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by: Ambereen Sleemi, IMR Surgical Director

In early December this year, I travelled to Malawi in partnership with the United Nations Population Fund (UNFPA- Malawi) to assess a surgical need for obstetric fistula surgery in the southern part of the country. Mulanje is a town nestled in the foothills of Mulanje Mountain. It's an area known for large tea plantations and borders Mozambique. It is also an area that is near five hotspots for development of maternal mortality, obstetric fistula and birth trauma in the region.

IMR was invited to help assess the feasibility of refurbishing a hospital ward in the Mulanje District Hospital. This ward would be renovated and reopened as an obstetric fistula word complete with a dedicated operating room. We would also help train and support hospital staff in surgical and nursing care.

My trip started in the capital Lilongwe with a visit to the only fistula ward in the country, the Bwaila Fistula Care Center, established in July 2012. It’s a wonderful model to inspire the proposed center in the south. A large operating room and open, well-lit ward offer services of repair and hope. A room for rehabilitation services with instructions on literacy and trade was just adjacent to the ward.

The Bwaila Fistula Ward opened in 2012

The Bwaila Fistula Ward opened in 2012

I was invited to the National Fistula Task Force meeting, a group that included staff from the hospitals where surgeries are performed, a Ministry of Health representative and other important participants in the fight to end obstetric fistula. I was impressed with the dedication of all members to moving forward in the efforts to prevent fistula with safe access to maternal health, and the need for surgical repair, including re-integration and rehabilitation services.

I next went to the Mulanje District Hospital, about 4.5 hours south via road. I traveled with Grace Hiwa, the the UNFPA point person on obstetric fistula. Grace is a former midwife and very impassioned advocate for the women and girls suffering from obstetric fistula. We met with administrators of the hospital and a had a detailed tour, focusing on the ward that is being considered for transformation into an obstetric fistula ward.

Proposed future fistula ward in Mulanje. It needs work, but has amazing potential to heal women and restore dignity.

Proposed future fistula ward in Mulanje. It needs work, but has amazing potential to heal women and restore dignity.

I returned to Lilongwe and met with the UNPFA Country Representative, Dr. Dan Odallo. Dan is a committed advocate for reproductive health rights for women and girls. He knows the issue of obstetric fistula well, including the associated stigma. We had worked together in Eritrea a few years ago on this very issue.

IMR's work ahead is great. We are committed to expanding surgical capacity, finding partners and funding for the rehabilitation and transformation of this ward into a safe and effective place to care for women with fistulas. We also look forward to working with UNFPA, the Ministry of Health and partners to train healthcare providers in caring for women with fistula.

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