Guinea

Guinea is a francophone country in West Africa. It had just two leaders in the 50 years following its independence in 1958. Although Guinea is rich with natural resources, most of the population lives in poverty. Access to quality obstetric care remains low, such that each Guinean woman in her lifetime has a one in 19 risk of death from maternal causes.

USAID-supported fistula services in Guinea began in January 2006. Fistula Care Guinea works with four large public hospitals:

• Kissidougou District Hospital, Kissidougou
• Ignace Deen University Teaching Hospital, Conakry
• Jean Paul II Hospital, Conakry
• Labé Regional Hospital, Labé

Fistula Care works closely with the Guinean Ministry of Health and the Ministry of Social Affairs. The vision is that by 2012, Fistula Care’s work will be sustainably integrated into the national safe motherhood program and the national program for social protection.

Program Results

As of June 2010 (since January 2006):

• A total of 1,347 fistula repair surgeries supported.
• In partnership with the Geneva Foundation for Medical Research, 55 doctors have been trained in surgical repair.
• Over 700 nurses and midwives have been trained in fistula case management, counseling, family planning, quality improvement, and male engagement.
• 147 community volunteers have been trained to conduct outreach within their communities on early marriage, gender-based violence, and danger signs during pregnancy and childbirth.

For Communication Materials developed in Guinea, please click here.

Supported Sites

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 Cote 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.

Ignace Deen  University Teaching Hospital was the first hospital ever constructed in Guinea. It is a large referral hospital in the capital of Conakry, and the urology department has historically been the only national referral site for fistula patients. Fistula Care has partnered with both the urology and maternity departments to support fistula surgery.

In 2008, Fistula Care expanded to the maternity unit of the Jean Paul II Hospital in Conakry. The Jean Paul II 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. The hospital also has space to admit more women with fistula than Ignace Deen is able to take in. Fistula Care Guinea has trained doctors and surgical teams and has equipped the Jean Paul II to provide fistula repairs.

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 is supporting doctors and health providers at the facility to provide fistula treatment and prevention services.

Program Activities

Strengthening services

Fistula Care Guinea monitors the provision of services to ensure that they are high-quality and comprehensive. Training updates are held quarterly for staff in nonsupported regional hospitals across the country to assess, diagnose, and refer fistula cases. Staff at supported sites are trained in case management, counseling, infection prevention, and program supervision. Fistula Care is collaborating with the Ministry of Health to establish a competency-based certification program for fistula surgeons.

Improving fistula prevention

Fistula Care Guinea 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. Fistula Care has established committees in numerous villages that work to educate women at the community level to make motherhood safer. Women who have had a fistula repaired have been invited to serve as advocates, sharing their experiences with others in their communities.

Reintegration of fistula clients

Fistula Care Guinea is implementing reintegration activities through social immersion of fistula clients. Patients are invited to spend one to three weeks socially immersed in host families right after their surgical repair. Several families near the Kissidougou District Hospital have kindly volunteered to host fistula clients. Many women have undergone a profound emotional decline, and when placed with these volunteer families, they are suddenly accepted by the community. For many of these women, the profound social isolation was worse than the physical torment of fistula. The reintegration program is underway in Kissidougou and will be soon extended to other sites. During the social immersion period, healed women conduct community awareness campaigns around social events (such as marriages and naming ceremonies). They also use rural radio to communicate relevant messages to communities.

Analyzing and reporting data

Staff at all supported sites monitor the outcomes of fistula surgeries and report on their progress quarterly. Staff and representatives from the Ministry of Health Data together review the data to improve the quality of services. The Kissidougou and Ignace Deen hospitals are participating in the global prospective study on the determinants of postoperative outcomes of fistula repair.

Encouraging a supportive policy environment

Fistula Care Guinea provides limited support to a national steering committee on fistula. It also organizes debates, roundtable discussions, and interviews of satisfied clients for the annual Fistula Day held in Conakry, Kissidougou, and Labé.