Sierra Leone Telegraph: 19 March 2019:
Sierra Leone Telegraph’s editor Abdul Rashid Thomas and the medical editor Dr Fawzia Hardy speak with Ivy Kalama who is a Non-Clinical Director of Freedom From Fistula, Africa, about the work of the Aberdeen Women’s Centre in Freetown in coping with the rape crisis and fistula epidemic in Sierra Leone, which was recently highlighted by the rape of a five year old girl.
This prompted president Julius Maada Bio to declare a national emergency, so that resources can be quickly and effectively mobilised to tackle the problem and people held accountable for their actions.
This is what Ivy Kalama (IK) told the Sierra Leone Telegraph (SLT):
SLT: Vesico -vaginal fistulas (VVF) are one of the most debilitating complications that a woman can face after difficult child birth or rape. In Sierra Leone, one of the most pressing issues is the availability of qualified gynaecologists with the expertise to deal with these cases. My question is, are there qualified VVF specialists on the ground to competently carry out these procedures?
IK: Aberdeen Women’s Centre (AWC) is the only permanent fistula centre in Sierra Leone, largely funded by Freedom From Fistula (FFF), an organisation working to eradicate fistulas in the developing world. FFF currently also has centres in Malawi and Madagascar.
At AWC, we have a specialised fistula training programme where an international qualified obstetrician/gynaecologist and specialised fistula surgeon, trains local medical officers in fistula surgeries. Since inception, we have trained three national doctors who have gone on to specialise in obstetrics and gynaecology in Nairobi and Ghana. However we currently have two medical officers who are training in fistula surgery under our international fistula surgeon.
However, even with this training programme, there are not enough specialised fistula surgeons in the country to meet the current demand.
SLT: Effective VVF intervention should involve the whole family of the effected woman. But of course, we know that many women are shunned and abandoned by their families, husbands and even children because of their condition. What efforts are being made to educate communities and families, so as to reintegrate these women back into their communities? (Photo below: Maternity Unit patients)
IK: We have been running sensitisation programmes on various national radio stations through radio announcements and jingles, as well as running roadshows during market days in the communities around Sierra Leone, in an effort to educate the communities on fistula, how it affects the women and the measures we take to help resolve fistulas. (Photo: Young fistula patient who has recovered and about to be discharged)
We have also started a Patient Ambassador programme, utilising former patients to identify other patients in their communities and sensitise the communities on the importance of seeking medical care before and during childbirth.
Freedom From Fistula prioritizes a holistic care approach, and through the Patient Rehabilitation, Education, and Empowerment Program (PREP) that involves health education, literacy & numeracy classes, skills classes and women are able to return to their communities with a sense of independence and self-worth.
SLT: It is recommended that laparoscopic approach is the best for treating VVF, simply because it is minimally invasive, with less complications and has a greater success rate. What steps is the government taking to produce specialists in the laparoscopic procedures so that our women can get the best treatment?
IK: Most fistulas in low resource countries, like Sierra Leone, are obstetric fistulas. These are normally located on the bladder neck and mid vagina. The best route for repairing these fistulas is the vaginal route, which is even less invasive than laparoscopic surgery. The fistulas in well developed countries are mostly secondary to complications of pelvic surgery. They are iatrogenic and are normally very high fistulas, vault or cervical and sometimes it is impossible to repair vaginally. (Photo: Doctors preparing a patient for Caesarean section)
Most studies done compare repairing these fistulas through open abdominal surgery and laparoscopic surgery. Laparoscopic equipment is also very expensive, since most of the trocars are disposable, therefore scarce resources should be used in improving access to health, and improving quality of care, in order to reduce the incidence of fistula.
There has been introduction of post-graduate specialist training in the country, which will hopefully include laparoscopic surgery training.
SLT: Generally speaking, what other equipment does the Aberdeen Women’s Centre need to improve its services? And what is the composition of your clinical staff?
IK: Aberdeen Women’s Centre is in need of an infant resuscitaire, a cardiotocography machine and three oxygen concentrators. Our clinical staff include an international qualified obstetrician/gynaecologist who is also a fistula surgeon, two national medical officers, an international tropical medicine doctor, two clinical officers, 25 midwives, and 40 nurses.
SLT: I note that the 5 year old girl who was raped, is still at the Centre receiving long term and ongoing medical care. Is there a reason why she is at your Centre long term? I would have expected that she has been adequately treated and discharged home.
IK: The child is suffering from a range of severe injuries following the rape and is paralysed. She requires ongoing medical care. She is also undergoing intensive physiotherapy at the centre and requires protection and safety during the ongoing court process. Freedom from Fistula is not only providing the medical care that she needs, but has also been working with other organisations and lawyers to ensure prosecution takes place. (Photo: FFF-President Dorthe Tate holds Infant in Safe Delivery Maternity Unit)
SLT: How are you coping to deliver services despite the acute need for funding, medical supplies, adequate drugs, and clean water facilities to address this fistula epidemic?
IK: We are doing the best we can to make efficient use of the resources available to us at the moment, but could treat more patients with additional funding and resources. We are delighted that the President organised for a borehole to be provided within the AWC following his recent visit in order to ensure that we have clean water supply at all times. This is a great boost to our work.
SLT: What specific help do you need right now in the short term and what are your plans for future expansion to deal with the possibility of an increasing number of cases, once more women feel confident enough to come out and seek help?
IK: We need help with the sensitisation of the entire country on fistula, its causes, effects and the need for women to deliver their babies in hospitals. We are currently doing 250 surgeries annually. However, we have the capacity of handling up to 400 surgeries per year. Communities and families across the country need to understand that fistula is not caused by the woman, it is a result of not getting access to medical care during a prolonged, obstructed labour – or rape. (Photo above: President Bio visiting the centre a few weeks ago)
The good news is fistula is preventable – through the provision of quality maternal healthcare across Sierra Leone and the eradication of rape against women and girls.
There are so many ways that individuals and communities can help these women and girls get treatment and return to a better quality of life.
Please visit us at http://www.freedomfromfistula.org.uk/support/donate for information on ways you can show your support.
SLT: Thank you Ivy kamala.
Photo credit: Freedom From Fistula