Out of the shadows and 6000 reasons to celebrate: An update from FIGO's fistula surgery training initiative

Abstract

Obstetric fistula is a devastating childbirth injury caused by unrelieved obstructed labor. Obstetric fistula leads to chronic incontinence and, in most cases, significant physical and emotional suffering. The condition continues to blight the lives of 1-2 million women in low-resource settings, with 50 000-100 000 new cases each year adding to the backlog. A trained, skilled fistula surgeon is essential to repair an obstetric fistula; however, owing to a global shortage of these surgeons, few women are able to receive life-restoring treatment. In 2011, to address the treatment gap, FIGO and partners released the Global Competency-Based Fistula Surgery Training Manual, the first standardized curriculum to train fistula surgeons. To increase the number of fistula surgeons, the FIGO Fistula Surgery Training Initiative was launched in 2012, and FIGO Fellows started to enter the program to train as fistula surgeons. Following a funding boost in 2014, the initiative has grown considerably. With 52 fellows involved and a new Expert Advisory Group in place, the program is achieving major milestones, with a record-breaking number of fistula repairs performed by FIGO Fellows in 2017, bringing the total number of repairs since the start of the project to more than 6000.

Training and capacity building in obstetric fistula repair: A scoping review

“…Through systematic database and gray literature searches, 405 records were identified (Figure 1). After removing duplicates and screening by title and abstract, there were 64 sources for full‐text screening, of which 24 sources were included in the scoping review 14–37 . Of these, six (25%) sources were from the gray literature, 13 (54.2%) were original articles from LMICs, and five (20.8%) were original articles from HICs (Table S1).…”

“…All of the nine LMIC training articles, highlighted in green in Table S1, are descriptive rather than explicitly prescriptive in that they retrospectively report the number of cases undertaken 26,27,31 or time spent in training. 20,21,24,28,30,32 The only exception is one article's reference to at least 200 to 300 repairs to become a trainer, 20…”

Identifying Opportunities for Prevention of Adverse Outcomes Following Female Genital Fistula Repair: Protocol for a Mixed-Methods Study in Uganda

“…This work is an important corollary to existing efforts to increase access to genital stula surgery among the estimated 500,000-2 million women currently living with this condition. 1,57 In addition to informing an important evidence gap, establishing a large longitudinal cohort such as this represents an important opportunity to develop an important resource for investigating other important research questions on the period following genital stula repair, including those focused on other physical concerns and psychosocial trajectories and outcomes, and we will encourage and support investigation in these areas through professional development among research team members, collaborating with other researchers, and developing capacity through the involvement of trainees in our project.…”

Addressing the fistula treatment gap and rising to the 2030 challenge

“… In 2011, after numerous stakeholder meetings, releasing the world's first standardized curriculum—FIGO and partners’ Global Competency‐based Fistula Surgery Training Manual—to train fistula surgeons In 2012, launching the Fistula Surgery Training Initiative—an ambitious multiyear program with the aim of training more fistula surgeons (using the Competency‐based Manual) to considerably increase the number of skilled fistula surgeons in affected countries so that significantly more women receive treatment. …”