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Mali is a richly diverse country in West Africa, with northern borders reaching deep into the Sahara Desert. The average Malian woman will have seven children in her lifetime, as just 7% of the population use modern contraception. Although the majority of women who live in the capital, Bamako, give birth in a hospital, 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.
Before the crisis in the northern part of the country, Fistula Care primarily partnered with the Gao Regional Hospital and local NGOs to strengthen the availability of quality fistula treatment services in the region of Gao. This included working with four district referral hospitals around the Gao Hospital - Bourem, Menaka, Ansongo and Gao - to reinforce the capacity of these facilities to prevent fistula, as well as diagnose and refer fistula clients for treatment to the regional hospital. Because Gao Hospital was ransacked by armed rebels and insecurity presides across northern Mali, Fistula Care has extended support to public sector hospitals in Kayes and Sikasso. Fistula Care has also provided technical support to 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 activities in Mali are implemented by IntraHealth International at two hospitals:
As of September 2013 (since October 2008):
Stories from the Field from Mali
Program Update: Mali's National Fistula Strategy
Kayes Hospital is a regional tertiary referral hospital in western Mali serving a population of approximately 120,000 residents, as well as providing referral and evacuation services for the populations of 7 health districts (a total regional population of more than 1,996,000). The hospital has a capacity of 133 beds and offers the following services: obstetrics and gynecology, surgery, pediatrics, internal medicine, anesthesia/intensive care, ophthalmology, ENT, dentistry, medical imaging, laboratory/pharmacy and physiotherapy.
Sikasso Hospital is a regional tertiary referral hospital located in the southeast of Mali serving a population of approximately 200,000 residents, as well as providing referral and evacuation services for the populations of 8 health districts (a total regional population of more than 2,625,000). The hospital has a capacity of 135 beds and offers the following services: obstetrics and gynecology, surgery, pediatrics, internal medicine, anesthesia/intensive care, ophthalmology, ENT, dentistry, medical imaging, laboratory/pharmacy, physiotherapy, cardiology and infectious diseases.
Fistula Care is building the capacity of Kayes and Sikasso Regional Hospitals to provide quality fistula diagnosis, counseling and repair services. The project provides necessary equipment and supplies and trains health workers in fistula counseling and pre- and postoperative nursing care. In collaboration with the International Association for Maternal and Neonatal Health (IAMANEH) Mali, Fistula Care is also mobilizing communities and improving fistula diagnosis and referral.
Prior to the March 2012 coup, Fistula Care provided support to build the capacity of Gao Hospital to provide quality fistula services including surgical team training, treatment workshops, and trainings on infection prevention, counseling, facilitative supervision, and quality improvement approaches. Fistula Care provided operating theater equipment and worked with the maternity ward staff to integrate family planning into fistula services. When Gao Hospital came under attack in early 2012, many women were on the wards, recovering from fistula surgery and awaiting repair. Fistula Care reached out to these women, and was able to ensure that 12 of them received the care they needed at Mopti Hospital.
Fistula Care currently collaborates with the local organization IAMANEH Mali to increase awareness in communities in Kayes and Sikasso about the causes of fistula and the availability of services. Previously, local nongovernmental organization, GREFFA, collaborated with the project in this area in the Gao region. The project also worked with the district referral hospitals in the Gao region to prevent fistula by raising awareness of the causes of fistula among providers, training them in fistula diagnosis, and training providers to improve normal delivery and emergency obstetric care practices. The project also collaborated with the nursing school in Gao to integrate fistula prevention and to strengthen emergency obstetric care in the school's curriculum.
With Fistula Care’s influence, Mali was among the first countries to explicitly track fistula treatment indicators in its national health information system. Fistula Care supports hospital staff at Sikasso and Kayes Hospitals to collect and analyze fistula data.
Fistula Care began supporting the Ministry of Health’s fistula program in October 2008 providing technical assistance for developing the National Strategy for Fistula Prevention, Treatment and Reintegration, which was disseminated in December 2010. The project also supported the MOH, in collaboration with other local and international partners in the development of national norms, protocols, guidelines and supervision tools for fistula services. Additionally, Fistula Care helped draft and finalize the National Quality Standards on Prevention and Treatment of Obstetric Fistula in Mali, which was disseminated in February 2012.