Kissidougou, Guinea — Kadiatou Diallo recalls the pain and isolation she suffered from fistula, a hole in the birth canal that resulted from her prolonged labor and difficult delivery. She shares her story with others, hoping to save other women from going through what she did.
She labored for 4 days at home with a traditional birth attendant before her family took her to the local health center in Yendé-Millimou, about 6 miles away. There, she gave birth to a stillborn baby. A day later, she returned to her village with empty arms, a broken heart—and a fistula.
For 7 months, she stayed home, ashamed by the stench of losing control of her stool. But then, she learned of the possibility that surgery could repair her fistula. “The neighbor came to tell me that she had heard on the radio that my illness could be treated here in the district hospital of Kissidougou at no cost,” Diallo says.
As part of the Guinea Health Service Delivery (HSD) Project, funded by the US Agency for International Development, fistula treatment at the hospital in Kissidougou offered hope to women like Diallo. Under the 5-year project, Jhpiego and partners EngenderHealth and Save the Children work closely with the Government of Guinea to ensure consistent and high-quality provision of an essential, integrated package of maternal and child health care and family planning at health facilities and in surrounding communities in seven target regions covering 85 percent of the population. The regions are Boké, Conakry, Faranah, Kankan, Kindia, Labé and Mamou.
The integrated package helps to ensure that high-quality care is available at each level of the country’s health care system, along with access to information and referrals for treatment of serious illnesses, obstetric fistula repair, and voluntary long-acting and permanent family planning methods.
At the outset, the HSD Project assessed seven obstetric fistula repair sites, which included the district hospital in Kissidougou, and identified performance gaps linked to the management of quality of care at the facilities. To date, through the HSD Project, clinical training has been conducted in collaboration with EngenderHealth for 12 surgeons on fistula repair and 75 providers on nursing for patients recovering from the surgery.
From January 2016 to December 2018, the HSD Project identified 900 women living with fistula, of which 706 had surgery with a success rate of 76 percent. Diallo was one of 538 women who made a full recovery; they had their fistulas closed with no incontinence. Eight percent had fistulas closed but had recurring incontinence, and 16 percent of surgeries were unsuccessful in correcting the problem.
Among the 194 women who did not have surgery, some were deemed no longer operable after having undergone previous surgeries, and others presented with complex (as opposed to simple) fistulas, which require specialized surgery offered only annually in Guinea by visting teams at certain hospitals.
To help guarantee ongoing high-quality care, the HSD Project reviewed and updated relevant national strategies and guidelines, in close collaboration with government and international stakeholders, including the National Obstetric Fistula Strategy, and competency-based fistula surgery training materials.
Such efforts are aimed at ensuring that quality obstetric fistula repair remains sustainable beyond the end of the HSD Project so that other women like Diallo receive the care they need and can continue to be active members of their communities.
Diallo was among the first women to avail themselves of the life-changing surgery at the outset of the project. “I am very pleased with the work of the team at Kissidougou Hospital,” she says, referring to the facility about 50 miles from her village. Before leaving to go home after the surgery, she voluntarily chose an implant as her family planning method.
When she and her husband were ready to try to become pregnant again, Diallo had the implant removed, and a healthy pregnancy followed. Seven months ago, she gave birth to a healthy baby girl at Kissidougou Hospital by cesarean section.
But Diallo didn’t want to let her story end there. When she saw a friend who was still suffering from fistula after having been operated on, Diallo urged her to go to Labé Regional Hospital, where a visiting team of specialists was able to perform a complex fistula surgery.
Obstetric fistula—nearly eradicated in developed countries more than a century ago—is preventable with the right health care provided at the right time. In Diallo’s case, that would have meant quality, midwife-led maternity care during pregnancy, labor and delivery.
“I encourage other women with the same condition to go to the hospital of Kissidougou or Labé to be treated at no cost,” Diallo says. “And especially for them not to lose hope.”
Sita Millimono is a senior clinical advisor for obstetric fistula with the HSD Project.
Alisha Horowitz is a senior editor for Jhpiego.