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Guest Blog – Overcoming Patient Fear to Improve Fistula Recovery

February 26, 2015

Loran Hollander.

Guest Blog by Loran Hollander, PT
WFF Rehabilitation Advisory Council

We medical professionals pore over clinical patient data looking for factors correlating to better recovery outcomes. I think we don’t always give enough attention to one factor that we can’t find in the data: helping the patient overcome their own fear during recovery.

My trip last November to Danja Fistula Center on behalf of Worldwide Fistula Fund’s Rehabilitation Advisory Council with Dr. Cambey Mikush bore this out. I learned a great deal by interviewing the women directly.

The fear of re-injury of a woman recovering from an obstetric fistula can impede her recovery by limiting her participation in that recovery. I already knew this from all my previous work with fistula patients. However, speaking directly to the women in Danja’s patient wards really illuminated the depth of their fear. Their lives are so different from mine and yours. Daily living — what we take for granted — is difficult for each woman: she travels long distances to find water; she must gather firewood sometimes over a vast area to secure enough for a fire.

I’ve been unable to cook or do laundry since my fistula. Now, I am afraid of doing these things and ripping the repair.

How can simple exercises help me do chores I haven’t done since my fistula happened?

I could see the fear in each woman’s eyes even when she did something as simple as shifting position in her hospital bed post-surgery. She knows the surgery is going to change her life and she is afraid of undoing it! My heart broke at what these women had already been through and their continued anxiety. To begin healing, we must first address the fear.

Address a woman’s generalized fear.

Surgery is a foreign concept and many of the women who come to Danja thought their fistula couldn’t be treated. Subsequently, Danja’s comprehensive approach to rehabilitation combining Physical and Occupational Therapies is also a foreign concept. Some women are reluctant to even begin the movements and exercises recommended to them. At Danja Fistula Center, on site “ambassadors” help women understand what the surgery and recovery process involves. “Ambassadors” are women who have already been through the surgery and rehabilitation process and can ease patients’ fears of the unknown, telling them what to expect.

Help her take her first step.

Teach each woman how to safely move in and out of bed post-surgery. It’s a first step. This is also a good time to discuss abdominal and pelvic muscles relating to movement. Small exercises to do in bed are also appropriate. Successful physiotherapy begins with a trusting relationship between therapist and patient. Only then can a woman build her confidence and believe that she will someday be able to do what she used to, and that therapy is going to get her to that point.

Help her connect the dots of how physiotherapy applies to life back home.

At Danja, staff reviews with each woman her timeline for rehabilitation and her actual exercises. They already explain how therapeutic exercises will help her when she returns home. I learned through patient interviews, conversations and focus groups that talk is cheap! Somehow, connecting the dots between therapy and real life activity isn’t happening in the women’s minds, which is contributing to their reluctance to do the exercises.

Cambey and I recommended combining group and individual exercises with actual chores and activities of daily living (ADL's). The long-term hostel at Danja where women stay during reintegration and rehabilitation provides many services during each woman’s recovery. Preparing meals, gathering firewood, boiling water and going to the market are all chores the women can work toward doing for themselves before they go home. Any progress made in a chore combined with therapeutic exercise helps connect the dots! Eventually, completing such chores allows a woman to return home confident and ready to build a new, post-fistula life!

Loran Hollander is a member of WFF’s Rehabilitation Advisory Council. She is a seasoned Physical Therapist and clinical instructor at Laguna Honda Hospital and Rehabilitation Center in San Francisco and an International Women’s Health Consultant for Women’s ACTION Initiative nonprofit organization. A leader in global women’s health and community-based rehabilitation and education, she spent over seven years in Goma, Democratic Republic of Congo as the Rehabilitation Coordinator for HEAL Africa Hospital. For over a decade Loran has served as a consulting physical therapist and community educator for organizations including Black Lion Hospital and Handicap National Action for Children with Disabilities in Ethiopia, in addition to HEAL Africa Hospital. Loran continues to advocate for women in under-resourced communities in developing nations, using her photography to provide a narrative through her images: who they are, what they have courageously endured, and, ultimately, all that they deserve.