Rwanda

Rwanda is a mountainous, landlocked country in Africa’s Great Lakes region. It is the most densely populated country in Africa, with a population of more than 8 million people in an area of 26,338 square km. Development in recent years has been rapid, but plenty remains to make motherhood safer for Rwandan women.

USAID-supported fistula services in Rwanda began in October 2006. Fistula Care Rwanda is working with three public hospitals:

Ruhengeri Hospital, Ruhengeri, North Province
Central University Teaching Hospital, Kigali
Kanombe Hospital, Kicukiro

Program Results

As of June2010 (since October 2006):

A total of 723 fistula repair surgeries supported.
45 surgeons and 105 nurses have been trained on fistula surgery and management.
Theater space at Ruhengeri has been renovated, and both hospitals have been equipped with surgical equipment, for a total of four operating rooms.
A training module in fistula counseling adapted from the Fistula Care fistula counseling curriculum is being translated into Kinyarwanda.

Supported Sites

Ruhengeri Hospital is located in the North Province near Lake Bulera and the national volcano park renowned for its population of gorillas. Fistula patients come to Ruhengeri from all corners of Rwanda, and some arrive from the Democratic Republic of Congo’s eastern provinces. Ruhengeri dates back to the opening of a dispensary in 1964. Today, it has 409 beds, including a 100-bed maternity ward, and serves a population of more than 350,000. Surgical repair for fistula is currently available at Ruhengeri only during fistula workshops held by visiting surgeons.

The Central University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali, or CHUK) dates back to 1918. It was at first a dispensary, but with time it grew into first an ordinary hospital and then a teaching hospital. Today, CHUK is a national teaching and referral hospital run by the Ministry of Health. Forty-two of the hospital’s 418 beds are in its maternity, where specialists treat a wide range of gynecologic problems. CHUK organizes its schedule to repair at least two fistulas each week. CHUK’s mission is to ensure the provision of quality health care services, to serve as a teaching and a clinical research center, and to provide technical support to district hospitals.

Kanombe Hospital is a military hospital that also serves as a designated district hospital in the district of Kicukiro. It is a 360-bed facility with 49 beds for obstetrics/gynecology and 3 beds reserved for fistula patients. There are three delivery rooms and one operating theater available for cesarean deliveries and other gynecological procedures. Kanombe Hospital has renovated an adjoining space to serve as an additional operating theater for OB/GYN and fistula patients. One day each week is currently reserved for fistula repair surgery.

Program Activities

Strengthening services

Fistula Care Rwanda has partnered with the Ministry of Health, GTZ, and UNFPA to increase access to quality fistula repair surgery. Periodic camps at the two facilities have helped some of the many women waiting for services, but Fistula Care is working to establish services so that fistula repair surgery is routinely available at the two facilities. Fistula surgeons are receiving advanced training there to hone their skills.

Improving fistula prevention

Fistula Care will partner with the USAID-supported project Twubakane, managed by IntraHealth International, to increase awareness in the community about fistula, safe motherhood, and family planning. Twubakane will be teaching community health workers to communicate key messages about fistula prevention, adapting educational materials, and collaborating with local groups.

Analyzing and reporting data

Staff at both supported sites monitor the outcomes of fistula surgeries and report on their progress quarterly. The project is collaborating with the MOH and other partners to integrate fistula and other maternal health services with family planning to improve prevention of fistula.

Encouraging a supportive policy environment

Fistula Care Rwanda provides technical and logistical support to the National Safe Motherhood Technical Working Group. In this capacity, it is helping to develop a national strategy document to tackle the problem of fistula in Rwanda. Beyond the big safe motherhood technical working group, a subgroup in charge of fistula activities has been created. This provides a forum for groups working on fistula in Rwanda to coordinate their efforts.