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by: Dr. Ambereen Sleemi, IMR Surgical Director

I was invited to talk to members of the Royal College of Obstetricians and Gynecologists (RCOG) at their annual Congress in Cape Town this past month.. A full-day workshop focused on current topics in Obstetric Fistula repair was offered as a pre-Congress event. I was honored to speak about IMR’s work and to join expert surgeons from Zambia and Tanzania and representatives from FIGO’s ( International Federation of Gynecologist and Obstetricians) Fistula Training Initiative. Travel was made possible through generous funding from the RCOG and a grant from the Polan-Bennack Foundation.

Topics ranged from current practices, urologic abdominal approaches to VVF, vaginal stenosis, and how to approach RVF’s. I spoke on training the next generation of VVF surgeons, using IMR’s work in Liberia and now Malawi as examples of how post-graduate training programs are now incorporating fistula training into the teaching curriculum. I’ve relied on my experience as a surgeon with the Eritrean Women’s Project over the last 9 years to help shape our teaching.

The surgical burden of fistula cases is enormous. The actual numbers are elusive given the nature of the condition, but an estimated 2 million women are currently suffering with fistula. We have been able to markedly increase the number of cases we do, but it is not nearly enough to decrease the incredible backlog that exists. Add to it a new 50-100,000 cases per year and it will take over a century to even catch up.

Table Mountain, Cape Town

Table Mountain, Cape Town

There are many thoughts on how best to train the next generation of fistula surgeons, including vetting candidates to find the best fit for this type of work. Our patients are the poorest, most marginalized people on earth. The pay is low and the surgeries are extremely complex and challenging. Even in the most expert hands, no one has 100% success with repairs. We’re hoping with early introduction to obstetric fistula training, some will make it their life’s work and others will incorporate it into their practice.

Well into our 2nd year of training residents in Liberia and a few months from launching fistula and training services in Malawi, IMR continues to strive to bring best practices in surgical work to areas with great need. We are fortunate to partner with WAHA (Women’s and Health Alliance) , the Liberian College of Surgeon’s and Physicians and UNFPA Liberia and UNFPA Malawi to treat women who suffer with obstetric fistula.