First Fistula-Gynecology Camp Bwindi Community Hospital, Uganda bis

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2 First Fistula-Gynecology Camp Bwindi Community Hospital, Uganda bis Leitung: PD Dr. med. Verena Geissbühler,RC Basel- Dreiländereck, Gynäkologin KSW Dr. med. Doris Hofstetter, Anästhesistin KSW Gerhard Amann, Anästhesiepflege KSW Dr. med. Ralph Meyer, Anästhesist Doritt Härtel, RC Basel-Dreiländereck

3 First Fistula-Gynecology Camp Bwindi Community Hospital Uganda bis Uganda Facts Medical Facts: Obstetric Fistulas Bwindi Community Hospital Operating Room Video: Interview with a fistula patient

4 Where is Uganda? GEOGRAPHY, DEMOGRAPHY

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7 Demography median life expectancy 54 years (CH 82 years) 6.4 children per woman 2008: maternal mortality rate 430/ (CH 5/ ) infant mortality rate 8% (CH 0.5%) under-five mortality rate 13.8% median age 15 Jahre (CH 42 years) 0.12 medical doctor per 1000 inhabitants (CH 3.97)

8 What is a fistula? MEDICAL FACTS

9 Vesico-vaginal fistulas Etiology: prolonged, obstructed labour without medical care Pathophysiology: constant pressure of the presenting fetal part against soft tissues around vagina and bladder and/or rectum > ischemic necrosis Extent of injury depends on duration of labour Fetus dies in about 95% of cases > head softents > stillbirth

10 Vesico-vaginal fistula

11 Vesico-vaginal fistulas Mio fistulas worldwide, new cases occuring annualy Regions: Sub-Saharan Africa and Asia Uganda: exact prevalence not known, estimated women in reproductive age (2.6%) Therapy: surgical repair, mostly vaginal Succes rate of surgical repair: 1. OP: 70-90% 2. OP: 50-60% 3. OP: < 40%

12 Vesico-vaginal fistuals: aftercare Foley catheter for 2 weeks Postoperative complication: residual stress incontinence about 20% Problem: bladder capacity

13 Social impact of permanent leakage of urin or stool Isolation from society due to shame Rejection by the husband Loss of status and dignity Loss of income Donnay F, Weil L: Obstetric fistula: the international response. The Lancet 2004, 363:71-2.

14 Bwindi Community Hospital Catchment area > people Non-governmental hospital founded 2003 hospital beds: 112 employees: 115

15 Bwindi Community Hospital ambulant consultations per year hospitalisations (with obstetrics) 2011: 1174 births Teenage pregnancies: 19.5% Cesarean section rate: 24%

16 Project description, objectives Duration: 3-5 years medical staff (doctors and nurses) from Switzerland will support the treatment of obstetrical fistulae in the Bwindi Community Hospital (southwestern Uganda), in partnership with medical staff (doctors and nurses) from Uganda. Objectives: 1. Surgical treatment of simple and complex fistula 2. Regular organization and implementation of specialized camps 1-2x per year: "Fistula-Gynecology Camp". Duration: 7 to 10 days, including pre-operative preparations. Scheduled cases: in 5-6 days. free of charge. 3. Cooperation and coordination of our activities with Dr. med. Forat Sadry (radiologist) from Africomed, an association of doctors from the canton Fribourg in Switzerland. Dr. med Forat Sadry is the initiator and founder of the Bwindi Community Hospital Project (she started in 2006) 4. Teaching fistula surgery by and for local surgeons. objective: establish permanent competence in treating fistulae at the BCH. 5. Creating an instructional video for fistula surgery 6. Sustainable cooperation between medical staff from Switzerland and Uganda 7. Quality control, clinical research: documentation of therapy and follow-up. Together with ongoing study at Mbarara Regional Referral Hospital, medical faculty of Mbarara University 8. Support of the construction of a reliable anesthesia department (with general anesthesia, teaching local people) 9. The Bwindi Community Hospital together with the local host, RC Kihihi, will be responsible for the recruitment of patients (website, radio, church) as well as for the provision of the infrastructure and material 10. Consumables like perfusions, threads, drugs etc. should be bought in Uganda, in consultation with the authorities of BCH. 11. Additional recruitment of local partners that are involved in fistula surgery, e.g., EngenderHealth Fistula Care Project Uganda (Peter Mukasa)

17 Thank you for your attention!