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Guinea is a francophone country in West Africa. In 2010, the country held its first democratic election since its independence in 1958. Despite great mineral wealth, Guineans are among the world’s poorest. Access to quality obstetric care remains low, such that each Guinean woman in her lifetime has a one in 30 risk of death from maternal causes according to UN estimates.
USAID-supported fistula services in Guinea began in January 2006. Fistula Care Guinea works with nine public hospitals to provide fistula treatment and prevention services.
Fistula Care works closely with the Guinean Ministry of Health, the Ministry of National Solidarity and Promotion of Women’s and Children’s Affairs, and the Ministry of Decentralization and Local Development.
Between January 2006 and December 2012:
Client Education Tools Developed in Guinea
Stories from the Field from Guinea
Program Update: Fistula Care Launches Activities at Fourth Guinean Hospital
Program Update: Program for Women Permanently Disabled by Fistula
Profile of fistula champion Paul Keita, Mayor of Kissidougou
Profile of fistula champion Sita Millimono, Program Officer for the Fistula Care project
Ignace Deen University Teaching Hospital is supported as a prevention site in Conakry. The urology department has historically been the only national referral site for fistula patients. Due to increasingly limited space in the urology and maternity departments, Ignace Deen was unable to continue to provide fistula services and in 2010, Fistula Care supported the facility to transition from a fistula treatment site to a prevention site. Kindia is also a prevention site in this region.
Jean Paul II Hospital is located in Conakry. The facility is well placed to understand the unique needs of fistula patients, as it has long had social workers dedicated to ensuring that indigent and handicapped patients have access to health care. In 2008, Fistula Care expanded the fistula program to the maternity unit of Jean Paul II. The hospital has ample space to serve a great number of women with fistula. Fistula Care Guinea has trained doctors and surgical teams and has equipped the Jean Paul II to provide fistula repairs. In 2011, in collaboration with American Friends of Guinea (AFG), Fistula Care supported the opening of the Bebe Sylla Welcome Center where fistula patients can stay during the preoperative and long-term postoperative periods.
The Kissidougou District Hospital is a large referral facility located in the city of Kissidougou, in the forest region of Guinea’s south. Incursions of rebels from Côte d’Ivoire, Liberia, and Sierra Leone into this region have led to an increased incidence of traumatic fistula, in addition to the ongoing burden of obstetric fistula. The hospital is home to one of the few surgeons outside of Conakry who has been repairing simple fistula cases. Prevention sites Faranah and N’Zérékoré are also located in this region.
In May 2009, Fistula Care launched fistula activities at the maternity unit in Labé Regional Hospital in the city of Labé, located in the central Fouta Djallon region of Guinea. The celebration of the program launch coincided with the fourth annual National Fistula Day in Guinea. Fistula Care supports doctors and health providers at the facility to provide fistula treatment and prevention services. In 2010, the mayor’s office opened the Karen Beattie Welcome Center to house fistula patients during the preoperative and long-term postoperative period. The prevention site of Mamou is also located in this region.
In addition to the support provided to treatment sites, Fistula Care has provided support to improve the quality of maternal health services including partograph use and emergency obstetric care to promote fistula prevention at facilities: Boké, Faranah, Kindia, Mamou, and N’Zérékoré. The project reinforced capacity at these sites to identify and refer fistula clients to repair sites. These sites have also been supported to improve family planning and quality improvement practices such as infection prevention.
Fistula Care works with local health officials to monitor the provision of services to ensure that they are high-quality and comprehensive. Staff are trained in case management, counseling, infection prevention, and program supervision at supported sites. The project is also supporting sites to improve the quality of data and the use of data for decision making to improve the quality of services. Fistula Care is collaborating with the Ministry of Health to establish a competency-based certification program for fistula surgeons.
Fistula Care is strengthening maternal health care at public facilities in a number of ways. Health workers are trained to provide quality antenatal care, to monitor labor appropriately, and to perform cesarean sections when indicated. Family planning services and counseling are made available to all who want them at supported sites. In Kissidougou and Labé, Fistula Care has worked with the local government to establish committees that work to educate women and families in numerous villages on ways to make motherhood safer. This community volunteer approach is currently being improved and expanded to Boké. Women who have had a fistula repaired are supported by the project to serve as volunteer advocates, sharing their experiences with others in their communities.
Fistula Care is implementing reintegration activities through social immersion of fistula clients. Patients are invited to spend one to three weeks with host families immediately after their surgical repair. Families near the Kissidougou District Hospital volunteer to host fistula clients to facilitate their transition back into society. Many women have undergone a profound emotional decline caused by years of social exclusion, and when placed with these volunteer families, they are immediately accepted by the community. For many of these women, the social isolation was worse than the physical torment of fistula. The reintegration program is underway in Kissidougou and Labé. During the social immersion period, healed women voluntarily conduct community awareness talks around social events (such as marriages and baptisms). Rural radio is also used to capture the stories of the women and their host families to communicate relevant messages to communities.
Staff monitor the outcomes of fistula surgeries and report on their progress quarterly at all supported sites. Staff and representatives from the Ministry of Health together review the data and make decisions to improve the quality of services together. Kissidougou was one of 11 study sites that participated in the global prospective study on the determinants of postoperative outcomes of fistula repair. Kindia and Kissidougou participated in the global study on indications for cesarean sections.
Fistula Care provides limited support to a national steering committee on fistula. It also organizes debates and roundtable discussions. Fistula Care holds an annual Fistula Day each June.
The project works extensively with the local governments in Kissidougou and Labé to engage these partners and garner support for fistula treatment, prevention, and reintegration activities. To read more about Mr. Paul Keita, a Fistula Care champion from Guinea who has been a leader in these efforts, click here.