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Maternal health

Supporting women with obstetric fistula now and in the future


Barbara Margolie

The Executive Director of IOWD

“In Rwanda, we have now examined approximately 2,697 patients, and performed 885 life-changing surgeries.”

“As of May, 2017 the International Organization for Women & Development (IOWD) has travelled to Kigali, Rwanda on 22 medical missions. We have examined approximately 2,697 patients and have performed 885 surgical procedures (not all are fistula,some are hysterectomies, cancer cases, prolapse, benign tumors, repair of extreme mistakes of episiotomies, etc.)

How are you helping Rwandan women and communities?

“All surgeries are performed by IOWD urogynecologists/pelvic floor reconstructive surgeons and urologists, and are assisted by Rwandan obstetrician/gynecologist residents and Rwandan nursing staff.

“We work with seven to nine Rwandan medical students on each trip, who take medical histories and translate for patients and our surgical teams.

But what else do IOWD do on their mission to alleviate fistula now and in the future:

  • Every patient is prepared for her surgery by individual consultations with IOWD’s anesthesia staff, which includes an anesthesiologist and anesthesia nurse.
  • Twice-daily, post-surgical examinations for patients.
  • Provide all medical supplies, instruments, anesthesia medications, and antibiotics necessary for surgery and post-operative care.
  • Post-operative follow-up exams for all former surgical patients. (Every patient receives a bottle of perfume if she returns for that exam, and we are seeing over 60-70% follow-up patients!)
  • Outreach Educational Program in Health Centres. We use an over-sized, pictorial, flip book to explain pregnancy and fistula. Rwandan midwife, Immaculee Kantengwa, presents this program in Kinyarwanda. A Rwandan doctor or medical student always accompanies us.
  • Our obstetricians/gynecologists provide free surgery for vaginal and cesarean births and various other gynecological procedures. Hands-on teaching is offered on every surgical case.
  • Workshops and lectures on fistula and maternal health on every mission.
  • We have produced a film on cesarean births; the surgery was done by Rwandan doctors, assisted by Rwandan nurses. The film is available to all in Rwanda.

“Fortunately, IOWD is completely supported by the Ministry of Health who provide operating theaters, Rwandan staff to always assist in surgery and in post-operative care, food for the patients, housing for the patients and transportation costs… without which, women would NOT be able to come to Kibagabaga for help!

We know that we cannot repair every woman who comes for help, but our success rate is over 90%.

“In summary, we benefit from a wonderful relationship with the Rwandan medical staff and medical students who work with us on every mission. As our doctors and nurses return again and again, the trust and respect that has developed with the Rwandans over the past seven years is quite remarkable.

What does the future look like?

“We know that we cannot repair every woman who comes for help – some are very badly damaged and operating on them would only cause more damage. At this time, we can only offer these women waterproof panties with two washable inserts. For those on whom we do operate, our success rate is above 90%.

Training doctors and nurses will help Rwandans to care for fistula patients in the future.

“IOWD is committed to training doctors and nurses in fistula repair and post-operative care so that, in the future, Rwandans will be able to care for any fistula patients and our specific, fisula-related services will no longer be needed in this country.”

photo credits: IOWD

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