Bangladesh

Bangladesh is one of the most densely populated countries in the world. Situated on the Bay of Bengal in South Asia, Bangladesh has a population of more than 150 million that continues to grow. Frequent natural disasters stretch its infrastructure. Bangladesh’s population growth has slowed in recent decades because of the availability and uptake of family planning services. Although maternal mortality has been halved in the past 15 years, there is still roughly one Bangladeshi maternal death every hour.

USAID-supported fistula services in Bangladesh began in July 2005. Fistula Care Bangladesh works with private hospitals to prevent and repair fistula and to link women with rehabilitation and reintegration activities:

Kumudini Hospital, Mirzapur, Tangail

LAMB Hospital, Parbatipur, Dinajpur

Ad-Din Hospital, Dhaka

Ad-Din Hospital, Jessore

Memorial Christian Hospital, Malumghat, Cox’s Bazar (through 2008)

Program Results

As of June (since July 2005):

588 fistula repair surgeries supported.
Nine doctors and 128 nurses received training on fistula surgery and management from the National Fistula Center.
Over 300 doctors and nurses were trained on fistula counseling and safe motherhood.
192 doctors and nurses from both the government of Bangladesh and nongovernmental organizations received community outreach and advocacy training.

In addition to fistula work, each hospital provides a range of maternity services, including antenatal care, family planning services, and deliveries, including cesarean sections. Sites also carry out community outreach activities with fistula prevention messages. Fistula Care has been collaborating with the Ministry of Health and Family Welfare and UNFPA to establish a National Fistula Task Force in Bangladesh.

For Communications Materials developed in Bangladesh, click here.

Supported Sites

Kumudini Hospital was established by R.P. Shaha in 1938 as a modest 20-bed hospital at Mirzapur, Tangail, 70 km north of Dhaka. Since then, it has grown to be one of the largest private hospitals in Bangladesh, with 750 beds. It cares for about 34,000 inpatients and 245,000 outpatients each year, including emergency cases. It recently completed renovations of a 20-bed ward that will be dedicated to fistula patients. The hospital is a part of the Kumudini Welfare Trust, which also runs a medical college, a nursing school, a trade training school, a village outreach program, a handicrafts center, and other public welfare initiatives. These projects are funded through Kumudini Welfare Trust’s income-generating projects.

LAMB Hospital is part of a faith-based integrated health and development project located at Parbatipur, Dinajpur, 350 km from Dhaka. It has been working in the Dinajpur and Rangpur areas of northwest Bangladesh for nearly 30 years. Started in 1983, LAMB Hospital is now a 150-bed general hospital. It cares for about 8,500 inpatients and 55,000 outpatients each year. The eight-bed fistula unit at LAMB was opened in February 2006. Obstetric fistulas are routinely repaired on Tuesdays by a trained gynecologist, as well as by visiting surgeons at camps held a couple of times each year. Much of LAMB’s work takes place in the community. Its safe motherhood program includes training of traditional birth attendants and community-based skilled birth attendants, as well as the provision of technical assistance to community-run safe delivery units. A team holds workshops with different community members, health care providers, high school students, and religious leaders to raise awareness about fistula prevention and treatment. In 2009, 3,037 women delivered at LAMB Hospital.

Ad-Din Hospital/Dhaka is located in the capital city, Dhaka. The hospital is a social enterprise of the business conglomerate Akij Group. A number of development and welfare projects are implemented by Ad-din, including a chain of hospitals, an underprivileged children home, and income-generating enterprises to support the welfare projects. Ad-din aims to provide quality preventive and curative care for children and women at low cost. It operates a busy and popular outpatient department for women and children, providing antenatal and postnatal care, family planning, treatment for sexually transmitted infections, obstetric, gynecologic, and surgical services for women, and child health services. In 2008 a total of 8,592 women delivered at Ad-Din Hospital in Dhaka.

Ad-Din Hospital/Jessore is a satellite of the Ad-Din Hospital, located 300 km from Dhaka. It has 72 beds for women and children. Ad-Din Hospital/Jessore offers similar inpatient and outpatient services to the Ad-Din Hospital in Dhaka. In 2007, some 50,000 women and more than 60,000 children received outpatient services from the hospital. The inpatient department provided services to nearly 5,000 women and 3,000 babies were delivered over the course of the year.

Memorial Christian Hospital is a 65-bed hospital offering general medical, surgical, and obstetric care in southeastern Bangladesh, 400 km from Dhaka in Malumghat, Cox’s Bazar. It dates from before the Liberation War, when the death of a missionary due to the lack of surgical facilities prompted supporting churches to raise funds for a surgical facility that could serve the local population. Memorial Christian Hospital now serves an outreach area of 10 million people, with a strong emphasis on maternity care. Annually, it treats roughly 66,000 outpatients and 6,500 inpatients. Fistulas were repaired by a resident surgeon through the end of 2008.

Program Activities

Strengthening services

Fistula Care Bangladesh has been working with the three supported sites to ensure the continued provision of quality fistula repair services. Fistula Care has been providing refresher trainings for staff on a wide range of subjects, including comprehensive fistula case management, postpartum hemorrhage, fistula counseling, and male involvement. Fistula Care collaborates with the National Fistula Center of Dhaka Medical College Hospital to organize training for surgeons from Fistula Care- supported programs. The project has set up 127 billboards about obstetric fistula in the areas around LAMB and Kumudini Hospitals.

Improving fistula prevention

Fistula Care has been working to increase community awareness about the prevention and treatment of fistula within the expanded catchment areas of the fistula repair sites and surrounding districts. As of December 31, 2008, a total of 67,131 community members and 387 journalists had been oriented. A booklet of fistula survivors’ stories is being developed to highlight the importance of prevention and to raise awareness about the magnitude of the fistula burden and the solutions needed to reduce maternal mortality and morbidity. Fistula Care Bangladesh has developed partnerships with microcredit groups to increase awareness about fistula prevention and engage community leaders, religious leaders, and extended families in rehabilitation and reintegration.

Analyzing and reporting data

Fistula Care Bangladesh is ensuring that data about fistula repairs and prevention activities are routinely analyzed and reported. Site staff are receiving refresher training about management information systems. Staff compile data quarterly, analyzing how each site can improve its performance. Two Bangladesh sites are participating in the global prospective study on the determinants of post operative outcomes of fistula repair.

Encouraging a supportive policy environment

Fistula Care Bangladesh holds meetings to orient and follow up with media personnel and religious leaders on issues related to fistula. With other stakeholders, Fistula Care is supporting the Directorate General of Health Services of the Government of Bangladesh to establish a National Task Force on Obstetric Fistula. This task force will develop a national strategic vision and a national action plan for prevention, treatment, and rehabilitation of obstetric fistula cases within the framework of the National Maternal Health Strategy.