RESUMO
Obstetric fistula, an abnormal connection between a woman's genital tract and urinary tract or rectum, can be physically and psychosocially debilitating. We describe a sustainable obstetric fistula surgical trip model that includes providers from Women and Infants Hospital at Brown University. These surgical trips provide pre-operative, surgical, and post-operative care to patients with fistulae at Kibagabaga Hospital in Kigali, Rwanda. To ensure patients are prepared for the recovery process after fistula surgery, the team created a post-operative education curriculum that includes illustrative visual aids and teaching guides translated into Kinyarwanda, focusing on topics including urinary catheter care, wound care, and pain management. Through this program, the team is committed to restoring women's dignity through fistula repair as well as providing a model for delivery of sustainable surgical care in low-resource settings. Involvement of trainees into a global health team like this can benefit both the trainee and the patients served.
Assuntos
Obstetrícia/educação , Fístula Retovaginal/cirurgia , Fístula Vesicovaginal/cirurgia , Adulto , África Subsaariana , Feminino , Humanos , Complicações do Trabalho de Parto , Gravidez , Fístula Retovaginal/reabilitação , Ruanda , Apoio ao Desenvolvimento de Recursos Humanos , Resultado do Tratamento , Fístula Vesicovaginal/reabilitaçãoRESUMO
This article examines the social and physical causes of obstetric fistulas, as well as resulting social and psychological consequences. Preventative strategies are addressed using Niger as a microcosm for this devastating condition that affects two million women worldwide.
Assuntos
Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde Materna , Complicações do Trabalho de Parto , Fístula Retovaginal , Fístula Vesicovaginal , Adolescente , África Subsaariana , Feminino , Humanos , Idade Materna , Nigéria , Complicações do Trabalho de Parto/prevenção & controle , Gravidez , Fístula Retovaginal/prevenção & controle , Fístula Retovaginal/psicologia , Fístula Retovaginal/reabilitação , Estigma Social , Fístula Vesicovaginal/prevenção & controle , Fístula Vesicovaginal/psicologia , Fístula Vesicovaginal/reabilitação , Instituições Filantrópicas de SaúdeAssuntos
Países em Desenvolvimento , Complicações do Trabalho de Parto/prevenção & controle , Transtornos Puerperais/prevenção & controle , Fístula Retovaginal/prevenção & controle , Fístula Vesicovaginal/prevenção & controle , Adolescente , África , Feminino , Humanos , Recém-Nascido , Missões Médicas , Medicina Tradicional , Pessoa de Meia-Idade , Tocologia , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/reabilitação , Equipe de Assistência ao Paciente , Gravidez , Transtornos Puerperais/etiologia , Transtornos Puerperais/reabilitação , Fístula Retovaginal/etiologia , Fístula Retovaginal/reabilitação , Fatores de Risco , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/reabilitaçãoRESUMO
From July 1969 to December 1975, 86 patients with 100 fistulas required one or a combination of three modern nutritional aids: central intravenous hyperalimentation; the peripheral intravenous, lipid-amino acid-carbohydrate system; and elemental, nutritionally complete liquid diets. Of the fistulas, 81 closed spontaneously, and in 11 operative closure was attempted; 89 fistulas healed. Eight patients died (9.3%). Before 1969, in an earlier comparable group of patients who had not received such nutrition, the mortality was 40.0%. Fistula drainage and sepsis were controlled. Abscesses were drained. Skin was protected. The most successful way of identifying the nature and origin of a fistula was by instillation of radiopaque liquid into the external opening. Prolonged fistula drainage occurred with distal bowel narrowing and inflammation; previous irradiation to the area; underlying granulomatous bowel disease; bowel adjacent to skin; and foreign bodies in the fistulous tract. Operative closure (resection) was necessary only for distal obstruction and wide breakdown or complete disruption of an anastomosis. Patients who did require operation were in a better nutritional state to withstand operation after receiving specialized nutritional support. Adequate calories and amino acids afforded healing and secretory and mechanical rest for the gastrointestinal tract.