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Posted Nov 04 2009 10:04pm

I had a professional very exciting and pleasant stay in Nigeria, but it is anyhow good to be back home in Ethiopia.

What did I learn from my visit in Nigeria?

Fistula surgeons in general concentrate on closing the fistula opening by suturing the bladder wall. Dr Kees has a different approach. The fistula is to be considered as part of a major traumatic tissue lost of important structures – muscles and fascia – in the pelvic floor. In short he is focusing on reconstruction of the tissue (fascial) defect, and during that process the fistula is closed as well - just as the continence mechanism is restored.

I watched and learned his operation for restoring continence in women with severe stress incontinence (inability to hold the urine) after successfully closure of a fistula. Step by step the urethra was shown with repeated measurements to lengthen before your eyes, and from flowing uncontrollable the urine gradually was controlled completely. An original and beautiful procedure which could help innumerable women not only in the third world but in the first world as well.

The unfortunate thing is that it is extremely difficult for people over there to accept that something can be learned from the third world.

I even learned something new about surgery for prolapse – a very simple way of restraining a uterine prolapse and a better way to do a cystocele repair.

All this I hope to demonstrate with pictures on my pages here on the blog after a while.

Being in the business for some time nothing surprises anymore. That the Fistula Project which Dr Kees is running – the largest in the world – has insufficient financial support to that extent that he from time to time has to pay from his own pocket is however a scandal.

As I have stated repeatedly the vast majority of the NGOs are considering curative healthcare (hospital inpatient care) as not worthy of financial support. Support to preventive health exclusively is considered politically correct.

Why is it so difficult to understand that the only way to cure a fistula is by surgery and the only way to prevent a fistula is by surgery – that is a cesarian in due time.

If there is no functional obstetric service which offers a cesarean in about four hours after a delivery gets obstructed all other means are useless. What is the use of identifying risk mothers at antenatal clinics or complications during delivery if there is no hospital where the delivering mother can be referred and get a cesarean in due time? What does empowering women and enlightening them about their right to good health care help if there is no good health care around?  

All that money which are poured out on different “fistula projects” – billions of dollars – are wasted as long as there is no functional hospitals with professional and efficient obstetric service including surgical relief of an obstructed labor.

What did the recent meeting in Addis Abeba where all the “big shots” and “experts” from all over the world discussed maternal health care in the developing world cost? Millions of dollars for business class flights, 5 star hotels and 5 stars restaurants – and maybe whiskey and women? (who know? I wouldn’t be surprised). And what came out of it? Nothing but empty words, a promise to reduce maternal death by 75% in 5 years! Wonderful - if only talking could do it. Unfortunately however I haven’t seen any documentation until now that talking saved a single mother’s life or closed a single fistula.


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