Prevention and treatment of post-partum complications (fistulae) in Pakistan From Despair to Dignity PNFWH Dr. Sajjad Ahmed Siddiqui

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 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 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 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 ratio down by 75% by the year 2015

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 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

Obstetric fistula, a devastating maternal morbidity

Women in Pakistan

Underage Marriages in Pakistan

Genital Tract Fistula

IN PAKISTAN PNFWH started in Nov 2005

Fistula Centers Larkana

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 healthMDG targets

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 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 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

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: Nurses & Midwives Trained (Year wise)

A total of 3678 patients were treated from Jan 2006 to June Twenty one (21) out-reach camps for fistula patients were held from2006 to 2012 in which about Three hundred (300) fistulas were treated. Achievements:

Prevention 1.Obstetric fistula 2.Iatrogenic Fistula

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 CMW

Prevention-Obstetric fistula-LHW

Prevention-Obstetric fistula-CW

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

Early catheterization for all prolong labour

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

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

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 Purpose: To provide adequate and accessible facilities for the treatment of fistula and to prevent the incidence of Fistula in future

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

Dr. John Kelly's

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