The mobile surgical outreach program for management of patients with genital fistula in the Democratic Republic of Congo

Abstract

Objective: To describe components of the mobile surgical outreach (MSO) program as a model of care delivery for women with genital fistula; present program results; and discuss operational strengths and challenges. Methods: A retrospective observational study of routinely collected health data from women treated via the MSO program (2013-2018). The program was developed at Panzi Hospital in the Democratic Republic of Congo to meet the needs of women with fistula living in remote provinces, where travel is prohibited. It includes healthcare delivery, medico-surgical training, and community sensitization components. Results: The MSO team cared for 1517 women at 41 clinic sites across 18 provinces over the study period. Average age at presentation was 31 years (range, 1-81 years). Most women (n=1359, 89.6%) presented with vesicovaginal fistula. Most surgeries were successful, and few women reported residual incontinence postoperatively. Local teams were receptive and engaged in clinical skills training and public health education efforts. Conclusion:The MSO program addresses the backlog of patients awaiting fistula surgery and provides a template for a national strategic plan to treat and ultimately end fistula in DRC. It offers a patient-centered approach that brings medico-surgical care and psychosocial support to women with fistula in their own communities.

Childbirth-Associated Fistula and Perineal Tears Repaired on Outreach Campaigns in Remote Democratic Republic of Congo

“…Similar findings were recently reported in a study that compiled data on patients treated on outreach for genitourinary fistula during a 5 year timeframe (2013-2018). 12 In a study conducted in northern DRC on obstetric fistulas, the mean duration of the illness before repair during surgical campaigns, was 8.4 years. 15 Our study adds to the growing body of literature highlighting a longstanding need for fistula related care for women in rural and remote areas.…”

“…In particular, the DRC is known to have a maternal mortality ratio of 550 to 100,000 live births and as of 2018, more than 42,000 women are awaiting surgical care for genital fistulas alone. 12 This problem is compounded by the fact that the majority of DRC's population resides in rural areas, where qualified medical care is even more scarce. 13 Despite only accounting for approximately 30% of the DRC population, the 2014 Demographic and Health Survey estimated that 80% of all skilled birth attendance and well-equipped facilities are located in urban areas.…”

Etiology and factors associated with urogenital fistula among women who have undergone cesarean section: a cross-sectional study

“…In 2011, a surgical outreach program was developed by Panzi General Reference Hospital in the South Kivu province of the DRC [ 11 ]. The program was initiated to provide specialized fistula care to women in remote, underserved areas who are not able to travel to Panzi Hospital for treatment.…”

Etiology and factors associated with urogenital fistula among women who have undergone Cesarean section in the Democratic Republic of Congo

“…This study was approved by the DRC National Health Ethics Committee (UCB/CIE/NC/10/2013). In 2011, a surgical outreach program was developed by Panzi General Reference Hospital in the South Kivu province [10]. The program was initiated to provide specialized stula care to women in remote, underserved areas who are not able to travel to Panzi Hospital for treatment.…”