A First for Garissa County as Resident Surgeons are trained on Fistula Management

Garissa County Referral Hospital will be the first ever-public hospital in Garissa County to have Resident Fistula surgeons

A major step towards preventing and reducing the backlog of fistula cases in Garissa County was made with the first ever fistula training programme of two resident surgeons from Garissa County Referral Hospital: Dr Lado Wani and Dr Bishar Aden, Consultant Gynaecologist and General Surgeon respectively.

The one-month training that kicked off on 7 October was designed through a partnership between Amref Health Africa in Kenya, International Federation of Gynaecology and Obstetrics (FIGO), Global One,  United Nations Population Fund (UNFPA), County Government of Garissa and Gynocare Fistula Centre.

While remarkable progress has been made to reduce the backlog of fistula cases, the County still faces a myriad of challenges when it comes to management of fistula repair cases. Lack of trained fistula surgeons forces some patients to wait for over six months to receive treatment from free fistula camps, a situation that worsens their condition.

In some cases, the patients are referred to Kenyatta National Hospital and owing to the poor economic status of many patients; many resign to living with their condition.

 “The two surgeons will not only address the situation in larger North Eastern region of Kenya, but also help neighbouring Somalia that has fistula cases. This is a major milestone in the public healthcare system. We appreciate the support from Global One, the County Government of Garissa, UNFPA, Gynocare Fistula Centre and FIGO and consider this as one of a kind of partnership to set an example to other Counties,” said Dr Elizabeth Wala, Director of Amref Health Africa in Kenya’s Health System Strengthening programme under which the fistula program falls.

According to the World Health Organisation (WHO), approximately 3,000 women and girls develop fistula in Kenya every year, while the backlog of those living with untreated fistula is estimated to be between 30,000 and 300,000 cases.

Guided by the certified training manual by FIGO, CEO of Gynocare Fistula Centre Dr Hillary Mabeya, lead trainer overseeing the training programme incorporates theory training with hands-on surgical sessions to provide the practitioners with a wide array of excellent skills to grow their surgical expertise.

“The surgeons have demonstrated their commitment and passion in venturing into the fistula world to help women in Garissa County. As a training centre certified by FIGO, we use a training manual developed by FIGO that provides a competency-based approach. The course focuses on a lot of theory as well as hands on training,” said Dr Mabeya.

He urged the County Government and partners to collaborate and equip the theatre at Garissa Hospital with fistula surgical items as well as set aside a Fistula Centre or ward to handle the highly complicated operations.

During a visit to the Centre, Gillian Slinger, Senior Project Manager at FIGO said, “The FIGO programme aims to address the shortage of fistula surgeons by identifying and training skilled fistula surgeons in high need countries. We work with partners to support the fistula surgeon fellows, check and identify their equipment needs and supply them with fistula instruments to enhance their surgical work. In addition, we also provide ongoing supervision coaching visits at their facilities with FIGO trainers, this is crucial because the trainers focus on the surgeons to build their fistula surgical skills.”

“In the future, we plan to expand the programme to have more fellows and team from high needs neglected countries that are not yet part of the programme. We believe that there are 60 affected countries in the world. Many countries like South Sudan, Central Africa urgently need help.”

The Kenya Demographic Health Survey (KDHS) report of 2014 estimates that only 32.4% of deliveries in North Eastern Kenya are attended to by skilled health personnel, meaning that Traditional Birth Attendants (TBAs) attend to 68%.

Fatuma Iman Maalim from the Department of Family Health at the County Government of Garissa said that the number of fistula cases would reduce.

“Many mothers develop fistula after prolonged and obstructed labour by unskilled birth attendants. The referral hospital serves people across the County as well as Somalia and the refugee camps. We have to plan and dedicate a ward and theatre for fistula cases,” said Fatuma.

Dr Lade, one of the fistula surgeons in training said, “We encounter a number of fistula cases in Garissa. Patients have to wait for the free fistula camps so as to receive treatment. After this training, I will be able to handle uncomplicated fistula cases immediately without waiting for the camps. What drives me to enrol in this field is the number of women I have turned down because I was unable to conduct fistula repair surgeries. We expect to face a challenge, as we do not have a fistula centre or ward in our facility. This is a lifelong intensive training and we will need support to progress our training and refresher training. I am grateful for this opportunity.”

Country Director of Global One Najat Mohamed said, “The trained surgeons will improve sustainability by serving women in North Eastern Kenya. We will continue to collaborate with Amref to train Community Health Volunteers (CHVs), support women with free fistula repair, raise awareness and sensitise communities so that women can come out in large numbers. We will also support the training of a few nurses from Garissa County who are critical in the recovery of fistula patients.”

“We have learnt a lot and provided with hands-on experience. Once I complete the training, I will be fit to handle fistula cases in Garissa because we have all it takes to serve our patients. We do not have a fistula surgeon in our area, all cases we refer to Nairobi. With the training, we hope everything will be solved at our facility and assist many women who need this service, said Dr Bishar.

The design of the course is structured is such a way that after training, the surgeons can conduct uncomplicated fistula repair surgeries on their own. Upon completion of this course, the surgeons will be involved in fistula camps, a platform to practice their surgical skills together with other senior fistula surgeons.

The next Free Obstetric Fistula camp organised by Amref in partnership with Global One and Garissa County Government is set to take place from 1 December to 7 December at the Garissa County Referral Hospital.