They frequently face insurmountable barriers because of the cost of treatment, transport, accommodation and food. It is for this reason we decided to dedicate a whole edition of RCOG International News to the subject of obstetric fistulae and are immensely grateful to our contributors for their willingness to share their insights and experience.
To set the scene, ‘In their own words’ has women with fistulae sharing their stories, followed by an insightful overview of the problem of obstetric fistulae by Michael Bishop, a retired consultant urologist who has worked in fistula care in several developing countries.
Sohier Elneil, a consultant urogynaecologist at University College, London, discusses the planning for provision of fistula programmes and gives a very useful update on the FIGO/RCOG and Partners Competency-based Fistula Training Manual. Andrew Browning,who worked for many years in fistula care in Ethiopia before moving to work in Northern Tanzania, discusses the problem of residual incontinence following surgery to ‘close the hole’, most notably stress incontinence as a consequence of damage to the closing mechanism at the bladder neck.
Maggie Bangser pleads for a balanced view of ‘the fistula sufferer’ and reminds us to celebrate the dignity, resilience and achievements of women with fistulae. Julia Irani undertook research investigating the experiences of women reintegrating into their local communities after fistula repair. Her work reminds us of the possibility and need for more research in the field of obstetric fistulae, in order that fistula services are evidence-based.
We are pleased to include news of fistula services in Nepal, Sierra Leone, Bangladesh, Tanzania and Uganda, but are aware that there are many other centres for which we do not have information. We would urge others working in the field to contact us. We would be interested to hear from students encountering fistulae during electives and about research in the field.
Last, but not least, we have included a journal club summarising two papers published in 2011 on the psychosocial experiences of women with fistulae and their birth histories. Classically, we are taught that there are three points of delay in accessing assisted delivery – first, the delay in a decision to access care by the woman, her family or carers; second, the delay in reaching a health facility because of a lack of transport; and third, the delay in intervention having reached a health facility. In the second powerful paper Mselle and colleagues note that once the health facility is reached there is a subcategory, namely receiving correct care, because of a lack of skilled decision-making capacity, lack of will or low numbers of appropriately skilled personnel able to deliver the required care.