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GPH News Winter 2012

FEATURE STORY Since 1995 Drs Judith Goh and Hannah Krause have volunteered in many parts of Africa and Asia including Bangladesh, DR Congo, Sierra Leone, Liberia, Uganda and Ethiopia. Doctors improving healthcare for women in developing countries Women’s Health Obstetric Fistula How We Help Around the world, over 90 per cent of maternal Obstetric fistula, caused by childbirth injuries, Since 1995 Dr Hannah Krause and I have deaths occur in Africa and Asia. In parts of sub- is the most common genital fistula world-wide. volunteered in many parts of Africa and Asia Saharan Africa, the lifetime risk of a woman dying Prolonged, obstructed, neglected labour is the including Bangladesh, DR Congo, Sierra Leone, most frequent cause. The average length of Liberia, Uganda and Ethiopia. We are also during pregnancy and childbirth is 1:16 compared labour for women who have obstetric fistulae is fund-raising to pay for the women’s surgeries. to nearly 1:3000 in developed countries. For each four days and over 90 per cent deliver a stillborn It costs about 200 dollars per woman for the total maternal death, there are many more women baby. The baby’s head obstructed in the maternal treatment, including transportation to and from injured from pregnancy and childbirth. In many pelvis for a prolonged period of time causes the hospital, stay in hospital and in-patient stay parts of the world, most women deliver in rural pressure necrosis of tissues between the baby’s including food. Although this may seem very areas with no ready access to emergency obstetric head and the pelvic bones (vagina/bladder and/ inexpensive, when a family earns two dollars services. Most of the rural families live in poverty or vagina/rectum). This results in the sloughing a day and this is barely enough for food, health with an income of two dollars a day. This is barely of the tissue and an abnormal communication care is a luxury the family cannot afford. enough to feed the family let alone educate the or fistula develops between the vagina and lower urinary tract and/or vagina and rectum. In early July 2012, we returned to Uganda children or access health care. Hospitals, including for further volunteer work. We would like toThe woman will be totally incontinent of urine government hospitals, are too costly. This in thank Greenslopes Private Hospital for a recentand/or faeces, depending on the site of the combination with the limited roads plus cost fistula. The urine/faeces comes through the donation to Kagando Hospital, western Uganda, and availability of public transportation further fistula and the woman experiences leakage to fund operations. reduces accessibility for the poor rural family. of urine/faeces via the vagina. Usually, before our arrival, a radio Uterovaginal prolapse is also a common Today, there are several million women with announcement is made in the various dialects problem in parts of Africa. Many women do untreated obstetric fistula. For most women in the region. As most of the women are illiterate, not seek assistance even with a severe prolapse. with an obstetric fistula, this occurs during the written notices are of little value in providing This may be due to a number of reasons including first delivery. Many of these young women are information. A nurse often also goes out to the outcasts as they are an embarrassment to their villages to ‘collect’ the women just before we the cost of treatment and many health care friends and families. Successful fistula closure arrive and transport them to the hospital. professionals do not have the expertise may be achieved in up to 90 per cent of women in to assist these women. During this visit we saw 104 women in the specialised fistula units. Post-fistula complications outpatients and performed 50 major operations. such as pelvic organ/sexual/reproductive and mental health dysfunction may occur. Prof Judith Goh GPH specialist recognised in 2012 Queen’s Birthday Honours List Congratulations to Professor Judith Goh who was recognised in this year’s Queen’s Birthday Honours List becoming an Officer (AO) in the General Division of the Order of Australia for distinguished service to gynaecological medicine, particularly in the field of fistula surgery, and to the promotion of the rights of women and children in developing countries. GPHnews 7


GPH News Winter 2012
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