Progress Reports - Fistula Report UNFPA

fistulalogo_37.pngRotary International Project “Improvement of Maternal Health - Prevention and Treatment of Obstetric Fistula”

In Kaduna and Kano State 2005-2009

Report on Rotary International´s activities in the field of VVF in Nigeria
UNFPA suggested to Prof. Dr. Robert Zinser in 2004 to contribute to the campaign ‘End Fistula’ when he visited the UNFPA Headquarter as Chairman of the Rotarian Action Group for Population Growth & Sustainable Development (RFPD). Zinser then initiated a project. 

A) General Remarks

Project and Sponsors
The Rotary project “Improvement of Maternal Health –Prevention and Treatment of Obstetric Fistulae in Northern Nigeria” aims to reduce maternal mortality and morbidity including VVF and fetal mortality in this region. 

It is sponsored by 100 Rotary, Rotaract and Inner Wheel Clubs of Germany and Austria.

Co-sponsors are THE ROTARY FOUNDATION, German Government, Aventis Foundation and International Association for Maternal and Newborn Health (IAMANEH). The Project amount is one million Euro. Contribution of Rotary satellite projects and contributions of stakeholders run up to additional 2 million Euro. The project runs from July 2005 till December 2009. 

The projectwas started in full compliance with the “National Strategic Framework and Plan for VVF Eradication in Nigeria” edited by the Nigerian Federal Ministry of Health in December 2004. We also were aware of the results of the UNFPA Fistula Fortnight Nigeria from 21st February thru 6th March 2005.

Project Area
The project area comprises Kano State and Kaduna State. 

Organization and Personnel (voluntary and paid staff) 
Project offices are in Kano, Zaria, Kaduna and Abuja. The project is headed by Dr. Kola Owoka as the National Chairman in Nigeria and Prof. Robert Zinser as the German-Austrian- Nigerian coordinator. Attached please find the Organigram of the Nigerian project-team. 

B) Prevention

1. Prevention by Awareness Campaign 

Education of the public by advocacy and awareness campaigns to political, traditional and religious leaders
From the beginning there was close collaboration with the Commissioners of Healththe Directors of Hospital Management and the Commissioners of Women affairs and social development, both in Kano and Kaduna State. The Emirs of Zaria and Kano were always important partners and were briefed regularly on all activities. All LGA representatives were visited and information was given on the aim of the project. 

Public awareness in villages, markets and schools
To get to the grass roots our fieldworkers visited villages, announcing their visits to the village heads and chiefs. Community dialogues brought together the villagers, women, men, youth and the TBAs of the village and information on the causes of VVF was passed on to them. In addition they were advised in good nutrition in pregnancy, antenatal care and early detection of risks before delivery. In schools the issue of family health and AIDS prevention was addressed. 

Radio serials
A radio serial has been broadcasted by Radio companies in Kano and Kaduna State in Hausa language. In a sensitive and emotional way the issue of reproductive health was dealt with by a PMC-made Educational soap opera called “Gugar Goge” (tell it to me straight). Baseline studies revealed that information in the rural regions can be passed on best by radio. An evaluation of the Ohio university found out that fistula patients visited our fistula centers after listening to the radio serial. 

2. Prevention by Antenatal Care and early Caesarean section

We realized that Fistula repair and awareness campaigns on this issue will not lead to a significant reduction of Fistulae in Nigeria. Prevention by improving obstetric services will bring the best results because the most important cause of a fistula is obstructed unrelieved labour. 

Identification of five hospitals in Kano and Kaduna State
In Kano State the partnering hospitals are Kano Sheik Jidda, Wudil General Hospital, Gaya General Hospital, Sumaila General Hospital, Takai General Hospital. The Supervising Hospital is Aminu Kano Teaching Hospital, Kano

In Kaduna the hospitals are Zaria Hajiya Gambo Sawaba Gen. Hospital Kofan Gayan, Kaduna Yusuf Dantsoho Mem. Hospital, Lere Alhaji Dabo Lere Hospital, Saminaka General Hospital Kafanchan, Birnin Gwari General Hospital. The Supervising Hospital is Ahmadu Bello University Teaching Hospital, Zaria

Training of the staff 
All hospitals have been upgraded in their equipment. In all hospitals the staff of the obstetric department have been trained in recognition and management of risks during pregnancy and labour as well as in life saving skills. 

