LIBERIA FISTULA PROJECT

1. LIBERIA FISTULA PROJECT LIBERIA FISTULA PROJECT BY Dr. John Mulbah,MD,CES, FWACS

2. Introduction and Rational • Population of 4.1 million • Maternal mortality ratio 994/100,000 live births • Infant mortality rate 72/1,000 • Proportion of home deliveries 57% (LDHS 2007) • Low contraceptive prevalence rate 11% • Severe shortage of manpower - 3 Obstetricians - 412 Midwives

3. Rationale of OF Study 2006: Survey conducted with two objectives 1. To assess the extend of obstetric fistula situation in Liberia 2. Use the survey findings to formulate a comprehensive program to include treatment, prevention, and reintegration

4. MAP OF LIBERIA

5. SURVEY RESULTS • 351 operated by expatriates ( 2004- 2005) • Obstetric causes of fistula 87% while 13 % were traumatic • Only 27.4% of the institutions had ambulance services for referring patients. • 37.1% had telephone or high frequency radio (HF) for communication. • Stigmatization was highly noted : - Rejection by husband accounted for 56.6%

6. National response to survey results National fistula project established and launched April 6th, 2007 by MOH, UNFPA for a comprehensive approach consisting of: • Fistula prevention • Treatment • Rehabilitation and reintegration

7. Summary of achievements • Advocacy and Awareness creation • Training of Core-team • Training of health service providers • Establishment of Project sites • Repairing of Fistulae • Establishment of Rehabilitation Center • Establishment of partnership

8. ADVOCACY AND AWARENESS CREATION MEDIA • Media campaign against fistula launched • Dissemination of fistula messages in all 15 vernaculars in Liberia • Conduct lives radio and television programs • Use of print media

9. Contd. • Training of 15 journalists as special advocates • Airing of fistula jingles and messages on urban and rural radio stations • Intensified media coverage of all major fistula activities

10. AWARENESS CONTD. SCHOOLS: • Involvement of students and teachers in fistula prevention in eight counties • Lofa Maryland • Grand Bassa River-gee • Nimba Grand Gedeh • Montserrado Bong

11. Contd. • Interacted with over 12,000 students from 16 schools: • Main causes of obstetric fistula • Discussed Family Planning as key to fistula prevention • Highlighted the role of students and their teachers in the prevention and treatment . • Established a fistula fan club in each school • Finally organized a national school debate about fistula.

12. AWARENESS CONTD. • Training of Fistula survivors and students as special advocates • 20 fistula survivors and 10 students trained • Community involvement: • 800 community members from eight counties sensitized: • Traditional Birth Attendants • Traditional and religious leaders • Drivers and marketing union • Other influential groups

13. TRAINING OF HEALTH WORKERS • 69 county trainers trained • Step-down training of 105 nurses by county trainers • Fistula management integrated in training curriculum of Medical training institutions

14. SURGICAL ACTIVITIES • Total number of surgeries: 720 ( 2007-2010) 150 cases in 2011 so far • Average age group: 11 to 20 years • Types: Obstetric: 676 94% Traumatic: 44 6% • Rape: 14 • Surgery:17 • FGM: 13 • Success rate: 83%

15. Types of fistula by percentage

16. Percentage of traumatic cases

17. County of origin of operated patients

18. No. of cases vs. year

19. Number of rehabilitation per year

20. Skills acquired from the center • General training

21. Specific Skills Acquired

22. Nationality of rehabilitated survivors

23. Current Residence

24. ESTIMATED COST FOR THE TRAINING OF ONE FISTULA SURVIVOR FOR 4 MONTHS • Meals $5.00/day x 4months $620.00 • Provision $10.00/month x 4 40.00 • Training Materials $50.00/mn x 4 200.00 • Medical care $20.00/month 4 80.00 • Post training starter kit (Average) 300.00 • Transportation 100.00 Total 1,340.00 This excludes administrative and operational cost

25. Additional strength of the project • National ownership of the program 2. Strong political will 3. Commitment of County Health Teams and community members 4. Partnership with local and international NGO 5 Support. From UNFPA, ZONTA, Johnson and Johnson UNMIL, 7. South-South Cooperation 8. Partnership with Miss Liberia and ECOWAS 9. services provided free of charge

26. Way forward • Establishment of a national task force on fistula • Establishment of a national EmONC training center in Bong county to include fistula services 3. Establishment of 3 selected excellent sites to integrate fistula services in the regular RH services

27. Contd. 4. Continue training at the new Rehabilitation center in Bong County - Rejected treated survivors - Incurable patients 5. Diversify skill training curriculum to include farming 6.Establishment of maternity waiting home 7. Hosting of yearly national survivors retreat 8.Provision of fistula services in Ivoirian refugee camps in Liberia

28. CONSTRAINTS • Bad road condition: • Access to project sites difficult by the mobile team • Access to institutions by patients difficult • Limited assistance to transport patients by other partners

29. Contd. 2. Limited transport facilities • The only 4 wheel drive jeep in bad shape for the road condition as it has outlived its usefulness 3. Increasing demand of fistula services • Because of effective awareness creation • Increased utilization of facilities • Effective community involvement

30. Contd. 4. Difficulty in transporting back rehabilitated survivors • Far Distances • Survivor and kit to be transported • Lack of vehicle for reintegration and monitoring

31. THANKS FOR YOUR ATTENTION