Collaborating to advance women’s health and rights – Women Deliver

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April 30, 2018 Gillian Slinger, Senior Project Manager, Fistula Surgery Training Initiative FIGO

Collaborating to advance women’s health and rights

There is no doubt that collaborative partnerships are an integral part in moving the Sustainable Development Goals (SDGs) forward.

In fact, I would go even further, to say that achievement of the SDGs will largely be determined by the 3 Cs and the 3 Ps; communication, coordination and collaboration, and partners, partners, partners!

Obstetricians and gynecologists, and of course midwives, alongside other health professionals, are key actors in ensuring that the UN SDGs are achieved and women’s sexual and reproductive health is enhanced.  Yet, major shortages of trained professionals represent a serious concern. This is particularly vital in low and middle income countries where it is reported that an estimated 18 million additional health workers will be needed by 2030 to attain high and effective coverage of the broad range of health services necessary to ensure healthy lives for all.

One neglected public health and human rights issue that FIGO focuses on, in partnership with a number of organisations, is the huge unmet need to treat and repair the backlog of women with obstetric fistula.

This condition shatters women’s lives, leaving them ashamed, suffering and often ostracised from their family and society. Fistula affects an estimated two million women in some 55 low resource countries of Sub-Saharan Africa and South Asia; with up to 100,000 additional women tragically developing a fistula every year in some of the world’s poorest and most disadvantaged communities.

Sadly, only one woman in 50 is currently able to access treatment for her fistula, simply because of a global shortage of trained, skilled fistula surgeons. Here at FIGO, we were compelled to help affected women, by addressing the huge treatment gap, no matter how great the challenges. There are simply not enough trained surgeons capable of repairing obstetric fistula in the countries where this devastating condition occurs.

In response, FIGO and partners produced the first ever competency-based Fistula Surgery Training Manual in 2011, providing the first standardised curriculum –developed by leading fistula surgeons and key organisations working on the issue- to train the next generation of fistula surgeons.

Following release of the manual, the FIGO Fistula Surgery Training Initiative was launched, and with crucial, on-going funding from the Fistula Foundation in California, the programme has grown significantly since its early days.  FIGO works in direct collaboration with key partners in the fistula world, including established Training and Fistula Treatment Centres such as Hamlin Fistula Ethiopia.

With the help of multiple partners, including fistula experts, fistula treatment facilities and governments, as well as many other agencies focusing on fistula, such as the Fistula Foundation, UNFPA, EngenderHealth, AMREF, Norwegian Red Cross and many others, there are currently 52 FIGO Fellows –trainee fistula surgeons- on the programme, from 19 affected countries in Africa and Asia. Despite many challenges, collectively, these surgeons have performed more than 6,000 fistula repair operations, helping thousands of women regain their lives from this debilitating condition which if left untreated, leaves them permanently incontinent.

One such surgeon is Dr. Sr Elisabetta Raule from Chad:

 “Receiving on-going training on the FIGO Programme has widened my knowledge about maternal complications. I can now better understand some of the terrible consequences of obstructed labour in poor regions, and I can better detect fistula cases and help solve the problem. I feel a great satisfaction when I repair and heal a woman with a fistula. For a surgeon working practically alone in the poorest conditions, having the chance of being trained on the FIGO Programme & sharing clinical experiences with other fistula surgeons is a great opportunity!” 

If we are to meet the 2030 targets, health interventions need to be expanded, particularly in the hardest to reach regions that suffer the greatest burden of maternal /newborn health problems. This will place a huge demand on the global health workforce. Long term solutions require ensuring well-functioning maternal health systems, including safe delivery services and emergency obstetric care. For the immediate future, it’s essential that more surgeons are trained on fistula repair and more health facilities are able to provide holistic fistula treatment services, including rehabilitation and social assistance.

From the perspective of pure human suffering, it is absolutely unacceptable that only one woman in 50 is presently able to access fistula treatment, while all other affected women are at risk of rejection from their families and their communities.

Through the power of partnerships, it’s time obstetric fistula was brought back to the forefront of global conversation and to ensure that no woman is left behind, especially the most vulnerable. It’s time to ensure that more affected women receive life transforming care.

Join us on the International Day to End Obstetric Fistula on May 23rd and help more women suffering the dire consequences of fistula recover and re-build their lives.


About the author

Gillian Slinger is a Midwife & holds a BSc in Health Management, an MSc in Public Health, & a Teaching Certificate. After completing her Nurse & Midwifery training in the UK, Gillian worked as a Midwife for 10 years in French speaking Switzerland, before joining Médecins Sans Frontières (MSF) & Save the Children UK as a field Midwife & Trainer in numerous countries, including Mali, Chad, DRC & Sierra Leone. She then spent 3 years in MSF Head Quarters in Geneva as Reproductive Health Advisor. As part of her MSF duties, Gillian led maternal & new-born health activities in 25 low resource countries across the world, & had an active role in the development of projects for women with obstetric fistula. Since this time, she has become an international activist for fistula & her involvement in fistula work has increased considerably, taking her to New York for 4 years as Coordinator of the global Campaign to End Fistula with UNFPA where she was instrumental in establishing the UN approved International Day to End Obstetric Fistula, & bringing her to the International Federation of Gynecology & Obstetrics (FIGO) in London in 2014 to undertake her present role as Senior Project Manager of the FIGO Fistula Surgery Training Initiative. Now that Gillian is back in Europe, as well as pursuing her great passion of helping women with obstetric fistula, she is delighted to continue her teaching in the Liverpool School of Tropical Medicine and to be on the Board of Directors of MSF Switzerland.


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