Outcomes postoperatively are generally good, with up to 85% of patients being continent at 1-year follow-up. Those who are not cured will be considered for further surgery or alternative management. There are also reasonable obstetric outcomes for those wishing further pregnancy, with up to 20% of patients who have had a fistula going on to have a normal pregnancy and healthy baby delivered by caesarean section. At Aberdeen Women’s Centre there is also a maternity unit where patients who have had a fistula will receive free antenatal care and planned delivery. All patients receive health education about future pregnancies and are offered family planning.
Of course, the key to better women’s health in the future is preventing fistulae from happening in the first place. This requires a concerted national and international effort to strengthen maternity health services in countries such as Sierra Leone; recognising maternal health as a priority and providing access to skilled birth attendants who are able to recognise the signs of obstructed labour and refer for early intervention. It also requires education for women to enable them to advocate for their own rights and to know that in pregnancy and labour they do not have to suffer in silence as their mothers and grandmothers have done.
Alyona F Lewis MD, Senior Medical Officer/Obstetric Fistula Surgeon, Aberdeen Women’s Centre, Freetown, Sierra Leone
Carolyn Ford MRCOG, MBChB, DTMH, Obstetrician and Gynaecologist, Aberdeen Women’s Centre, Freetown, Sierra Leone
Tagie Gbowuru Mansaray, Medical Officer and Fistula Surgeon Trainee