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Obstetric Fistula

Technical Publications and Resources

Study Protocol: Non-inferiority of short-term catheterization following fistula repair surgery
(2014) English (PDF, 527KB), French (PDF, 632KB)

Counseling the Obstetric Fistula Client: A Training Curriculum
Counseling is an integral part of comprehensive fistula care services. The curriculum developed by Fistula Care guides nurses, midwives, and physicians to help their clients make informed and voluntary decisions about their care. The curriculum addresses counseling needs related to fistula prevention, treatment, and social reintegration. Service providers can also find information about how to engage with the client’s family and how to link the client to supportive organizations in the community.
(2012) English (PDF, 2.5MB), French (PDF, 2.8MB)

Counseling the Traumatic Fistula Client: A Supplement to the Obstetric Fistula Counseling Curriculum
Clients seeking care for traumatic fistula—fistula caused by sexual assault—need access to counseling that addresses the complex effects of their condition. This supplement developed by Fistula Care complements the counseling curriculum to address the physical, social, and psychological impacts specific to traumatic fistula. The supplement also provides information on how health care providers working with traumatic fistula clients can seek support for themselves.
(2012) English (PDF, 3.2MB), French (PDF, 3.2MB)

The Prevention and Management of Obstetric Fistula: A Curriculum for Nurses and Midwives
Nursing and midwifery are both integral to comprehensive obstetric fistula care services. The goal of this curriculum is to train nurses and midwives so that they have the knowledge, skills, and attitudes that will enable them to prevent obstetric fistula and care for clients who are living with obstetric fistula. This comprehensive curriculum, developed by the East, Central, and Southern Africa Health Community, with support from USAID and Fistula Care, addresses several critical areas: preventive care; surgical treatment and postoperative recovery; information; education; family and community involvement; counseling; and data collection and use. It also presents learning activities and competency-based skills checklists that help nurses and midwives develop real-world skills for the clinical environment.
(2012) English (PDF, 4.1MB), French (PDF, 5.7MB)

Data for Decision Making in Fistula Care: A Supplemental Module for Facilitative Supervision
In keeping with its commitment to quality improvement, EngenderHealth promotes the use of data for decision making. This series of training modules developed by Fistula Care provides clinical supervisors, service providers, and national-level stakeholders with skills to review and interpret data in order to strengthen health systems and services. The document includes guides for discussion and interactive activities, as well as handouts and other tools to teach lessons about data gathering, analysis, and application. The modules supplement EngenderHealth’s facilitative supervision tools, which emphasize team problem solving and communication.
(2011) English (PDF, 2.8MB), French (PDF, 2.6MB)

Digital Stories Facilitator's Guide
This guide developed by Fistula Care serves as a companion to the Learn From My Story series, a collection of video testimonies from fistula clients in Uganda. To help people listen to and use the stories, a facilitator's guide was created and includes: the text of each woman's story, discussion questions tailored to each woman's story, and key messages for facilitators to convey. The guide is intended for use with three main audiences: health care providers, women with fistula, and community members.
(2010) English (2.8MB), French (2.7MB)

Informed Consent in Fistula Care
Informed consent is a critical component of quality fistula care services. This booklet developed by Fistula Care for service administrators, staff, and supervisors provides guidance on counseling patients before fistula surgery. Clients may find the provided information helpful in making an informed decision on care. 
(2010) English (630KB), French (671KB)

Family Planning for Women and Couples Following Fistula Care
This booklet developed by Fistula Care provides clients with information about family planning methods for couples following a woman's fistula repair. 
(2010) English (1MB), French (1.2MB)

Improving Partograph Use in Uganda through Coaching and Mentoring
Since 2010, Fistula Care has collaborated with the Reproductive Health Department of the Ugandan Ministry of Health to strengthen partograph use. This Fistula Care technical brief describes the challenges and achievements of developing and implementing a new approach to support partograph use in five facilities across three districts and makes recommendations for future partograph programming at the national, district, and facility levels.
(2013) English (PDF, 2.8MB), French (PDF, 2.6MB)

Creating an Enabling Environment for Fistula Prevention and Treatment in Uganda
The Fistula Technical Working Group was established by the Ugandan Ministry of Health’s Clinical Services Department to ensure equitable access to health care for women with fistula, promote prevention strategies, maximize the efficient use of resources, eliminate duplication of effort, and foster a community of providers. This Fistula Care technical brief describes three important achievements of the Uganda Ministry of Health and the Fistula Technical Working Group: building an information base for obstetric fistula to better plan for and manage prevention, treatment, and reintegration services; integrating fistula services into the Uganda health system; and establishing standards, guidelines, and protocols to guide services.
(2013) English (PDF, 14KB), French (PDF, 2.1MB)

Living with Obstetric Fistula: Qualitative Research Findings from Bangladesh and the Democratic Republic of the Congo
What are the social consequences of fistula? What affects how women with fistula are treated? Fistula Care is pleased to announce its latest technical brief, which provides insights into the experiences of women with fistula in Bangladesh and the Democratic Republic of the Congo. This qualitative research examines the lives of women suffering from fistula in two very different sociocultural contexts, including the physical and social consequences associated with the condition and women’s attempts to obtain care.
(2012) English (PDF, 1MB), French (PDF, 750KB)

Community-Based Screening for Obstetric Fistula in Ebonyi State, Nigeria
In 2007, the Mother and Child Care Initiative (MCCI) was launched in Ebonyi State, under the leadership and support of the governor’s wife, the Honorable Mrs. Josephine Elechi. In 2008, prior to the construction of a new obstetric fistula center in the state, MCCI coordinated with local governments to deploy a specialized medical team to conduct community-based screening for obstetric fistula throughout Ebonyi State, in order to estimate the potential backlog of women needing fistula repair surgery. This Fistula Care technical brief describes the planning process for the community screening and the results of this effort.
(2012) English (PDF, 981KB), French (PDF, 1.3MB)

