Introduction and hypothesis Genitourinary fistulas (usually arising following prolonged obstructed labor) are particularly devastating for women in low-income counties. Surgical repair is often difficult and delayed. While much attention has been devoted to technical surgical issues, the challenges of returning to normal personal, family, and community life after surgical treatment have received less scrutiny from researchers. We surveyed young Ugandan women recovering from genitourinary fistula surgery to assess their social reintegration needs following surgery. Methods A cross-sectional survey of 61 young women aged 14–24 years was carried out 6 months postoperatively. Interviews were carried out in local languages using a standardized, interviewer-administered, semistructured questionnaire. Data were entered using EpiData and analyzed using SPSS. Results Ongoing reintegration needs fell into interrelated medical, economic, and psychosocial domains. Although >90% of fistulas were closed successfully, more than half of women had medical comorbidities requiring ongoing treatment. Physical limitations, such as foot drop and pelvic muscle dysfunction impacted their ability to work and resume their marital relationships. Anxieties about living arrangements, income, physical strength, future fertility, spouse/partner fidelity and support, and possible economic exploitation were common. Sexual dysfunction after surgery—including dyspareunia, loss of libido, fear of intercourse, and anxieties about the outcome of future pregnancies—negatively impacted women’s relationships and self-esteem. Conclusions Young women recovering from genitourinary fistula surgery require individualized assessment of their social reintegration needs. Postoperative social reintegration services must be strengthened to do this effectively.

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Uganda has one of the highest obstetric fistula rates in the world with approximately 200,000 women currently suffering. Surgical closure successfully treats fistula in the majority of cases, yet there is a severe shortage of facilities and trained surgeons in low-resource countries. The purpose of this study was to examine Ugandan women's experiences of obstetric fistula with the aim of adding narrative depth to the clinical literature on this devastating birth injury. Data were collected through semistructured interviews, focus groups, and participant observation. Resulting narratives were consensus coded, and key themes were member-checked using reciprocal ethnography. Women who suffered from fistula described barriers in accessing essential obstetric care during labor-barriers that are consistent with the three delays framework developed by Thaddeus and Maine. In this article, we extend this scholarship to discuss a fourth, critical delay experienced by fistula survivors-the delay in the diagnosis and treatment of their birth injury.

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-The engineering profession is increasingly recognizing that engineers' abilities to utilize a systems perspective and collaborate on multidisciplinary teams are critical professional competencies required to solve contemporary engineering challenges. Understanding context, including but not limited to social and cultural context, is one aspect of systems thinking that is important to effective problem-solving, yet such training is not yet standard in our engineering curricula. Humanitarian engineering-related capstone design projects offer both hands-on and field opportunities to integrate social and cultural appropriateness into a formal engineering design curriculum. Over the 2015-2016 academic year, Oregon State University offered a capstone project aimed at optimizing and implementing an improved soap-making process for TERREWODE, a non-governmental organization in Uganda. The ultimate goal of this soap-making project was to expand income-generating opportunities for victims and survivors of obstetric fistula. The project consisted of a six-month, on-campus design phase and a three-week field implementation and research trip in Soroti, Uganda. Six Social Justice (SJ) criteria were used in assessing project context and developing design requirements. Throughout the design phase, experimental testing drove the majority of design decisions. During field implementation and research, the three-student capstone design team worked closely with TERREWODE and their members to optimize the process, understand cultural conditions, and recommend options for potential local solar power systems.