- The problem of genita fistulas is often misunderstood. One tends to associate the condition incorrectly with genital mutilation or with sexual violence and rape in war situations. The genital fistulas that we come across and are trying to treat do not get a lot of media attention no capture the imagination. One does not find any statistics on them in scientific or medical papers. These cases are often regarded as a 'common' ailment and remain generally under the radar. However, because of this lack of attention, they are even more tragic.
- Genital fistulas mainly affect the most vulnerable group of women. They usually arise as a result of complications in childbirth, which are common in young, teenage mothers. Chronic malnutrition means that many young women are of petite size and thereby risk needing a caesarean section. Poverty in general, living far away from the nearest birth clinic or hospital and inferior road conditions leave many women unable to find help in case of perinatal problems. If labour continues for too long, the continuous pressure of the trapped baby cuts the blood flow in the pelvis minor. This results in irreversible damage; an opening is formed between the bladder and the vagina; a genital fistula.
- Because of the fistulas, these young women may experience constant urine loss and, in some cases, fecal incontinence. Given the limites hygienic resources they can use for protection and the African temperatures, they start to smell and face social isolation.
- Women are often rejected by their husband, family and community, and are sometimes not even allowed to take care of their children or participate in working on the land. Suddenly all aspects of life are affected and any hope to return to normal life is lost.
Solfa stands for a global approach based on the SOLFA model: Treatment of genital fistula is not emergency medicine and the fact that these interventions can be planned allowed us to develop and apply a vision of global approach, with simultaneous focus on prevention, sustainability and empowerment.
Fistula repair surgery can only be atttempted by urologists or gynaecologiste with sufficient experience in treating this pathology. Although often done with the best of intentions, one has to avoid surgery carried out by less experienced ans less skilled surgeons. Some cases of genital fistula are very compls and a second intervention can be required. Even then recurrences are not exception. The quality of post-operative nursing is equaliy important to ensure the success of the therapy. The treatment of genital fistula is not emergeny medecin, this allows us to make a carreful selection of the patients and prepare the patients in optimal conditions.
A successful fistula program is one in which no more fistula need to be repaired because:
- there are no new cases being presented.
- the number of medically assisted deliveries increases.
- the numeber of preventive caesarean sections increases.
- the perinatal mortality decreases.
How can we achieve this: by ensuring a good level of prenatal care, by informing the population and raising awareness, by cooperating with the local medical provider, by making sure that highly pregnant women can await the onset of their labour in safe circumstances and nearby a place (waiting maternity homes) where, if needed, a emergency section can be performed.
We try to share our medical-technical knowledge, skills and expertise as much as possible with the team of our local partner HGR Hôpital St Luc in Kisantu, Kongo-Central in RDC. Collegues from Kinshasa or other regions who are interested in our project, are always welcome to visit us during our missions.
- Financially for the hospital:
The application of technical expertise does not assume that the hospital infrastructure and medical services are available free of charges to our program. Solfa instead pays the invoices of her patients according to the usual rates or flat rates. This gives financial oxygen to the hospital each year, as seen through our program, a non-negligible quota of paying patients.
- For families: the reversal not only restores the fistula but the woman and with her, her whole family.
- For the communities: the tabloo around this particular disease, its causes and consequences, is broken.
Investing in parallel programs for self-financing of the fistula programme is a guarantee of durability. It also creates a greater involvement of the whole community. For more info see the section ' social enterprise '