RWANDAN MATERNAL HEALTH AND OBSTETRIC FISTULA PROJECT



Background:

Rwanda is the smallest and one of the most densely populated countries of Africa and one of the poorest in the world. Sixty per cent of the population live below the poverty line. Poverty is related to economic and historical factors such as lack of productivity in the agricultural sector in the context of a rapidly growing, largely rural population and the recent genocide and civil war. The war disrupted development efforts and further increased poverty (Poverty Reduction Strategy Paper, UNDP, 2002).

Rwanda has a population of 8.4 million (2003 census), 94% of which is rural. Enrolment in secondary education is very low. Life expectancy is 49 years and maternal and infant mortality is very high. Thus, the basic human rights to education, health and economic security are denied to a majority of the people of Rwanda. Recognizing that immediate and sustained action is required to address these problems, the Government of National Unity of Rwanda is developing several strategies to address the problems of poverty and the legacy of genocide.

Women especially are victims of the breakdown in civil society in Rwanda. Not only is the risk of death in childbirth one of the highest in the world (1071: 1000,000 compared with 7: 100,000 in Canada), but in addition the risk of suffering from a type of birth injury called obstetric fistulae is also extremely high. Obstetric fistula is an abnormal opening between the vagina and bladder and of rectum. Most obstetric fistulae are caused by long obstructed labour, in which the baby cannot pass through the mother's pelvis. The pressure of the baby's head cuts off the blood supply to the tissues creating a breakdown of the tissue and the opening between the organs. Associated factors include malnutrition, very young age, lack of access to, or failure to obtain, appropriate emergency care, and cultural beliefs and practices. The result is uncontrollable bladder and/or bowel leakage through the vagina, constant wetness, skin excoriation and foul odour. The impacts of the condition on the woman are shame, long term debility and, in many cases, isolation and abandonment by her husband and family.

As recognized in the Poverty Reduction Strategy Paper some members of society will require specific attention to their needs through Government, NGOs and other organizations. Women in childbirth fall into one of these groups. Reliable statistics on the prevalence of obstetric fistulae rarely exist anywhere in Africa. This is true of Rwanda. However, studies by Raassen and Ilako (UNFPA 2002) calculated that between 6000-15000 fistulae cases occurred in East Africa per year, based on an estimation of two-five cases of fistulae for every one thousand of women surviving birth. A small study of 36 women who presented at Kigali Hospital Rwanda between 1995-1996 noted that 86% of cases were related to obstructed labour ((Karangwa), 1996). Reliable estimates form the World Health Organisation u the number of untreated cases at 2 million and 100,000 are added each year, mostly in sub-Saharan Africa. Most fistulae could have been prevented with appropriate obstetric care . but can also be treated surgically but presently there are not enough doctors and nurses with the skills to treat these women nor are there enough specialised facilities for treatment and training.

A further challenge to the health services of Rwanda is the murder, disappearance or emigration of large numbers of physicians and nurses during the genocide and civil war that has created a severe shortage of qualified health professionals. There are presently 300 doctors in the country of whom only 60% are in practice.

Solutions:

MaterCare proposes a project that will:

1.    provide courses to doctors and nurses in basic and advanced maternity care;
2.    provide training programs in fistulae surgery and pre and post-operative care for        physicians and nurses;
3.    introduce a comprehensive, rural maternal health service, similar to the models         developed in Nigeria and Ghana
4.    develop a 20-bed birth trauma centre (BTC) to provide treatment and rehabilitation        for women with obstetric fistulae. The BTC will provide the clinical training and        experience for health professionals in the surgical and nursing care of women with        fistulae. The BTC will have an operating room, in-patient unit, outpatients        department, utility rooms, laboratory, pharmacy, offices and staff accommodation.

Management:

·   This project has the full approval and support of the government of Rwanda
·    The land for the BTC is being donated by the Archdiocese of Kigali.
·    The project will be managed by a MaterCare (Rwanda) on behalf of the MaterCare      International. The Rwandan team will be strongly supported in the development and      operation of the education, rural maternity care and BTC projects by MaterCare      International through a written Memorandum of Understanding between the parties.

The overall purposes

·    To improve the quality of life and health for women in childbirth, especially for      women with fistulae.
·    To enhance the capacity of the Rwandan health services to provide the professional      services needed for women in childbirth and post-birth.
·    To increase the number of women involved at all levels of patient care, and hospital       and project management by active recruitment.

Sustainability

Of the project will be ensured by establishing it in collaboration with the Rwandan Ministry of Health and the Kigali Diocesan Health Committee.
© 2009 MaterCare International, All Rights Reserved
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