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 cities give birth in a hospital, but 85% of Malians live in rural areas, where access to antenatal and obstetric care is often limited. No one knows how many women have fistula in Mali, but one study 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 will also introduce 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.

Supported Site

Gao Regional Hospital is a public hospital located in the regional capital of Gao. It was officially established in 2003 by the Ministry of Health. Gao Regional Hospital is home to two surgeons who were previously trained to repair fistula, but the hospital has not historically been providing surgery to women with fistula.

Program Activities

As of June 2010 (since October 2008):

A total of 69 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.

Strengthening services


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

Starting repair services at Gao Hospital involves many activities. A protocol for fistula surgery must be developed in light of international expert guidelines. Surgeons will need refresher training, and members of the surgical team will be trained in infection control and counseling about family planning and fistula. Fistula Care will provide equipment and materials, facilitating 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 project Keneya Ciwara II to increase awareness in the community about the causes of fistula and the availability of services. The project will also collaborate 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 will work with the Ministry of Health and other major fistula partners, such as UNFPA, to integrate fistula into the National Roadmap for Maternal, Newborn, and Child Health.

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. 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.