Kathmandu, Nepal—For the first time ever, physicians and nurses in Nepal will be able to attend on-the-job training to repair obstetric fistula, a complication of birth that leaves women incontinent and social outcasts.
Jhpiego and the United Nations Population Fund (UNFPA) have worked in partnership and collaboratively with the National Health Training Center and the Ministry of Health and Population to develop this innovative program. Obstetric fistula develops as a result of obstructed labor; pressure from the baby’s head leaves a hole or “fistula” between a woman’s vagina and bladder. An estimated 200 to 400 women suffer from obstetric fistula every year in Nepal, but women’s health experts say most cases remain hidden due to the women’s lack of knowledge about its treatment, shame of having this condition and abandonment by their families.
The goal of the Jhpiego/UNFPA-supported program is to provide competency-based, on-the-job training to doctors and nurses so that women suffering from obstetric fistula can receive high-quality health care to repair the condition. To date, Nepal has had very limited service delivery sites for obstetric fistula. B.P. Koirala Institute of Health Sciences (BPKIHS) will serve as the first national training site for obstetric fistula, under a memorandum of understanding signed earlier this year. In the past, with no formal training available in the country, health care providers had to rely on apprenticeships to learn how to respond to this health condition.
A young patient at BPKIHS spoke passionately about her struggle of living with fistula. Incontinence left her isolated and afraid to leave her house. And when she did venture out, she recalled, people would comment on her appearance and the smell of urine. “Even though I bathed twice a day, I couldn’t completely remove the odor,” said the woman, who was awaiting her fourth surgery.
The new Jhpiego-supported learning package on fistula repair was developed with financial support from UNFPA as a four-month, on-the-job training led by a single trainer with a team of one doctor and two nurses as participants. The training package includes a Reference Manual, Facilitator’s Guide, Learner’s Handbook and logbook for participants to record their clinical exposure. The package follows the manual by the International Federation of Gynecology and Obstetrics (FIGO), Global Competency-Based Obstetric Fistula Surgery Training Manual. In addition, participants have the opportunity to watch videotapes of surgery to observe different surgical techniques.
The first graduates of the program—Doctors Ajay Agrawal and Tarun Pradhan and Nurses Binita Rai and Reeta Limbu—endorsed the training.
“We received the skills and knowledge” to treat women with this condition, says Rai, a staff nurse.
The graduates pledged to provide quality care and services in obstetric fistula treatment and surgery so that Nepalese women in need can return to lives free of this devastating condition.