IOFWG meeting 2012, Dhaka- Bangladesh

Obstetric Fistula overview in Afghanistan at CURE

International Hospital, Kabul

Dr. Yousuf Khan MDDeputy Medical Director CURE International Hospital, Kabul

Outline of presentation

• Introduction of Afghanistan• Health care structure review • Pregnancy related mortality ratios and other

maternal health indicators • Overview of obstetric fistula at CURE

International hospital, Afghanistan • Outreach effort by CURE hospital

Introduction

• Afghanistan is land locked country located in south central Asia

• Population: 29.7 million• Total land area of the country: 652,690 Square Km• Annual population growth rate: 2.6% • Around 85% of the population lived in the rural areas • 34 Administrative division (provinces) • About 36% population is un employed and lives

bellow poverty threshold

4

Health care structure Information

• Health post (hp): 10277• Health sub centre (HSC): 468 • Basic health centre (BHC): 807• Comprehensive health centre (CHC): 388 • District hospital (DH): 67• Provincial hospital (PH): 29• Regional hospital (RH): 5• National Hospital (NH): 24

Pregnancy Related Mortality Ratios and associated maternal health indicators

• Pregnancy related mortality ratio, AMS 2010

• Percentage of women receiving ANC from skilled provider

• Percentage of births delivered by SBA

• Percentage of births delivered in a health facility

• Percentage of ever married women age 15-49 with no education

327

60

34

32

88

Overview of obstetric fistula work at CURE Hospital, Kabul

• In 2006 obstetric fistula repair launched by an expatriate surgeon

• In 2007 CURE hospital sent two local obstetrician/ gynecologist to Hamlin fistula hospital in Addis Ababa for initial training

• Later on both doctors received an advance training in Hamlin hospital

Overview…• In 2011,3rd Obstetrician/gynecologist

received initial training in Hamlin hospital

• During this time 3 nurses and one OF coordinator received training in Hamlin hospital

• One Anesthesia technician received training in abroad as well

• since the program launched there is always visiting fistula surgeons support is available to help these doctors in repair of extensive fistula cases

• Construction of Fistula hostel in CURE hospital compound

All birth injury seen at CIH since program inception

1 2 3 4 5 6 70

20

40

60

80

100

120

140

160

2005 through 2011

Year of program

Abso

lute

num

ber o

f cas

es

Outreach efforts Obstetrical Fistula coordinator trips to provinces

• 20 minute power point explaining what OF is, how it is detected, how it can be prevented and how it can be treated for free at CIH

• Letter of introduction from MOPH essential

• Each trip lasts 2 to 4 weeks involving 15 to 25 training sessions at as many different health care facilities as possible

11

4784 health care workers at 329 different health care facilities in 16 provinces

Summary of 16 Outreach Trips July 2007 through July 2012

July 2011 210 HCW at 22 HF

Dec 2011 523 HCW at 31 HF

April 2012 – August 2012

1145 HCW at 76 HF

Jan. 2011 – June 2011

1376 HCW at 95 HF

August 2010 – December 2010

793 HCW at 52 HF

November 2009 – May 2010

737 HCW at 53 HF

Outreach con…

Clinical clerkships at CURE

• CURE was hosting 20 trainees per month from 20 different provinces to offer clinical refresher training in their fields. (OBGYN, PEDS, GEN SURG, INT MED, Nurses, Midwives, Anesthetist, lab technicians)

• We took some time during their orientation to explain about our free OF program and provided them with brochures in the local languages.

13

Over 700 healthcare providers from 20 provinces trained at CURE

Badak

hshan

Takh

ar

Baghlan

Jawzja

n

Sare-e-Pul

Farya

b Herat

Farah

Nimroz

Helman

d

Kandah

arZa

bul

Ghazni

Paktika

Paktia

Khost

Ningarhar

Lagh

manKonar

Bamya

n

Ward

ak

0102030405060708090

100

1 month clinical clerkship2009 - 2012

14

Outreach con…

OF training of provincial healthcare providers

• 2009 12 trainees came to CURE for 4 to 6 weeks – 1 surgeon– 4 anesthetists– 5 nurses– 2 midwives

• Provinces– 5 from Herat– 3 from Badakshan– 4 from Kabul

Outreach con…

Orientation of Midwives

• In sep 2012 totally 21 midwives were invited for two days OF orientation workshop from 21 different provincial hospitals

• Those midwives who came for training will act as focal points for OF referral in their respected hospitals and provinces

• An incentive plan were considered for each OF referral

Outreach con…

Mass Media

• TV• Radio • OF printed brochures

Mass media advertising March to October 2011

11-Mar

18-Mar

25-Mar1-A

pr8-A

pr

15-Apr

22-Apr

29-Apr

6-May

13-May

20-May

27-May

3-Jun

10-Jun

17-Jun

24-Jun

1-Jul8-Ju

l

15-Jul

22-Jul

29-Jul

5-Aug

12-Aug

19-Aug

26-Aug

2-Sep9-Se

p

16-Sep

23-Sep

30-Sep7-O

ct0

10

20

30

40

50

60

70

80

90

100

Number of 30 to 60 second spots

TV Radio

Way forward

• Prevention

- CURE Hospital has plans to continue its OB/GYN and family medicine training programs, In addition, CURE would like to augment this effort by expanding midwifery training at both its hospital and clinic

- we recognizes that these programs are having not only impact in decreasing maternal and infant mortality in Afghanistan, but also helping to prevent OF

Way forward

• Expansion of treatment capacity:CURE’s goal is to perform 160 repairs in 2012 alone and to be capable of repairing 200 annually by 2014

• Expansion of outreach activities

Thanks

• Women Hope International (WHI)

• Fistula Foundation (FF)

• Ministry of Public Health (MOPH), Afghanistan