Guest Blog — Expert Care Key to Successful Surgeries at Danja
July 20, 2017
Guest blog by Dr. Itengre Ouedraogo, DFC’s Chief Medical Officer
Obstetric Fistula is largely a disease of poverty, and West Africa is extremely poor.
Danja Fistula Center (DFC) is located in Niger, the world’s poorest nation, listed at 187 out of 187 ranked countries in the 2014 UN Human Development Index. Opened in 2012, DFC is the only fistula center in the country with an expert fistula surgeon trained to FIGO (International Federation of Gynecology and Obstetrics) standards.
I am so happy to share our recent study of 384 fistula patients at Danja Fistula Center!
The women we treat at Danja Fistula Center (DFC Niger) have lost everything and have few options. They are very poor, malnourished, uneducated and unhappy. They come to us seeking hope to change their lives!
We decided to do this study because most fistula surgery outcomes describe the patient’s condition when they are discharged from the hospital but some patients experience incontinence after surgery. Our hope is that our 6 month post-operative follow-up gives a better picture of the long term outcomes of fistula patients.
We studied 384 Danja Fistula Center patients 3-6 months after surgery between January 2013 and July 2014. Patients who participated in our 3 month reintegration course were assessed after their course and the rest were told to return at 6 months and not to become pregnant during that time and that they would be reimbursed for travel expenses.
All 384 patients returned!
The 100% follow-up rate of our patients “can be attributed to the high level of personal, compassionate care provided at the center, the availability of food and shelter at a dedicated patient hostel, payment of transportation expenses, and the intense desire of these fistula patients for future fertility.” – Dr. Wall
We assessed patients using a blue dye test and an interview with me and Dr. Wall. After a pelvic exam, a catheter was used to fill the bladder with blue dye, then a cough test was performed to test stress incontinence. Surgery was deemed successful if the patient was considered “closed and dry.”
Read the Study
Our patients were largely an ethnic mix of DFC Niger’s region with mostly Hausa women but we also had patients come from all sides of Niger, and one Arab woman who crossed the Sahara from North Africa to receive treatment.
The average patient age was 29 years old, but patients’ ages ranged from 14 to 65. Most married around 16 years old, the youngest girl was married at 12 and the average age of first delivery was 17 years old.
The average fistula patient had lived with fistula for over 6 years, but some for as long as 40 years. Labor that led to fistula generally lasted over 2 days, but up to 7 days for some women. Some women had as many as 14 children before developing fistula, but nearly half of our patients had no living children.
94% of our patients were illiterate, 23 had some formal education and only one woman went to university. Nearly all of our patients were not working and were supported by their husband, parents or relatives. Over 40% considered themselves divorced or separated as well.
The importance of expert care at the initial surgery is striking.
The first fistula repair surgery is the most likely to be successful. After that, the success rate continues down with more surgeries. 65% of the patients in our study had at least one failed prior fistula surgery but of the patients whose first surgery was performed at DFC Niger, 80% were successful. A points system developed by Dr. Steve Arrowsmith assigned levels of difficulty based on the degree of involvement of the urethra and bladder neck, scar tissue, and the number of previous repairs. “Easy” surgeries at DFC received a 92% success rate, “intermediate” surgeries 68% and “difficult” surgeries 57%, respectively.
Our exciting results show the importance of quality and expert care and the continuation of care for women with fistula. I am so happy to be able to help these women find healing!
The ultimate goal should be to make such centers obsolete as the quality of obstetric services improves and the incidence of prolonged obstructed labor falls.