistula Centers Larkana

Global campaign - End Fistula • Obstetric fistula was eliminated in Europe and the

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

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

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

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

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.

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

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

Prevention 1. Obstetric fistula 2. Iatrogenic Fistula

Preventing Obstetric Fistula Prevention is the key, it is possible ONLY WHEN • accessibility

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-CMW

Prevention-Obstetric fistula-LHW

Prevention-Obstetric fistula-LHW

Prevention-Obstetric fistula-CW

Prevention-Obstetric fistula-CW

Prevention • Training of Midwives • Health Workers • Activation of BHU / RHC

Prevention • Training of Midwives • Health Workers • Activation of BHU / RHC • Task Shifting ü Surgeries ü Anesthesia

Early catheterization for all prolong labour

Early catheterization for all prolong labour

Prevention - Iatrogenic • Post Graduate training Fistula • OBGY • Surgery • Training

Prevention - Iatrogenic • Post Graduate training Fistula • OBGY • Surgery • Training & Trainee

Way forward • Strategies to increasing awareness on its causes, consequences and access to

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

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

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

Out reach Camps

Dr. John Kelly's

Dr. John Kelly's

If we can ensure safe delivery and safe motherhood, one day obstetric fistula will

If we can ensure safe delivery and safe motherhood, one day obstetric fistula will be history. ” “ Thanks PNFWH