page contents

Viewing entries tagged
Fistula

Comment

Fistula program in Liberia continues

IMG_0041.JPG

In November, we returned from our sixth trip to Liberia where our surgery program is going remarkably well. We continue to work with the Liberian Ministry of Health and Dr. John Mulbah, our partner in Monrovia, to provide equipment, training, and care for women suffering with birth injuries and obstetric fistula (OF). OF is a devastating condition that affects almost 2 million women worldwide and it’s estimated that almost 100,000 new cases develop annually. OF is a condition of poverty and neglect and it affects the most marginalized populations: poor women who are pregnant.

Our work in Liberia started in 2015 after the Ebola outbreak and has been remarkably fruitful with over 150 cases done. We’re committed to training Liberian medical residents and surgeons in pelvic reconstructive surgery and fistula repair as these procedures are highly technical and require skilled surgeons. It’s estimated that each case costs $900 to $1000 per patient. These estimates include the operation, transportation, post operative care, food and all medications and equipment. It is our hope that in 2019, with your generous donations, we will continue our work helping in the recovery of at least another 60 women and continue training new young generation of surgeons who will go on to become vital to the medical care of this country.

Comment

Comment

Haitian Women's Collaborative Project Update

IMG_0020.JPG

This past September, IMR returned to Haiti for our third trip this year continuing our pelvic surgery training initiative: the Haitian Women's Collaborative Project. This trip was full of many highlights including operating on 15 patients alongside our Haitian colleagues and students, introducing our new volunteer Amaris Lunde to our care team in Haiti, being interviewed by Radio Television Caraibes, and an invitation for our Executive Director Dr. Ambereen Sleemi to join the Haitian Society of Obstetrics and Gynecology (SHOG) as an honorary member.

The week started at St. Boniface Hospital in southern Haiti, operating and caring for women with pelvic organ prolapse (a condition where one or more of the pelvic organs like the uterus or bladder drop to or through the vagina), vesicovaginal fistulas (a hole that forms in the vaginal wall), and more. Since 2014, we've worked with Haitian OB/GYN resident physicians at St. Boniface, National, and Croix des Bouquet Hospitals as part of their training program to increase their surgical skills. Our focus continues to be on improving a surgeon’s skills using a minimally invasive approach that leads to fewer complications and quicker recovery for our patients and implementing initiatives to increase patient safety in the Operating Room. IMR volunteer Amaris Lunde, a Nurse Practitioner from Portland, OR, assisted and trained Haitian nurses caring for patients in the post-operative period. Senior OB/GYN resident physicians from Port au Prince joined us for the week for training. We then traveled to Port au Prince, joining our longtime local partner Dr. Batsch. Together, we operated on women with obstetric fistula (a hole that forms between the vaginal wall and rectum or bladder due to prolonged, obstructed labor), again focusing on surgical techniques, patient safety, perioperative care and more.

Dr. Batsch and Dr. Sleemi with Radio Television Caraibes

Dr. Batsch and Dr. Sleemi with Radio Television Caraibes

In between their busy schedule operating on patients, Dr. Batsch and Dr. Sleemi were interviewed by Radio Television Caraibes, one of the oldest and most popular Haitian broadcasters, about maternal health, birth complications and obstetric fistula. Many women with fistulas and other pelvic floor disorders suffer silently so the chance to inform the public about these devastating conditions was an opportunity not to be missed. We continued our campaign to raise awareness by meeting with UNFPA Haiti (United Nations Populations Fund) to discuss how to assess prevalence of fistula and pelvic floor disorders in Haiti.

Finally, we would like to congratulate Dr. Sleemi, our Executive Director, who received an official invitation to be an honorary member of the Haitian Society of Obstetrics and Gynecology (SHOG), the professional organization for all OB/GYNs in Haiti. This honor is a reflection of her passion and continued dedication to caring for women of Haiti.

