DESPAIR TO DIGNITY Dr. Shershah Syed PNFWH President Pakistan National Forum on Women’s Health (PNFWH)

Gender inequality with limited educational opportunities Back ground: Poverty Illiteracy Gender inequality with limited educational opportunities Marriage at early age

Situation of Reproductive Health in Pakistan: Low Contraceptive Rate (30%) High Fertility (4.1) No priority of women’s health

High Maternal Mortality and Morbidity Situation of Reproductive Health in Pakistan: Non availability of EmOC services at community level Non Functioning of basic and secondary health facilities (BHU/MCH/RHC/THQ) for basic and comprehensive services 65% deliveries conduct in home mostly by DAIs No practice of HTSP Consequent pregnancy along with malnutrition and anemia prone to risk of pregnancy related complications High Maternal Mortality and Morbidity 276 deaths per 100,000 live births 300,000 women die due to pregnancy related complications 400,000 facing morbidities

Obstetric Fistula Devastating disease that makes the life of fistula patients miserable

Fistula Disease…. is a type of violence

Obstetric Fistula: Estimates of 3000 - 5000 new cases of Obstetrical each year in Pakistan. Limited indigenous surgical repair capability. Cultural and religious worldviews serve to perpetuate the status quo: “whatever will be, will be” “the will of God (Allah)” Women currently have neither the education, resources, nor rights to change the underlying causes of fistula.

FISTULA PROJECT Started in Nov 2005 PREVENTION AND TREATMENT OF POST-PARTUM COMPLICATIONS (FISTULAE) IN PAKISTAN Started in Nov 2005 PNFWH

Purpose: To provide adequate and accessible facilities for the treatment of fistula and to prevent the incidence of Fistula in future Strengthening of Seven Fistula Regional Centers. Enhancing Treatment Technical Capacity. Enhancing Accessibility of Patient to Quality Surgery. Rehabilitation Awareness and Promotion of Safe Delivery. Policy Advocacy

Achievements: 7 regional centers (Karachi, Larkana, Lahore, Multan, Islamabad, Quetta and Peshawar) 6 referral centers ( Karachi, Hyderabad, Abbottabad, Nawabshah, Peshawar, Quetta)

Achievements: doctors including gynaecologist, urologist & general surgeons were trained for providing services for fistula management. Doctors Trained (Year wise)

Achievements: 450 nurses & midwives being trained on fistula prevention and post-operative care. Nurses & Midwives Trained (Year wise)

Achievements: A total of 2866 patients were treated from Jan 2006 to Dec 2012. Twenty one (21) out-reach camps for fistula patients were held from2006 to 2012 in which about hundred and fifty (200) fistulas were treated.

Iatrogenic Fistula Increasing Challenge 50-60% of cases reporting since last two to three years Technical Assistance Surgeries/Technical skills of new surgeons????? Issue of Competence Issue of Negligence Issue of training Issue of Regulation of PMDC, CPSP………………….

Midwifery books were distributed to midwifery schools, all over Pakistan

IEC and advocacy material has been printed disseminated all over the country. Launching of an Urdu Medical Dictionary (Revised Edition) for midwifery & nursing students. Six articles on Fistula published in English, Urdu & Sindhi newspapers. Afsana, a collection of short Stories on fistula, was published in Urdu & English.

Production and Screening of Teleplay on Fistula

“Neglected No More Dignity Restored” International Gynaecological Conference on Genital Tract Fistula 4-6th March 2011 Sheraton Hotel Karachi “Neglected No More Dignity Restored”

NURSING & MIDWIFERY SYMPOSIUM Tuesday, 11th October 2011

Simple Fistula Repair Workshops

Rehabilitation

FISTULA TASK FORCE

Challenges / Bottlenecks Prevention of OF, Cultural & Social, obstacles Shortage of SBA. Capacity Building - trainees with master trainers Strategies to integrate fistula with safe motherhood and RH Prevalence / Incidence fistula still not know Increasing burden of Iatrogenic Fistula Integration into RH

Lesson Learned / Recommendation Training of doctors, Nurses & Midwives Training Private consultants on fistula repair Rehabilitation center for Fistula patients (Skill, Education) needed at all regional centers. Jobs for non- repairable patients Local fund generation including fund raising campaigns Liaison with Zakat and usher committees for funds

“Women are not dying because of diseases we cannot treat “Women are not dying because of diseases we cannot treat. They are dying because society has yet to make the decision that their lives are worth saving” Mahmoud Fathallha

Thanks PNFWH

Thanks PNFWH

Thanks PNFWH

Thanks PNFWH