23 May 2014

Kenya Gets 'Game Changing' Record Donation for Fistula Treatment

A "game changing" $2 million donation will help Kenyan surgeons to give 1,200 women life-transforming surgery to cure incontinence caused by fistula, a hole in the birth canal, and will train more specialists to perform the operation.

Two million women around the world live with fistula, a devastating childbirth injury caused by prolonged labour without access to caesarian section. Tissue dies due to pressure from the baby's head and a hole forms through which urine and/or faeces leak.

Some 3,000 to 7,000 Kenyan women develop fistula each year, according to surgeon Hillary Mabeya, and only 666 received treatment in 2011, according to the Global Fistula Map. Kenya has a backlog estimated at somewhere between 30,000 and 300,000 cases, according to Human Rights Watch.

"This is the largest donation ever provided by any organisation or individual in the history of fistula," said Kate Grant, chief executive officer of the Fistula Foundation, the recipient of the $2 million grant from Astellas, a Japanese pharmaceutical company.

"We're thrilled with this partnership with Astellas and its potential to be a 'game changer' for fistula treatment. We hope to make Kenya, and what we are doing here, a model that we can take to other places."

BOTTLENECK

Until now, donations have tended to focus on providing money to hospitals to perform free surgery, as women who get fistula are usually very poor.

This project aims to dig deeper. In addition to providing 1,200 women with fistula treatment over the next three years, it will set up a training centre for surgeons in Kenya and create a referral network to ensure patients with serious injuries receive the best possible care.

Some women have multiple operations but remain incontinent because their cases are complex and surgeons are inexperienced.

"The purpose for us was supporting a programme that was really sustainable," Astellas's president, Ken Jones, told Thomson Reuters Foundation. "The bottleneck really is the capacity of the surgeons in Kenya."

There are 13 centres offering fistula surgery in Kenya, but most do not have a dedicated surgeon permanently onsite. Instead, visiting surgeons perform 'camps' where they operate on as many patients as possible over several days.

There are only three internationally recognised fistula surgeons in Kenya, plus seven to 10 surgeons who have been trained to perform simple operations, Mabeya told Thomson Reuters Foundation.

Patients with several holes, or who have had most of their bladder destroyed, require lengthy operations by experienced specialists to become dry again.

"We want to have at least three more expert surgeons," Grant told Thomson Reuters Foundation. "In addition, we are going to be bringing people up a learning curve so that we will have more surgeons with at least modest degrees of training."

STIGMA

Mabeya has performed over 1,000 operations on women and girls aged between one and 94 at Gynocare in Eldoret, 300 km northwest of the capital, Nairobi. A recent high-profile case was that of Liz, a 16-year-old who was gang raped and thrown in a pit latrine.

"My prayer is that we are going to help these women who have suffered for so many years," he said at an Astellas and Fistula Foundation launch event in Nairobi. "Stigma from fistula is worse than stigma from HIV."

Women with fistula often become outcasts. Some are thrown out of their home by their husbands, believing that their condition is untreatable. The majority are clinically depressed.

Sarah Omega Kennedy lived with fistula for 12 years after being in labour for almost 40 hours before her dead baby was delivered by caesarean section.

"I was discharged with the hopeless message that only a doctor from abroad could correct my condition," she said at the launch. "I wished I could have died during childbirth rather than live with that condition."

She only found out that surgery was possible when she was hospitalised for depression, and is now the outreach manager for a charity called One by One, walking door to door and telling women about fistula surgery.

"For me this is a dream come true," she said. "Women shouldn't keep suffering when the help they need is available."

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