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The Democratic Republic of the Congo (DRC) borders nine countries in the heart of Africa and is approximately the size of the United States east of the Mississippi. After nearly four decades of war and conflict, people living in the DRC face numerous barriers to accessing quality reproductive health services. Due to its vast size and poorly developed road and communication systems, family planning and other basic services are extremely limited or altogether unavailable. Poor maternal health care has resulted in high maternal mortality as well as the occurrence of obstetric fistula, often caused by obstructed labor. Traumatic fistula—the same condition inflicted by sexual violence—is also common, due to the prevalence of gender-based violence in the DRC.
Since 2008, Fistula Care has worked to improve the quality of and access to fistula care services in the DRC. Under the original Fistula Care project from 2008 to 2013, we partnered with seven health centers and hospitals to train 44 doctors and 242 nurses in fistula repair surgery and 802 doctors and nurses in fistula counseling and follow-up care. Our work also included the improvement of emergency obstetric care and outreach to rural clinics to ensure that women in need of medical attention were referred to the hospitals for repair.
Today, EngenderHealth continues to tackle fistula care in the DRC through Fistula Care Plus. As our work expands, we are better able to address the backlog of women living with obstetric or traumatic fistula. We are also increasing the integration of family planning services with fistula and maternal health services as a key component of fistula prevention.
Work is underway at six facilities:
HEAL Africa Hospital is a faith-based hospital in the North Kivu capital, Goma. HEAL Africa began as a small surgical training clinic in 1996, and over time it has expanded its services to become a 180-bed hospital that performs more than 280 fistula surgeries per year. Local volunteers help to identify patients and bring them to the hospital. At any given time, between 120 and 160 women are waiting for fistula repair at the hospital. HEAL Africa also works with village and religious leaders to develop plans to care for the area’s vulnerable populations.
Imagerie des Grands Lacs is a private, non-profit facility located in the remote city of Beni in North Kivu province. The facility has 10 beds dedicated to fistula patients and serves a catchment population of 1.5 million, most of who are dispersed throughout the surrounding rural area, where demand for fistula repair services is extremely high. The hospital has one fistula surgeon and receives funding from Fistula Care to provide 108 fistula repairs each year.
Kisenso Hospital is a secondary referral hospital in Kinshasa, and like St. Joseph's Hospital, is also managed by the Archdiocese. At this time, fistula repair services are not available because the hospital does not have trained fistula surgeons. The hospital provides emergency obstetric services around the clock and the resident surgeon and support staff participate in exercises conducted by Fistula Care in Kinshasa with the goal of training the resident surgeon to provide fistula repair.
Maternité Sans Risque de Kindu (MSRK) is a private, non-profit hospital located in Kindu, Maniema province, in the remote interior of the DRC. MSRK has 31 beds and performs routine fistula surgeries three days a week. In addition to supporting the cost of fistula repair surgery, Fistula Care also provides opportunities for quality improvement and infection prevention training to MSRK staff, and provides equipment critical to successful fistula repair. MSRK is one of the only fistula repair centers in Maniema Province, and the facility is an important regional resource for women suffering from obstetric fistula.
St. Joseph Hospital is a private, faith-based hospital located in Kinshasa, the capital of the Democratic Republic of Congo. St. Joseph’s was originally constructed as a convent by the Bureau Diocesien des Oeuvres Medicales (the Archdiocese for Medical Services) but converted into a hospital in 1987, with fistula repair services beginning in 2003. The hospital, a tertiary referral center, serves a catchment area of 2 million people. The hospital also treats difficult cases from outside of its catchment area. Fistula Care supports fistula repairs at St. Joseph’s Hospital, in addition to building the capacity of its resident fistula surgeon through surgical training exercises.
The General Referral Hospital of Panzi is located in Bukavu, the capital of South Kivu. It opened in 1999, and in spite of numerous setbacks during the wars, it has grown to a 334-bed faith-based hospital that offers a diverse array of medical and surgical services. More than 70% of Panzi patients are survivors of sexual violence. Given the facility’s expertise in repairing fistula, patients now come to Panzi from all over the Kivu provinces in Eastern Congo and beyond.