New Fistula Training Package for Health Workers and Communities

A unique new training package will help health workers in Ethiopia to prevent, identify, and provide early treatment for women with obstetric fistula, one of the most damaging complications of childbirth. The training materials, developed by IntraHealth International with the Fistula Care Project, are intended for midwives, nurses, community health workers, and other staff who serve on the front lines of Ethiopia’s health care field.

An obstetric fistula is a hole that can develop between the vagina and the bladder or rectum during obstructed labor. Women with obstetric fistulas usually leak urine (and sometimes stool) and are at greater risk for other problems, such as pelvic infections, infertility, foot drop, and chronic malnutrition. Not only is the injury debilitating, but it’s also humiliating for sufferers, and many are cast out of their communities because of it.

Most fistula-related training programs focus on surgical instruction and are intended for physicians and other higher-level health workers. Most materials are also not standardized and don’t include information about how to prevent obstetric fistula.

The new training package developed by IntraHealth, though, focuses on prevention. It offers health workers techniques to avoid prolonged and obstructed labor—the most common cause of obstetric fistula. Through hands-on exercises, visual aids, and group discussions, the training modules teach health workers to recognize fistula, educate them about where to send patients for more extensive services, and instruct them on how to care for fistula patients during the time leading up to surgery.

The package includes modules specifically for community leaders, too. By educating religious elders and local authorities, IntraHealth aims to help communities recognize and address obstetric fistula and to prevent the social stigma that comes with it.

Ethiopia has one of the highest rates of obstetric fistula in the world—some 9,000 women develop the condition there every year. The country is also home to a unique pre-repair center model, wherein patients can receive care before their procedures. Health workers at four different centers in the Amhara region prepare patients by addressing malnutrition, infection, anemia, and parasites—all of which can complicate the surgery and lower its chances of success.

Health workers are often unable to identify women suffering from obstetric fistula, partly because the women aren’t always willing or able to seek care. IntraHealth’s new training materials will help communities and health workers find these women and offer them the care and resources they need.

The Fistula Care Project, which began in 2007 and will end in June 2013, is funded by the US Agency for International Development. EngenderHealth leads the project, and IntraHealth is a subcontractor. EngenderHealth will conduct a full evaluation of the training materials in February 2013.

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