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

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

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

4. 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

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

6. Fistula Disease…. is a type of violence

7. Obstetric Fistula:
Estimates of 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.

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

9. 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

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

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

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

13. 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.

14. 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………………….

15. Midwifery books were distributed to midwifery schools, all over Pakistan

16. 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.

17. Production and Screening of Teleplay on Fistula

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

19. NURSING & MIDWIFERY SYMPOSIUM
Tuesday, 11th October 2011

20. Simple Fistula Repair Workshops

21. Rehabilitation

22. FISTULA TASK FORCE

23. 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

24. 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

25. “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

26. Thanks
PNFWH

27. Thanks
PNFWH

28. Thanks
PNFWH

29. Thanks
PNFWH