Mali




	A repaired Malian participates in a literacy class at a reintegration center.

Mali is a landlocked country in West Africa, with northern borders reaching deep into the Sahara Desert. Most of Mali's people live near the Niger and Senegal rivers in the south. The average Malian woman will have seven children in her lifetime, as just 6% of the population use modern contraception. The majority of women who live in the capital, Bamako, give birth in a hospital, but 85% of Malians live in rural areas, where access to antenatal and obstetric care is often limited. It is unknown how many women have fistula in Mali, but one study of 2,000 villages in the region of Mopti indicated that there is at least one woman living with fistula in half of the rural villages surveyed.

Fistula Care's work in Mali began in October 2008 and is focused on strengthening fistula services at Gao Regional Hospital. Fistula Care is also introducing quality improvement practices in infection prevention and fistula counseling at the regional hospitals of Segou and Mopti and at Point G Hospital in Bamako, to improve the delivery of fistula services throughout Mali. Fistula Care partner IntraHealth International is managing the project's work in Mali.

Program Results

As of September 2011 (since October 2008):

A total of 151 fistula repair surgeries supported.
7 doctors have received training on fistula surgery and management.
Over 100 doctors and nurses were trained on counseling and safe motherhood.
54 people have been trained in fistula counseling.
28 nurses have been trained in fistula nursing.
16 health providers have been trained in c-sections, partograph use, and catheterization.

Links

A Story from the Field from Mali

Article on Mali's National Fistula Strategy

Supported Site

In October 2008, Fistula Care began supporting fistula services in Mali at the Gao Hospital located in the northeastern region of Gao. Gao Hospital is a tertiary referral hospital that serves as the designated government regional hospital. With support from the project four surgeons are currently being trained in fistula repairs at the hospital. The majority of repairs are done during outreach treatment and training workshops at Gao Hospital, led by the national fistula surgeon/trainer from Bamako.

Program Activities

Strengthening services


	Malian fistula survivors create beaded necklaces as part of an income-generating project.

Starting repair services at Gao Hospital has involved many activities. Doctors and their surgical teams (including nurses and anaesthetists) have been selected to pursue the fistula surgical training which has been done through training and treatment workshops with the national fistula trainer . These providers and other hospital staff have also received training in infection control and counseling for fistula. Fistula Care has provided equipment and materials and facilitated discussions among hospital staff in order to continually improve services. Fistula Care will also assist Segou, Mopti, and Point G hospitals to strengthen fistula services and to incorporate family planning into their work.

Improving fistula prevention


	Malian women with fistula prepare their food as they wait for surgery.

Fistula Care is collaborating with local nongovernmental organizations and the USAID/Mali bilateral projects to increase awareness in the community about the causes of fistula and the availability of services. The project is also collaborating with the nursing school in Gao to integrate fistula prevention and to strengthen emergency obstetric care in the school's curriculum. At the national level, Fistula Care works with the Ministry of Health, primarily through the national fistula point person, and other major fistula partners, such as UNFPA, to integrate fistula into the National Roadmap for Maternal, Newborn, and Child Health and to develop national norms, protocols and tools for fistula prevention.

Encouraging a supportive policy environment

Fistula Care Mali is working with the Ministry of Health, UNFPA, and other partners to establish a national policy for fistula prevention and repair. The project is developing a model framework at Gao for fistual treatment and prevention that can be adapted and rolled out nationally. Fistula Care will also work with a USAID-supported project that currently assists the Ministry of Health to introduce policies favorable to fistula treatment and prevention and to raise awareness among other partner organizations who support family planning and maternal, reproductive, and child health programs in Mali.