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Restoring dignity to Burundi´s women after Obstetric Fistula Repair

Operational Research News 
The Women of Burundi regain health and respect through MSF´s clinic at Gitega Fistula Centre.

    Having a baby is usually a happy event for every woman, but for 1500 Burundian patient, having a baby was a traumatic experience; the delivery was long and difficult, they lost their baby and ended up with an obstetric fistula* which made them suffer from incontinence.

    Besides these sufferings they are rejected from their community, family and even their husband due to the smell of urine. This causes an additional emotional pain of isolation. Fortunately, fistula is in most cases curable through surgery.

    Médecins Sans Frontières (MSF)  has been treating patients over a five year period from 2009 to 2015 for a very serious complication after their delivery, Obstetric Fistula, while restoring health and self-esteem to many of the patients. The Program National de la Santé de la Reproduction (PNSR) and the United Nations Population Fund (UNFPA) estimated that each year 750 women are affected by an Obstetric Fistula. However MSF does not agree with this estimation since they believe that through their many interventions the number is much lower.

    Free health care for all suffering from OF through MSF´s intervention

    It was in 2009 that MSF set up its Gitega Fistula Centre (GFC) within the Regional Hospital of Gitega (RHG) in Burundi. According to the report “Management of Obstetric Fistula in Burundi – The Experience from a Multidisciplinary Approach over Five Years”, there was no adequate national response to address the complications of Obstetric Fistula. MSF trained three doctors on-site in performing the very complex surgery. In addition MSF offered free, multidisciplinary health care all year round to women in need of fistula repair. Over 260 doctors, 1500 nurses and 3 000 nursing students were also trained to understand the causes of Obstetric Fistula and to refer patients to GFC. As part of its Reproductive Health Care Package, Médecins Sans Frontières has been treating this obstetric illness and restoring the dignity and self-esteem to hundreds of women. Fistula repair was not the only focus of the treatment. The women of Burundi who attended MSF´s GFC centre had other important treatments including phsysiotherapy, psycho-social support, nutrition, family planning and follow up care. There was increased awareness within communities, through increased health promotion activities, at church, through mass media and in several other forums.

    Raising awareness, removing the stigma of Fistula Repair

    At the local level, awareness was also raised at the social, political, cultural and religious contexts in Burundi. This was and still is critical to understand OF and change the negative perception and attitude of the community towards women who had gone through this experience. Women successfully treated went on to become Fistula Ambassadors providing much needed support  for their “sisters” regarding prevention, raising awareness and the women who were once shunned, were now able to laugh again. In addition, over 10 000 lay people were sensitized to the illness through community gatherings.

    MSF interventions also led to the local strategy which focused on prevention and cure of Obstetric Fistula (OF). MSF and its partners were able to change guidelines, adding OF repair free of charge, create a technical platform with partners and have GFC recognized as a national centre. On the international level, Médecins Sans Frontières has once again illustrated its commitment to treating those in need and delivering high quality care through its partnership with the UNFPAs’ 2013 Global Fistula Map Project.

    * An OF is a hole between the birth canal and the bladder or intestines/rectum  that develops when women have an obstructed labour lasting for 2 days or more.

    Find the report :
    Management of obstetric fistula in Burundi


    The integration of the Gitega Fistula Centre (GFC) and the transfer to the Gitega Regional Hospital (GRH) was planned from the outset. Between 2009 and 2015, a total of 1,559 patients were treated at GFC.
    Operational research and lobbying with policy-makers were critical components of this five-year project in order to place the “forgotten disease” back in the minds and hands of decision makers in Burundi and beyond.