www.canadianhealthcarenetwork.ca
April 29, 2011
Alexina Bonareri waited patiently in the packed hallways of Western Kenya’s Kisii National Hospital. More than a decade had passed since she lost her baby and her dignity. Today’s simple surgery would repair her torn body and give her back a normal life after 14 years as a social outcast.
The African Medical and Research Foundation’s (AMREF) five-day Safe Motherhood Surgical Outreach Camp would operate on 40 women at the Kisii Hospital, including Alexina, repairing fistula caused by obstructed or prolonged childbirth. More importantly, the specialist surgeons would leave behind a powerful legacy of local surgeons trained to treat women like Alexina. The lack of trained doctors, surgeons and other health workers is at crisis level across the continent and is a major obstacle to improved health.
Maternity is a minefield in Africa. With few health centres and dangerously low access to prenatal care, most women in sub-Saharan Africa deliver at home. Alexina’s case is all too common. After hours of agonizing labour, she was brought to a health centre. Her baby was dead and she had suffered a devastating injury: fistula.
“I have lived with this for 14 years. I had to wash my clothes all the time. The pain never went away and nobody was able to help me,” she says.
Vesico vaginal fistula (VVF) is a hole between the rectum and vagina or bladder and vagina, almost always caused by complications during prolonged childbirth. It is easily prevented with basic obstetric care and hasn’t existed in countries like Canada for more than a century. According to the United Nations Population Fund, there are 50,000 to 100,000 new cases in Africa every year.
The side-effects are debilitating. Women can’t control their bladders, bowels or sometimes both. They are isolated, often living in silence and shame for years.
AMREF’s five-day Safe Motherhood Surgical Outreach Camp repairs these devastating injuries through a routine operation that costs $300. For women like Alexina, finding the money and accessing a surgeon is nearly impossible; AMREF’s pro-bono operation was her only hope.
While the patients are deeply grateful, the primary objective of the AMREF experts is to train local doctors on the basic operation, ensuring the services are available after the outreach team is gone.
The long-lasting impact is undeniable.
“In Tanzania we have trained 24 local doctors and they now perform over 80% of AMREF’s fistula repair operations, while AMREF’s surgeons perform the rest,” says Dr. Tom Raassen AMREF’s consulting surgeon who founded the VVF outreach program.
Most remote communities across sub-Saharan Africa simply don’t have access to surgical care. A 2010 report in PLoS medicine on eight district hospitals in Tanzania, Uganda and Mozambique revealed none of the facilities had a surgeon or anesthesiologist on staff.
In Uganda, 10 specialist surgeons and 350 anesthetists serve a population of more than 30 million. In Western countries, nearly 11,000 surgeries are performed annually for every 100,000 people. In sub-Saharan Africa there are just 295 for every 100,000 people.
Originally founded as the Flying Doctors in 1957 by three surgeons in the foothills of Mt. Kiliminjaro, AMREF was one of the first organizations to bring expert surgical care to communities in rural East Africa.
Today Nairobi-based AMREF, a non-governmental organization, runs the most extensive surgical outreach and training programs on the continent.
“AMREF’s Flying Doctor Service is incredible at reaching remote communities and they have extensive expertise delivering high quality surgical care,” says Dr. Shahla Yekta a researcher at the University of Toronto’s Department of Plastic and Reconstructive Surgery.
Dr. Yekta and Chief of Plastic Surgery at Toronto’s St. Joseph Hospital and University of Toronto professor Dr. Leila Kasrai are working in partnership with AMREF on a University of Toronto research project investigating gaps in surgical care across East Africa.
“In Canada a child born with cleft lip and palate will be registered to have surgery in three months. In most of East Africa a child will not get the surgery until much later in life, if ever. This has a huge impact on the child’s ability to eat, breastfeed and their susceptibility to infections. Of course there is also stigma because of the disfigurement,” she says.
In addition to the Safe Motherhood Program which in 2010 provided more than 2,000 consultations and 1,200 pro-bono fistula repair operations, AMREF’s larger outreach program visits an additional150 hospitals in the Democratic Republic of Congo, Ethiopia, Kenya, Rwanda, Somaliland, South Sudan, Tanzania and Uganda.
Specialists in 23 different fields including general surgery, pediatrics, urology, orthopedics and gynecology conduct more than 7,000 operations annually.
The surgical procedures range from cleft palate and lip repairs, post-burn contracture releases and repairing deformities caused by leprosy and polio.
The challenges of performing the surgeries in remote hospitals and health facilities are immense. Water supplies are scarce and power cuts happen often. Incredibly, while operating AMREF experts also provide more than 1700 hours of formal training to 1300 doctors as well as 4000 nurses and other mid-level health professionals ever year.
Training the doctors and nurses in hospitals and health centres where they work ensures that the experience replicates their every day environment – regardless of how difficult.
The University of Toronto researchers hope their study will demonstrate that access to essential surgery is a public health concern, eventually increasing funding available internationally to address critical gaps in care for Africans.
“We’re talking about basic surgical care that will enable a person to be a functioning member of society and therefore contribute to their own well being as well as the well being of others,” says Dr. Yekta.
For women like Alexina basic surgical care gave her a second chance to live a normal life.
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