Currently the worldwide prevalence of fistula is estimated to affect in excess of two million women. Women with an obstetric fistula experience leakage of urine and/or faeces from their vaginal cavity. This leakage results from a hole between the vagina and bladder (vesicovaginal) or vagina and bowel (rectovaginal). An obstetric fistula has a tremendous clinical and societal burden on patients. As a result of their clinical symptoms, many patients are banned from their communities.
The annual incidence of obstetric fistula’s in sub-Saharan Africa is 123.9 per 100,000 deliveries (95%CI: 0-18).Surgery to repair Obstetric Fistula is difficult and requires extensive training. Often, even in the best hands, the surgery is unsuccessful due to the extensive tissue damage. The Global Fistula Map (globalfistulamap.org) shows the highest concentration of fistula to occur in most Sub-Saharan African countries, India and Pakistan and their neighbours.
Lack of access to safe Cesarean Section is one the most important factors in the development of a fistula , therefore ideally fistula should be prevented by improving maternity services in the countries where they are the most prevalent. This is obviously dependent on enormous amounts of funding and political input. In the interim, the surgical approach to fistula requires refinement. By simplifying the surgery and improving outcomes many more women would have access to treatment.
The efforts of current fistula programs is to improve access to prevention strategies and to improve surgical intervention. There has been little attention given to technology that could solve these problems. It would also place a more simple solution in more surgeons hands. Therefore our obstetric fistula technology program will focus on different areas in the prevention and treatment of obstetric fistula. Our program aims at emerging a prevention program that suits current societal, political and health care circumstances. A step-by-step approach for development of technological interventions that tackle current barriers in adequately curing women during and after labour. Also, an implementation framework will be realised taking into account local requirements.
The PFFSA promotes education in the field of fistula surgery. We have relationships with experts in fistula surgery world wide and our ambition is to support their travel to underdeveloped countries to locally educate physicians and other healthcare workers in fistula surgery.
In addition we plan to organize a teach the teacher program. There is a significant variation in insight about the optimal approach of fistula surgery, and such course would help to create uniformity in training worldwide.
Last but not least we hope to create a budget to sponsor every year 4 observerships, meaning that we facilitate the travel of a surgeon in an are with high prevalence of obstetric fistula to travel to another institute for additional training. That can be training in vaginal surgery, but also in coordination of care or in research.
The foundation supports a research consortium called FIN (Fistula innovations). The co-founders of the foundation participate as researcher in FIN, which also involves gynaecologists from US-universities and researchers with a strong record on product development.
FIN has the goal to develop a tissue engineered solution to cure obstetric fistula, meaning that instead of complicated surgery , the tissue is regenerated resulting in normal bladder function and normal sexual function after repair. The research group intends to design an application that is so simple to perform, that the local physicians can perform it with very limited training. In this way hundreds of thousands of women worldwide will get access to solutions for their obstetric failure, that are now depending on an expert fistula surgeon visiting their area.
In fistula surgery the quality of instruments is key. Many hospitals do not have access to the best instruments. The foundation has developed a list of surgical instruments that are most suitable to perform fistula surgery. We intend to help local hospitals in getting the best surgical instruments and in maintaining these instruments.
+27 82 2675 640
Foreshore, Cape Town 8000