obstetric fistula overview in afghanistan at cure international hospital, kabul dr. yousuf khan md...
TRANSCRIPT
IOFWG meeting 2012, Dhaka- Bangladesh
Obstetric Fistula overview in Afghanistan at CURE
International Hospital, Kabul
Dr. Yousuf Khan MDDeputy Medical Director CURE International Hospital, Kabul
Outline of presentation
• Introduction of Afghanistan• Health care structure review • Pregnancy related mortality ratios and other
maternal health indicators • Overview of obstetric fistula at CURE
International hospital, Afghanistan • Outreach effort by CURE hospital
Introduction
• Afghanistan is land locked country located in south central Asia
• Population: 29.7 million• Total land area of the country: 652,690 Square Km• Annual population growth rate: 2.6% • Around 85% of the population lived in the rural areas • 34 Administrative division (provinces) • About 36% population is un employed and lives
bellow poverty threshold
4
Health care structure Information
• Health post (hp): 10277• Health sub centre (HSC): 468 • Basic health centre (BHC): 807• Comprehensive health centre (CHC): 388 • District hospital (DH): 67• Provincial hospital (PH): 29• Regional hospital (RH): 5• National Hospital (NH): 24
Pregnancy Related Mortality Ratios and associated maternal health indicators
• Pregnancy related mortality ratio, AMS 2010
• Percentage of women receiving ANC from skilled provider
• Percentage of births delivered by SBA
• Percentage of births delivered in a health facility
• Percentage of ever married women age 15-49 with no education
327
60
34
32
88
Overview of obstetric fistula work at CURE Hospital, Kabul
• In 2006 obstetric fistula repair launched by an expatriate surgeon
• In 2007 CURE hospital sent two local obstetrician/ gynecologist to Hamlin fistula hospital in Addis Ababa for initial training
• Later on both doctors received an advance training in Hamlin hospital
Overview…• In 2011,3rd Obstetrician/gynecologist
received initial training in Hamlin hospital
• During this time 3 nurses and one OF coordinator received training in Hamlin hospital
• One Anesthesia technician received training in abroad as well
• since the program launched there is always visiting fistula surgeons support is available to help these doctors in repair of extensive fistula cases
• Construction of Fistula hostel in CURE hospital compound
All birth injury seen at CIH since program inception
1 2 3 4 5 6 70
20
40
60
80
100
120
140
160
2005 through 2011
Year of program
Abso
lute
num
ber o
f cas
es
Outreach efforts Obstetrical Fistula coordinator trips to provinces
• 20 minute power point explaining what OF is, how it is detected, how it can be prevented and how it can be treated for free at CIH
• Letter of introduction from MOPH essential
• Each trip lasts 2 to 4 weeks involving 15 to 25 training sessions at as many different health care facilities as possible
11
4784 health care workers at 329 different health care facilities in 16 provinces
Summary of 16 Outreach Trips July 2007 through July 2012
July 2011 210 HCW at 22 HF
Dec 2011 523 HCW at 31 HF
April 2012 – August 2012
1145 HCW at 76 HF
Jan. 2011 – June 2011
1376 HCW at 95 HF
August 2010 – December 2010
793 HCW at 52 HF
November 2009 – May 2010
737 HCW at 53 HF
Outreach con…
Clinical clerkships at CURE
• CURE was hosting 20 trainees per month from 20 different provinces to offer clinical refresher training in their fields. (OBGYN, PEDS, GEN SURG, INT MED, Nurses, Midwives, Anesthetist, lab technicians)
• We took some time during their orientation to explain about our free OF program and provided them with brochures in the local languages.
13
Over 700 healthcare providers from 20 provinces trained at CURE
Badak
hshan
Takh
ar
Baghlan
Jawzja
n
Sare-e-Pul
Farya
b Herat
Farah
Nimroz
Helman
d
Kandah
arZa
bul
Ghazni
Paktika
Paktia
Khost
Ningarhar
Lagh
manKonar
Bamya
n
Ward
ak
0102030405060708090
100
1 month clinical clerkship2009 - 2012
14
Outreach con…
OF training of provincial healthcare providers
• 2009 12 trainees came to CURE for 4 to 6 weeks – 1 surgeon– 4 anesthetists– 5 nurses– 2 midwives
• Provinces– 5 from Herat– 3 from Badakshan– 4 from Kabul
Outreach con…
Orientation of Midwives
• In sep 2012 totally 21 midwives were invited for two days OF orientation workshop from 21 different provincial hospitals
• Those midwives who came for training will act as focal points for OF referral in their respected hospitals and provinces
• An incentive plan were considered for each OF referral
Outreach con…
Mass Media
• TV• Radio • OF printed brochures
Mass media advertising March to October 2011
11-Mar
18-Mar
25-Mar1-A
pr8-A
pr
15-Apr
22-Apr
29-Apr
6-May
13-May
20-May
27-May
3-Jun
10-Jun
17-Jun
24-Jun
1-Jul8-Ju
l
15-Jul
22-Jul
29-Jul
5-Aug
12-Aug
19-Aug
26-Aug
2-Sep9-Se
p
16-Sep
23-Sep
30-Sep7-O
ct0
10
20
30
40
50
60
70
80
90
100
Number of 30 to 60 second spots
TV Radio
Way forward
• Prevention
- CURE Hospital has plans to continue its OB/GYN and family medicine training programs, In addition, CURE would like to augment this effort by expanding midwifery training at both its hospital and clinic
- we recognizes that these programs are having not only impact in decreasing maternal and infant mortality in Afghanistan, but also helping to prevent OF
Way forward
• Expansion of treatment capacity:CURE’s goal is to perform 160 repairs in 2012 alone and to be capable of repairing 200 annually by 2014
• Expansion of outreach activities
Thanks
• Women Hope International (WHI)
• Fistula Foundation (FF)
• Ministry of Public Health (MOPH), Afghanistan