The role of counseling for obstetric fistula patients: Lessons learned from Eritrea

Abstract

Objective The goal of this study was to evaluate the first formal counseling program for obstetric fistula patients in Eritrea. Methods To evaluate the impact of the counseling program, clients were interviewed both before pre-operative counseling and again after post-operative counseling. A questionnaire was used in the interviews to assess women's knowledge about fistula, self-esteem, and their behavioral intentions for health maintenance and social reintegration following surgical repair. In addition, two focus groups were conducted with a total of 19 clients assessing their experiences with the surgical care and counseling. Results Data from the questionnaires revealed significant improvements in women's knowledge about fistula, self-esteem, and behavioral intentions following counseling. Focus group data also supported increased knowledge and self-esteem. Conclusion Evaluation of the short-term impact of an initial formal counseling program for fistula patients in sub-Saharan Africa affirmed the positive effects that such a program has for fistula patients, with increased knowledge about the causes of fistula, fistula prevention and enhanced self-esteem. Practical implications Culturally appropriate counseling can be incorporated into services for surgical repair of obstetric fistula in low-resource settings and has the potential to improve the physical and mental well-being of women undergoing fistula repair.

An Exploratory Study of Reintegration of Women Following Obstetric Fistula Surgery in West Pokot, Kenya

“…A study conducted in Eritrea among fistula patients established the need for a standardized counseling program for fistula patients (Turan et al, 2007). In a later study in Eritrea, Johnson et al (2010) demonstrated a significant and positive impact of a formal counseling program on fistula patients. The study aimed to evaluate the short-term impact of pre-and post-surgery counseling by trained counselors established that counseling improved patients' knowledge on fistula, improved their self-esteem, enhanced their mental health, and helped them have positive behavioral intentions (Johnson et al, 2010).…”

Quality of life of Ethiopian women after fistula repair: implications on rehabilitation and social reintegration policy and programming

“…Thus, it is critical to establish systems that help women and their families understand the real risks of repeat fistula and the factors that may lead to it. There is a need for greater research on effective pre-and post-operative counselling programmes for fistula patients such as the one pioneered by Johnson et al (2010) in Eritrea. This study revealed promising results in promoting women's knowledge about fistula and its prevention.…”

Religious coping among women with obstetric fistula in Tanzania

“…Treatment of depression in this population may therefore benefit from cognitive behavioural approaches (van’t Hof, Cuijpers, Waheed, & Stein, 2011), which could help to replace such thoughts with alternative medical explanations of the fistula. Although counseling interventions for this population exist (Gerten, Venkatesh, Norman, Shu’aibu, & Richter, 2009; Johnson et al, 2010), none utilise cognitive behavioural approaches within a religious framework. A religious framework that directly addresses religious and spiritual struggles that are experienced as a result of a stigmatised medical condition may be more salient in this setting than a purely secular framework (Tarakeshwar, Pearce, & Sikkema, 2005).…”