1. Rehabilitation/Reintegration of Successfully Repaired Obstetric Fistula Patients Rehabilitation (Home) COUNSELING Family Community shun away negative thinking alleviate any specific fears prepare the patient for hospital,

2. Rehabilitation (Hosp) COUNSELING INVESTIGATION TREATMENT unfamiliar and uncomfortable examinations To adjust to the hospital environment prepare them psychologically for a successful opera-tion

3. Rehabilitation Home CONTINOUS COUNSELING Oral Fluid Intake Literacy workshops Intensive training Vocational skills

4. Social Reintegration for Women Deemed Incurable Musa Isah Fistula Foundation Nigeria

5. Those who have sustained extensive birth injury resulting in complex fistula Women in whom fistula surgery may not be possible Those who have undergone repeated failed attempted surgical repairs Who are the Incurables?

6. Extensive trauma Contributing Factors of Incurability Many Attempted unsuccessful repairs

7. CONSEQUENCES OF INCURABLITY SURVIVORS continues to constantly leak urine/faeces SURVIVORS finds it difficult to live In harmony with their Spouses & or relatives SURVIVORS commonly Spend the remaining Years of their lives in Shame & isolation, literally waiting to die

8. Coping Strategies SURVIVORS Prefer staying in Hospitals (Fistularia) SURVIVORS Prefer renting compounds for women with similar condition Engage in different type of survival tactics e.g. aggressive begging, commercial sex work, increasing risk of HIV/AIDS.

9. Findings from our Survey of 100 WDI in Kano, Nigeria Places of living 63 Fistula Survivors living in the Hospital environment 21 living in hired Rooms (5 per room) 12 living in ISOLATION in the Community 4 Survivors living in their matrimonial homes under pressure of ‘Bahanya’

10. Findings from our Survey of 100 WDI in Kano, Nigeria Common Causes 62 – patients with failed fistula repairs 38– repeated home deliveries after initial successful repair

11. Findings from our Survey of 100 WDI in Kano, Nigeria Survival Struggles 90% Engage solely into Begging for survival 5% working as Nannies 1% self employed 3% Psychiatric Condition & Commercial sex work

12. Findings from our Survey of 100 WDI in Kano, Nigeria Coping with Incurability: how long for? 43 - (aged 15 – 20 yrs for 2 - 3 yrs) 9 - (aged 21 – 35yrs for 5 – 10 yrs) 7 - (aged 50 – above for 30 yrs) 41 – (aged 36 – 40 yrs for 15 – 20yrs)

13. Survivors frequent Question Any hope for the leaking to STOP ?

14. Preparing Community Acceptance Advocacy to Community Gatekeepers Reduce stigmatization & all forms of isolation from family & community. To mobilize for increased commitment & support of the family members & the community in general towards women living with fistula.

15. Preparing Community Acceptance Parents, Family & Community Reconciliation approach Counseling with family Members including Husband To Reduce Stigma & Discriminations  Encourage Participation In religious & social life  Increased Social support for Marriage/re-marriage as desired

16. Rehabilitations Physical, Psychological & economic support building their capacity to serve as fistula advocates Daily individual & Group Counseling Health Talk

17. Literacy Workshops For Basic Reading & Writing equip them to return to their communities empower them to make their own decisions

18. Intensive Vocational Trainings skills based on their interests & that will enhance their dignity skills sets required to succeed in their communities skills that will support them to become self-sustaining members of their community Skills that will offers them pathway out of extreme Poverty and towards dignity

19. Supporting the Patients with Equipments

20. Re - Connecting them back to the Family/community After long gap of rejection Escorting them back to their communities Family counseling to dispel any myths that will make them outcasts by explaining the condition and its causes

21. (6months) Community Follow Ups Successfully Repaired overwhelming majority of the pa-tients are in their child bearing ages and have poor obstetric history guide and zero tolerance to re- occurrence of obstetric fistula abstain from sexual intercourse for at least three months following fistula surgery Mobilize for increased commitment and support of the family towards pregnant women & women living with fistula

22. (6months) Community Follow Ups assess the level of reintegration into the family and community as well as vulnerability Evaluate the Income Generating Activities reduce stigma and discrimination

23. FISTULA FOUNDATION NIGERIA Empowering Women suffering from fistula

24. Thank You for bringing back smiles to our lifes!