Low-Cost Ambulance Network to Improve Access to Maternity Services in Dhaka, Bangladesh
Transportation to skilled maternity care is critical. In 2008, the Ad-din Hospital recognized that many women in Dhaka were unable to access emergency obstetric care and established a low-cost ambulance service. This Fistula Care technical brief describes how Ad-din uses mobile phones and global positioning system (GPS) tracking to manage a fleet of 66 ambulances stationed throughout the city.
(2012) English (PDF, 736KB), French (PDF, 781KB)

Increasing Access to Maternity Services in Rural Bangladesh: Sustainable Facility-Community Links
The Ad-din Hospital for Women and Children and the LAMB Project in Bangladesh have established community-level services for women in rural, underserved communities. This Fistula Care technical brief describes their noteworthy programs, which ensure community ownership and sustainability. One program is integrated into a microfinance program to enable financial independence; the other empowers community members to truly own and manage its services.
(2012) English (PDF, 1.1MB), French (PDF, 1.2MB)

Integrating Fistula Treatment and Prevention: The Launch of a Maternity Unit in Sierra Leone
The Aberdeen Women's Centre maternity unit began offering delivery services in May 2010. Today, its dedicated staff provide hundreds with women high-quality maternity services each year. This Fistula Care technical brief details the challenges of opening a maternity centre, and the factors that have led to the success of the clinic today.
(2012) English (PDF, 2.3MB), French (PDF, 1.6MB)

Making Mobile Phones Work for Women with Fistula: The M-PESA Experience in Kenya and Tanzania
This Fistula Care technical brief discusses the work of the Freedom from Fistula Foundation in Kenya and Comprehensive Community Based Rehabilitation in Tanzania. Both programs use an innovative combination of mobile banking and community education to provide free fistula treatment to women who need it.
(2011) English (PDF, 2.2MB), French (PDF, 666KB)

Beyond Repair: Involving Communities in Fistula Prevention and Reintegration--Experience from Kissidougou, Guinea
This Fistula Care technical brief discusses engaging local government and community members in treatment, reintegration and prevention of fistula.
(2010) English (PDF, 2MB), French (PDF, 3.3MB)

A Collaborative Network to Improve Access to Fistula Treatment in Nigeria
This Fistula Care technical brief describes the pooled effort strategy that the Nigeria team has been leading to expand access to fistula repair services.
(2010) English (PDF, 3.4MB), French (PDF, 600KB)

Fistula Pre-Repair Center Model in the Amhara Region of Ethiopia
This Fistula Care technical brief provides readers with an overview of USAID support to three pre-repair centers in the Amhara Region which are part of a partnership with the Amahara Regional Health Bureau and the Bahir Dar Hamlin Fistula Hospital.
(2009) English (PDF, 467KB), French (PDF, 639KB)

Risk and Resilience: Obstetric Fistula in Tanzania
A qualitative study conducted by EngenderHealth and the Women’s Dignity Project in Tanzania to understand the many dimensions of obstetric fistula and its related social vulnerability. The report explores the experiences and views of girls and women living with fistula, as well as those of their families and communities and of the health workers who care for them. The study also explores participants’ recommendations on locally appropriate solutions for preventing and managing obstetric fistula.
(2006) English (PDF, 767KB)

A Report of a Meeting on Traumatic Gynecologic Fistula Held in Addis Ababa, Ethiopia
The Addis Ababa Fistula Hospital, EngenderHealth/The ACQUIRE Project, the Ethiopian Society of Obstetricians and Gynecologists (ESOG), and Synergie des Femmes pour les Victimes des Violences Sexuelles (SFVS) cosponsored the first-ever conference on traumatic fistula in Addis Ababa, Ethiopia, from September 6 to 8, 2005. Participants included fistula surgeons, health and social workers, psychologists, activists, and lawyers from 12 African countries where traumatic fistula is known to exist, as well as global humanitarian and public health experts.
(2005) English (PDF, 487KB), French (PDF, 362KB)

Obstetric Fistula Needs Assessment Report: Findings from Nine African Countries
The first report to map obstetric fistula, a debilitating pregnancy-related condition, in Sub-Saharan Africa. The report, which is based on a study conducted by EngenderHealth on behalf of UNFPA (United Nations Population Fund), contains detailed information on themore than 35 health care sites visited, specific issues and challenges in providing services, and possible recommendations for prevention and treatment. A condensed version of the report, the information kit Campaign to End Fistula, Step One: Recognizing the Needs in Africa, is alsoavailable. Produced jointly by UNFPA and EngenderHealth.
(2003) Report: English MCH-03R; French MCH-03RF / Information kit: English MCH-03K; French MCH-03KF.
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Situation Analysis of Obstetric Fistula in Bangladesh
This report is the first attempt to determine the obstetric fistula situation in Bangladesh, and was undertaken by UNFPA (United Nations Population Fund) and EngenderHealth.
(2003) English (PDF, 280KB)

Obstetric Fistula: A Needs Assessment in Ghana and Rwanda
This report is modeled on an earlier study, Obstetric Fistula Needs Assessment: Findings from Nine African Countries, and builds on what was learned after completion of that study. It finds that in Ghana and Rwanda, like other countries, few staff members or surgeons are trained in or experienced with fistula repair, and women with fistula often do not know where or how to seek treatment. The report also provides country-specific recommendations on addressing the critical needs in each country.
(2004) English (PDF, 358KB)

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