Introduction of a system of quality improvement 
A system of quality improvement has been established by data collection and data evaluation on quarterly basis and review meetings of doctors, nurses/midwives every 6 months. The quality of structure, process and outcome has already improved.
The goal is to establish an Institute of Quality Assurance in Obstetric services.

C. Repair

Centres for Fistula repair
In Kano and in Kaduna State in each one centre for fistula repair has been established. In Kano it is Wudil General Hospital which started repair operations in 2007. This hospital received complete equipment for the operation theatre including operating bed, instruments, trolley and sterilizer. 

In Kaduna repair operations already started in 2005. In 2006 the State Government of Kaduna provided a newly built operating theatre building which was completely equipped by the Rotary project in Hajiya Gambo Sawaba General Hospital in Zaria. 
We also brought down a borehole and erected a 40.000 litre overhead water tank to ensure water supply for the hospital and improve hygienic conditions. A big generator guarantees the power during the time of surgery. 

In cooperation with skilled fistula surgeons the project also sponsored repair operations in Murtala Mohammed Specialist Hospital in Kano. Until July 2009 a total of 1350 Women have been repaired by the Rotary project. 

D. Rehabilitation

Centres for Rehabilitation
In Kaduna State a brand new centre for Rehabilitation of repaired Fistula patients was built in cooperation with FCEIS (Family Care Eduvision International Services) and sponsored by the Japanese Embassy. In this centre all repaired patients are rehabilitated medically and many of them receive vocational training in different skills like sewing, knitting, spaghetti making and preparing meals with the wood saving stove “Save 80”.

In Kano State also FCEIS created a building for vocational training. The Local Government later transferred rehabilitation to a different place in Wudil. The same vocational training as in Kofan Gayan is offered. Until now more than 150 Patients received vocational training in both centres.

Some of the patients were given a micro credit to enable them to start some business ensuring their living themselves.

E. Sustainability by Training of Fistula Surgeons and Introduction of Vouchers

Training of fistula surgeons with the involvement of theatre and ward nurses
The Chief Consultant to the Nigerian Government, Dr. Kees Waaldijk, served as the trainer for doctors who wanted to step in or improve their skills in fistula surgery. In total 10 doctors have been sponsored to be trained, some of them several times. 

We are in discussion with the University Teaching Hospitals in Kano and Zaria to Include training of fistula surgeons into their curricula of medical students. This has also been discussed with government and stakeholders.

For including repairs in these teaching hospitals we sponsored repairs there by issueing vouchers. At the same time we regard these vouchers as a pilot project for the introduction of vouchers with which the patients can select the surgeons and by which more surgeons take interest in repairing fistula.

Training of TBAs (Traditional Birth Attendants)
Because most of the neglected deliveries occur in the villages during home deliveries we made strong efforts to get in touch with Traditional Birth Attendant (TBAs) and train them on early risk recognition and in avoiding first and second delay. 

F. Cooperation with stakeholders (Motto: “Nobody can do it alone”)

The Rotary project team emphasizes on cooperation with as many stakeholders dealing with maternal health as possible, including Federal and State Government as well as traditional rulers. Right from the beginning of the project in 2005 each year Prof. Zinser met, escorted by other members of the German-Austrian/Nigerian Team, with representatives of UNFPA, USAID, UNICEF, Population Council, Engender Health, ACQUIRE, Pathfinder, The David and Lucile Packard Foundation and others to coordinate activities of our project with their own in the field of Fistula repair and training of doctors in repair surgery. In 2009 several meetings took place, in February, August and October. 

Prof. Dr. Robert Zinser
Past Governor of Rotary International 
Project Coordinator 

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