Findings of the Report
In Mbarara region, cases of obstetric fistula are many. They come from neighbouring areas which include Isingiro, Kiruhura, Kyegegwa, Ntungamo, Bushenyi, Mitooma, Sheema, Rakai, Rubirizi. By far, the majority of cases come from Isingiro.
Each year in this region, Mbarara hospital jointly with Mbarara University Medical School and the Universuty of California in Los Angeles support two fistula camps. One camp is organized in March and the other in September. Each camp runs for at least 10 days. However, in September 2012, the camp did not take place because of the outbreak of Marburg disease. The most recent camp took place on September 2013.
Because there is a trained Doctor for fistula operations in Mbarara Hospital, routine fistula operations are carried out all year round depending on the need.
The mothers who come to attend the camps receive pre-and post operation counselling, which is aimed at telling them what to should expect during and after the operation. These counselling sessions are attended by both the fistula cases and their caretakers. Thereafter they are screened to confirm whether they are true cases of fistula or not. Fistula cases which are to be operated receive free accommodation, drugs, food and water. In some cases where the individual is very poor and cannot afford transporting herself to the hospital and back home, the hospital provides transport to this individual but not to the caretaker. The caretakers enjoy other privileges except for transport and water.
In March 2012, thirty four (34) women attended the camp and among these, 8 were none VVF. For this camp, 21 operations were successful, 2 failed and 3 developed stress incontinence. The success rate was about 80% for March 2012 and the incontinence rate at 75%.
In the March 2013 camp, 45 women came for operation. Out of these, 35 had Vescal Vaginal Fistula (VVF). Twenty one (21) women were operated on successfully while 5 failed, 6 developed stress incontinence and 3 escaped before discharge. Also 13 had Rectal Vaginal Fistula (RVF) and all these were operated on successfully.
Failed cases and those which are inoperable are referred to Kitovu hospital in Masaka where EngenderHealth has consultants who perform fistula repairs.
Challenges and areas recommended for action
· Shortage of trained surgeons to operate on the backlog of fistula cases in the region.
· Existing health facilities are inadequately equipped in terms of theatre equipment and supplies.
· Financial constraints to support the surgical teams conducting the camps (training and facilitation).
· Fistula cases are financially constrained.
· Lack of general awareness by the public on the causes, prevention and treatment of fistula.
· Lack of adequate political and policy makers’ commitment to addressing fistula.
Terms of Reference (ToRs)/ Scope of Work (SoW) of the landscape consultancy
1. Assess prevalence and severity of Obstetric Fistula in Mbarara region.
2. Assess health services available to Fistula cases in terms of accessibility, affordability and adequacy.
3. Assess whether fistula camps exist. Who runs them. How often and their duration.
4. Assess the support both technical and financial for the Fistula camps.
5. Assess the costs of transportation of Fistula cases, their healthcare fees as well as their feeding needs.
6. Determine the success rates of the operations, and how both the operable and inoperable cases are re-integrated in society.
7. Make recommendations to how Commat Uganda could be useful in the prevention, treatment and re-integration of fistula cases in the region.
The consultant, Dabtience Tumusiime interviewed Dr Musa Kayondo who is an Obstetrician/ Gynaecologist in preparation for this report.