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Ethiopia USA U.N. Human Development Index 160 4 Population 80m 313m

Ethiopia USA U.N. Human Development Index 160 4 Population 80m 313m No. of children / women 6 2.06 Per Capita income USD 131 22,365 Infant mortality / 1000 122 6.06 Population / State Physician 40,000 400 Adult literacy (%) 37 99. Medical Staffing in Ethiopia.

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Ethiopia USA U.N. Human Development Index 160 4 Population 80m 313m

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  1. Ethiopia USA U.N. Human Development Index1604 Population 80m313m No. of children / women62.06 Per Capita income USD13122,365 Infant mortality / 10001226.06 Population / State Physician40,000400 Adult literacy (%)3799

  2. Medical Staffing in Ethiopia • 95% of doctors leave for USA on graduation • 155 gynaecologists • 501 specialists work for the State • 850 doctors work for NGO’s • Midwife training increased to 4 yrs • Health Officer training for pelvic surgery 3 yrs • Emphasis on prevention at village level

  3. Spectrum of Trauma Secondary to Obstructed Labour • Urological • Gynaecological • Gastroenterological • Musculoskeletal • Neurological • Dermatological • Foetal • Social / Psychiatric

  4. 1959-2011 Holistic care

  5. 5 New locations in Ethiopia Planned increase from 2500 procedures/year to >4000

  6. Mekele Centre

  7. Length of Stay > 52 days n = 15

  8. The Fistula Hospital • Biochemistry • Haematology • Bacteriology • Virology • Blood Transfusion • Radiology

  9. Ureterovaginal Fistula (122)

  10. Causative Procedure Stillborn 28 Alive • Caesarean Section: 86 • Uterine Rupture: 20 • Instrumental delivery: 6 • Hysterectomy for gynaecological causes: 10 2

  11. Number of Operations

  12. Annual Performance Report for 2010

  13. Additional Major Procedures • Stress procedures • Tears • Ileal conduits • Mainz II Pouches • Enterocystoplasty • Uretericreimplant • Stones • Colostomy

  14. VVF Patients: 2010 (n = 1,321) 93%Successful first repairs 4% Unsuccessful first repairs 2% Incurable 24% Successful repair BUT still incontinent • Overflow 16% • Pure Stress 6% • Mixed stress/ Detrusor over activity78%

  15. Training • Facilities • Local • International • Basic & Advanced • Doctors & Nurses • Hospital links

  16. Urodynamic Findings –Patients previously operated n = 176 Stress Incontinence & Detrusor Over activity 121 Overflow 29 Pure Stress Incontinence 18 Normal 6 Detrusor Over activity 2

  17. Treatment of Detrusor over activity / Stress incontinence Bladder training and Oxybutynin for 2 months (n = 164) Cured = 9 Improved = 65 (urgency, dry bed, some voiding) Dry with plug = 45 Still wet = 45

  18. Mixed Incontinence n = 45

  19. “Superbugs” and Fistula Patients

  20. Study 2 573 urine cultures • 140 sterile • 4 resistant to all antibiotics • 16 sensitive to only one antibiotic • 181 out of 433 (42%) of bacteria were sensitive to < 4 antibiotics

  21. Ileal Conduits • 156 patients • 127 Primiparous, 25 multiparous, 4 nulliparous • Mean age at operation: 26 yrs, • Range 14 – 65 years • Mean duration of incontinence: 5 yrs, 7 mths

  22. Ileal Conduits (155): Prior Surgery 112 - Attempted fistula closure, mean 2, range 1 – 7 15 - Stress incontinence procedure • 7 - Removal of urogenital calculus • 4 - Bladder augmentation • 2 - Mainz II Pouch

  23. Additional findings 74 – Renal obstruction 45 – Abnormal renal function 9 – Recurrent or severe urinary tract infection

  24. Desta Mender

  25. A Community of Affliction • The bag is the icon of their identity • Neglects enduring social networks and embeddeness of the women • Erects parallel structures of self care • Prolonged stay in a paradise of sorts • Lifetime dependence

  26. Programme at Desta Mender • Non-formal adult education • Literacy and numeracy skills • Building self-confidence • Communication skills • Skills for independent living • Vocational training • Dairy, Poultry, Horticulture • Catering • Tailoring

  27. Survival • Patients – 156 • Surviving – 144 • Range: 6 days – 22 years • Mean 5 yrs 9 months

  28. Deaths 12 patients died • 8 Renal failure, range: 6 days – 17 years • 1 Disseminated TB and CRF: 3 months • 3 Unknown cause • Median survival after surgery: 5yrs 7months

  29. Outcomes • 31 of 47 women with abnormal renal function improved • 48 of 76 women with obstructed kidneys improved • All women have improved quality of life, life expectancy and opportunities for work and living outside Desta Mender

  30. Costs • One piece appliance / year US$ 220 x35 = $7,700 • Two piece appliance / year US$ 7,700 x 117 = $81,900 • Total for appliances: $89,600 • Desta Mender Cost / year US$ 307,410 • Grand Total: US$ 397,010

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