Comment

Comment

Learning from a Master Surgeon: The Northern Nigerian Realm of Dr. Waaldijk

Documenting all

Documenting all

I was in Northern Nigeria at the end of January for a couple of weeks to visit with one of the world’s most experienced fistula surgeons and see the centers he has established over the last few decades. Dr. Kees Waaldijk is a surgical mentor of mine for over the last 10 years. He single-handedly has done the most fistula repairs of anyone in the world, over 25,000. Dr. Waaldijk is one of the best vaginal and fistula surgeons I have ever worked with. The execution of expertly placed suture, the precision of an incision and the economy of motion (as I teach it to my residents and trainees) is a beautiful thing to witness. That, coupled with meticulous documentation of each operation and outcome, is a good as it gets.

Notes on instruments and inventory

Notes on instruments and inventory

As IMR is preparing to help launch a new fistula ward in southern Malawi in April, it was important to visit with him and see how these centers were planned and how they are run. Over 2 weeks and 1500 km we went to 4 centers in Sokoto, Zaria, Kano and Katsina. All have served as training centers for 100’s of nurses and surgeons, all have high volumes of patients with obstetric trauma and fistulas. It was important to see how these centers have set up the operating rooms, the rehabilitation centers and importantly, training of surgeons and nurses.

Sokoto’s only fistula center

Sokoto’s only fistula center

Thoughtful post op ward design

Thoughtful post op ward design

What is the best way to train surgeons in a highly complex surgery like fistula surgery, where the best shot a success is on the 1st attempt? How do you prepare trainees in the anatomy and surgical techniques needed for a vaginal approach.  Much of the same questions are asked when trainees are learning other surgical operations. Focusing on providing the best care and best training possible is our goal. Looking forward to April when we launch the project. Stay tuned.

-Ambereen Sleemi, MD

 

Comment

Comment

Treating fistulas in Liberia

This past April, I returned to Liberia for the third obstetric fistula campaign in 9 months. Each visit builds on the previous trip, on the surgical skills taught to the Ob/Gyn residents in Phebe and the care given to our fistula patients, many whom need multiple surgeries to repair pelvic damage due to obstructed labor and fistula formation.

This last trip was funded in part by WAHA International and I am very grateful for their support. WAHA is an amazing organization that is committed to helping women and children worldwide. Our work was also supported by the hospital staff and the Liberian College of Physicians and Surgeons as well as the Ministry of Health. On the ground, in addition to wonderful staff, nothing could have been done with out the help and coordination of Dr. Lise Rehwaldt, an Ob/Gyn and attending in Phebe and the senior Liberian Ob/Gyn residents, Drs. Wheesah, Massaquoi, Geha and Karbah.

The Phebe Hospital and School of Nursing is in Bong County, Liberia, over 100 miles from the capital, Monrovia. It was opened in 1965 with the support of various churches and the Liberian Government . It currently relies heavily on donor assistance. Major departments include medicine, Pediatrics, Surgery nad Ob/Gyn. It was established as a 62 bed hospital with rudimentary Intensive and Critical Care units. It is also a school of nursing in collaboration with nearby Cuttington University.

Phebe has 2 operating rooms and has a dedicated generator. Running water is occasionally present, however, my experience was more with stored water in large plastic containers. There are full-time Nurse Anesthetists and NA students who are highly capable, helpful and always available. The senior Ob/Gyn residents spend the year in at Phebe and and a local Maternity Hospital.

A structured and MOH-approved VVF curriculum allows for a resident to scrub on every fistula case and also for a structured series of lectures based on FIGO’s VVF Training Manual.

After arriving late in the evening into Monrovia, I was met by a driver from the Liberian College of Physicians and Surgeons. I spent the night in Monrovia and left for Phebe, a 3 hour drive, early in the AM. Upon arrival, I settled into a room on the Phebe Hospital grounds spent the day pre-operatively evaluating the women who may need surgery. With Dr. Rehwaldt, and Ob/Gyn based in Phebe and senior Ob/Gyn residents, women were interviewed, examined and scheduled for surgery if deemed candidates for an operation. Lectures that are part of the residents’ fistula training curriculum were given during 2 afternoon sessions.

We are grateful to these Liberian women for trusting us with their care and thankful that IMR can continue to work with Phebe Hospital to train the next generation of Ob/Gyns in Liberia in vaginal surgery and obstetric fistula repairs.

Together with our partners who support us and those on the ground, we can make strides to end fistula in Liberia! Our next trip is planned for fall of 2016. We would love your support to continue our work!

Ambereen Sleemi

Comment