Better surgical training needed to check uro-genital fistula casesSeptember 30, 2014
Jamshoro: Department of Obstetrics and Gynecology Isra University Hospital and UNFPA jointly organized a one day seminar & workshop on “Prevention of Iatrogenic Fistula”.
Urogenital fistula is one of the major health problem of developing countries. It is an abnormal communication between genital tract and urinary tract secondary to obstetrical trauma or iatrogenic insult, causing continuous urinary leakage.
The chief guest of this occasion Prof. Dr. Asadullah Kazi said that the developing countriesis essentially concentrated on the reduction of maternal mortality. He said however attention also needs to be focused on complications of child birth which are not fatal, the most disabling of which, is obstetric fistula. He further said this condition, having been virtually eliminated in the most of the developed world, the problem is still common in some developing countries, like Sub-Saharan Africa and parts of the Indian subcontinent.
The Guest of Honor of this occasion Pro-Vice Chancellor & Director Isra Hospital Dr. Abdul Ghani Kazi hoped constant focus in the prevention of iatrogenic fistulae will reduce our burden of fistula since yet we have to fight for eradication of obstetrical fistulae which are still persisting and the iatrogenic fistulae should never be allowed to emerge as a new problem in future.
Professor Emirates Dr. Afatb A. Munir, Isra University warmly welcome all the distinguished guests
The Focal person of Fistula Project of United Nation Population Funding Agency (UNFPA) Hyderabad Centre and the Professor of Department of Obstetrics and Gynecology Isra University Hospital Prof. Dr. Pushpa Srichand said that the victims of this condition lead miserable life, the constant soakage with urine leads to severe local excoriation and dermatitis and other medical morbidities in form of limb contractures, amenorrhea, bladder and vaginal calculi and subfertility.
Dr. Pushpa said beside these complications these women have to face the psychosocial morbidity which is hard to estimate. The continuous leakage of urine and smell carries a huge burden of grief leading to increased suicidal tendency. Most of these women are socially outcaste; they are not allowed to sit in the family, attend family gatherings and are thrown out of public transport while travelling. These patients are soon disliked by their husbands leading to marital disharmony and divorce. The negative social behavior with frequent verbal abuse, labeling them to be having curse from God due to some sins shuns the door to live a healthy life.
Dr. Pushpa informed that the cause of urogenital fistula varies globally depending on the level of health care provided. The obstetrical fistula is no more seen in the developed countries, but is a common morbidity in the developing countries secondary to neglected obstructed labor. The reported incidence of urinary fistula is 1% in Ethiopia and India.
The World Health Organization estimates more than 2 million women around the world are suffering from urogenital fistulae with additional 50000 to 100000 cases added each year.
A Pakistani report has revealed about 5000 to 6ooo cases of urinary fistulae occur each year. The exact prevalence is very hard to estimate since majority of the sufferers are from the low resource areas having no or poor access to health care facilities. Besides this the problem often remains undisguised due to shame and social deprivation. The myths of having an incurable illness and unawareness about treatment centre often leads to delay in seeking treatment.
The spectrum of problem remained unaddressed until November 2005 when UNFPA (United Nation Funding Population Agency) took the initiative as a campaign to end fistula in Pakistan. At present there are 7 main centers and several referral centers for fistula patients in Pakistan.
The fistula referral center is established in December 2011 at Isra University Hospital, and since then it is providing free treatment facilities, and conducting awareness and training programs. The enormous support from the administration department and UNFPA has made possible to treat more than 100 patients free of cost, and provide them rehabilitation support.
The moot was told during our working over this project we have noticed a marked change in etiology of fistula. The previous studies from Pakistan show obstructed labor as main cause of urogenital fistula, but recently we have received an increased number of patients after gynecological and obstetrical surgeries mainly hysterectomies and caesarean section. This might be due to lack of proper surgical training of doctors performing these surgeries. Considering this as an important health issue we planned to conduct this one day seminar and workshop on prevention of iatrogenic fistulae for gynecologist and obstetrician and post graduate’s trainees from all public sector and private hospitals of Hyderabad and Nawabshah cities.
About 200 doctors attended seminar. The program started with recitation of versus from Holy Quran, followed by scientific presentations, and video demonstrations.
The aim was to refresh their knowledge about the surgical anatomy, highlight the iatrogenic causes of urogenital fistulae, and observe the preventive measures to minimize the risk of developing iatrogenic fistulae during simple and complicated surgical procedures.
The hands on session on “Bladder injury Repair” was to improve the surgical skill of doctors to deal with common complication of bladder trauma encountered during gynecological and obstetrical surgery.
Workshop was ended with vote of thanks by the Head of the Department of Obstetrics and Gynecology Isra University Hospital Prof. Dr. Nishat Zohra. She also distributed the certificates to participants. More than 250 participants from different cities attended the workshop and seminar.
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