A Q&A with Evelyn Landry

How Fistula Research Can Transform Health and Lives

Evelyn Landry, Deputy Director of EngenderHealth's Fistula Care Project, discusses research initiatives under way to improve treatment and care for women living with obstetric fistula. Fistula Care represents the largest investment by the U.S. government in fistula prevention and treatment to date. In addition to training fistula surgeons and increasing access to services, the project also conducts research to identify best practices for treating and caring for women living with fistula.

 
Why is research on fistula so important?

Over the course of their careers, dedicated fistula surgeons have gathered information and published on cases they have attended, but there are very few data that analyze what has been most successful on a broader scale. Because fistula is a stigmatized condition and until recently received little public attention and support, most of the advances in fistula surgery have not been widely shared. But with the advent of Fistula Care and the launch of the International Society of Obstetric Fistula Surgeons (ISOFS), that is beginning to change. A key conclusion at the most recent ISOFS Congress in Dakar, Senegal, in December 2010 was the need for more data and an improved evidence base-specifically, prospective and randomized clinical trials-that will help identify best practices for quality fistula treatment and care.

 
What research is the Fistula Care project doing on fistula practices?

In 2009, we surveyed fistula surgeons across Africa and Asia, asking them to share their current surgical practices. From their responses, we determined that studying the duration of catheter use after fistula surgery would have the greatest potential impact on improving results for women. A catheter is a tube that is inserted in the urethra to drain urine from the bladder following surgery. Currently, the duration of catheter use postsurgery varies widely among the surgeons who responded to the survey. Depending on the type of fistula, some women are catheterized for fewer than five days, while others are catheterized for as many as 42 days. In collaboration with the World Health Organization, we have designed a randomized clinical trial to understand the effects of short-term catheterization, and we plan to begin the trial in 2011.

 
What impact could this clinical trial have on the treatment of fistula?

The findings of the trial could be quite important in informing the optimal ways to treat women with less complex fistula. The longer a woman is catheterized, the greater the potential for infections or other complications and the longer she has to stay in a hospital. Reducing the length of time a woman is catheterized after surgery could potentially improve outcomes for the woman, enabling her to return home sooner following surgery. This would reduce costs for health care facilities and enable a hospital to treat more women by having more beds available.

 
What other research is the Fistula Care team conducting right now?

We are completing two studies. One is a three-year observational study to understand which aspects of treatment and care may influence the success of fistula repair. The second study is a retrospective review of hospital records to understand the reasons why surgeons decide to perform a cesarean section. Obstetric fistula occurs when a woman endures prolonged, obstructed labor without a timely cesarean intervention, so providing a safe cesarean is an important fistula prevention strategy. While there are substantial data about the rates of cesarean sections, this study will help us understand more clearly the reasons for these surgeries. Findings from the study will also help identify other areas of obstetric care that can be strengthened.

Our proximity to and experience in partnering with fistula care providers give us the ability to help shape fistula care practices based on the results of research. EngenderHealth has worked directly with fistula care providers since 2002. Through Fistula Care, we have worked in 13 countries and have assisted our partners to provide 13,000 surgeries between 2005 and September 2010. We train surgeons and support health facilities so they can provide holistic care to women with fistula.

 
Where can someone go to find out more information about Fistula Care?

Visit our web site at www.fistulacare.org.

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