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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. It is home to vast natural resources and mineral wealth, but it is still one of the poorest countries in the world, beset recently by the deadliest conflict since the end of World War II. The DRC’s vast size, poorly developed road and communication systems, and fragile stability have contributed to the low quality and small number of basic social and health services in many areas. In addition to the low access to family planning and maternal health care, which leads to obstetric fistula, the prevalence of brutal sexual violence in the east of the country has led to an epidemic of traumatic fistula.
USAID-supported fistula services in the DRC began in July 2005. Fistula Care was invited to implement these activities starting in 2008. The program seeks to reduce the number of new fistula cases and to rehabilitate women who have been disabled by obstetric or gynecologic trauma in the provinces of North and South Kivu, Maniema, and Kinshasa. Work is underway at seven facilities:
Additionally, Fistula Care supports surgeon training efforts in the DRC undertaken by the Harvard Humanitarian Initiative. Through support from Fistula Care, the Harvard Humanitarian Initiative sends teams of surgeons to Eastern Congo to provide advanced trainings to fistula surgeons, and to help local teams address the backlog of fistula cases awaiting repair.
As of March 2013:
Note: Repairs conducted in the Democratic Republic of the Congo prior to 2009 were funded by a USAID/DRC bilateral agreement with the International Rescue Committee.
The Democratic Republic of the Congo Community of Practice blog
EngenderHealth Update: "It's the Work of the Heart: Repairing Bodies, Restoring Spirits in the Congo"
Lumo: a film about traumatic fistula in the DRC
Biamba Marie Mutombo Hospital is a private, not-for-profit facility located in Kinshasa, operated by the Dikembe Mutombo Foundation. Financing for the hospital’s founding was provided by the former Houston Rockets player Dikembe Mutombo, and the hospital was built in 2001. The hospital has three doctors and one fistula surgeon, and 6 beds available for clients recovering from fistula surgery.
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.
Fistula Care is supporting the above-listed facilities to expand fistula repair services and ensure the provision of transportation, counseling services, and follow-up care. The hospitals are also working with rural clinics and other partners to strengthen referral systems. Fistula Care is supporting the hospitals to train doctors and nurses in obstetric care and continue as centers of excellence for fistula repair in the DRC.
Each of these supported hospitals work with doctors, midwives, and nurses to improve their case management for complicated pregnancy and birth. The hospitals also try to improve referral systems and to reintegrate fistula survivors into their communities. Three Obstetric Fistula Community of Practice meetings have been held in the DRC to-date (November 2009, April 2010, March 2012), and several trainings and quality improvement sessions have been held at each site.
The dedicated work of fistula repair providers in the DRC has inspired the media to bring the problem of traumatic fistula into the international spotlight. Fistula Care advocates for greater attention to the problem of traumatic fistula on the world stage.