Feature Story

07 September 2012

Expert Ethiopian Fistula Surgeons Train Physicians in Mozambique

South-south cooperation builds capacity to improve the quality of care for fistula patients
FistulaRepair-BeiraHospital.jpg

Esther Joakim, 25 years old, with her daughter at Beira Central Hospital after her successful fistula repair surgery.
Photo: UNFPA Mozambique

BEIRA, Mozambique — Following a successful fistula repair surgery, 25-year-old Esther Joakim Chimoio envisions a better life. Although her husband abandoned her because of her condition, she now has ambitious plans that will allow her to take care of her children on her own.

"I want to go back and start my own banana and orange business to support my children. Before I was working in the fields for a woman in my area due to my limited strength because of fistula," she says, beaming.

Esther was one of the 94 women treated during a training mission for 12 of the most experienced fistula surgeons and surgical technicians in Mozambique under the supervision of Dr. Ambaye Geda from Women and Health Alliance International in Ethiopia at Beira Central Hospital.

The training mission. which was facilitated by the Mozambique Ministry of Health as part of the Campaign to End Fistula,  tapped into the reservoir of expertise in the region to advance the skills of the Mozambican team of fistula surgeons and surgical technicians even further – in the context of south-south collaboration.

Exchanging skills and knowledge

Women with fistula after examination at Beira Central Hospital
Photo: UNFPA Mozambique

"I believe the south-south collaboration is the best approach to improve the skills needed for the difficult fistula repair," says Dr. Ambaye, who has dedicated herself to performing thousands of fistula repairs since 1994.

"The problems we face on the continent in the area of fistula surgery are similar, and the exchanges of experience and expertise among physicians are likely to have an immediate application," she added.

The Mozambican participants were impressed with the experienced and competent hand of Dr. Ambaye. Her presence lent new inspiration and advanced techniques to their tireless efforts to end the suffering of the fistula patients.

New techniques, renewed commitment

"This training has brought me different techniques that I can apply in practice right away, and the natural and passionate way Dr. Ambaye cared for the girls and women was a boost to my own dedication," said Dr. Teófilo Braga who practices at a rural hospital in Muxúngue, Sofala.

One of the local co-trainers further applauded the training mission from a quality care perspective: "This training was groundbreaking in Mozambique because our colleagues for the first time was exposed to different and more simple surgical techniques through the presence of Dr. Ambaye that will help them improve their work and appreciate the importance of specific skills needed to undertake the difficult fistula repair," added Dr. Igor Vaz, a urologist at Maputo Central Hospital.

UNFPA facilitated the collaboration as part of its technical assistance to the Mozambique Ministry of Health, which plans to bring back Dr. Ambaye for another training mission, as well as send a few surgical technicians to Ethiopia to further improve their skills.

Working to address the backlog of cases

Dr. Ambaye demonstrating different techniques, Beira Central Hospital
Photo: UNFPA Mozambique

Although ensuring all women can deliver safely is the best way to end the scourge of obstetric fistula, Mozambique has an urgent need for surgeons and surgical technicians well trained in repairing the condition. Some 2000 new cases of obstetric fistula occur annually in Mozambique, adding to the backlog of women who suffer with the incontinence and isolation that most survivors face.

But surgical repair requires specialized training and techniques, and is not yet is available in all provinces in Mozambique. The patients to be treated during the training mission came from far districts in the Provinces of Manica, Tete and Sofala Province in the Central Region.

A large percentage of maternal deaths (36.8 per cent) in Mozambique, and related disability occur among young (15-24 year old) women like Esther. She had lived with the condition for four years with little hope of returning to full health. It was only when she gave birth to her daughter Rosa through a Caesarean section at the Hospital that she learned her condition was possible to treat with surgery, and now she is telling others.

"Many women in my zone had told me that my uncontrollable leaking of urine and faeces could come to an end by seeking assistance at the Hospital, but I didn’t believe them and thought that this condition was just how things had to be for me," said Esther. But now her face shines with her renewed hopes and aspirations for herself and her children.

Helene Christensen, UNFPA Mozambique