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Prevention and Management of Obstetric Fistula: a Curriculum for Nurses and Midwives

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Prevention and Management of Obstetric Fistula: a Curriculum for Nurses and Midwives The Prevention and Management of Obstetric Fistula: A Curriculum for Nurses and Midwives A collaborative publication of The East, Central, and Southern African Health Community and USAID Fistula Care EngenderHealth ECSACON East, Central and Southern Africa Health Community © 2012 East, Central, and Southern African Health Community (ECSA-HC) and EngenderHealth/Fistula Care. All rights reserved. East, Central, and Southern African Health Community (ECSA-HC) The Director General ECSA Health Community Secretariat 157 Olorien, Njiro Road P.O. Box 1009 Arusha, Tanzania Telephone: 255-27-254 9362/5/6 Fax: 255-27-254-9324/9392 e-mail: [email protected] or [email protected] http://www.crhcs.or.tz Fistula Care c/o EngenderHealth 440 Ninth Avenue New York, NY 10001 U.S.A. Telephone: 212-561-8000 Fax: 212-561-8067 e-mail: [email protected] www.fistulacare.org This publication was made possible by the generous support of the American people through the Office of Maternal and Child Health, U.S. Agency for International Development (USAID), under the terms of associate cooperative agreement GHS-A-00-07-00021-0 and Strategic Objective Grant Agreement (SOAG): Implementation Letter No. 4, Activity No: 623-SOAG6230011.02- 60087. The contents are the responsibility of ECSA-HC and the Fistula Care project and do not necessarily reflect the views of USAID or the United States Government. Photo credits (cover, top to bottom): C. Svingen/EngenderHealth; C. Svingen/ EngenderHealth; L. Pesso/EngenderHealth. ISBN 978-1-937410-02-5 Suggested citation: East, Central, and Southern African Health Community (ECSA-HC) and Fistula Care/EngenderHealth. 2012. The prevention and management of obstetric fistula: A curriculum for nurses and midwives. New York: EngenderHealth/Fistula Care. CONTENTS Acknowledgements .................................................................................................................. v Foreword ................................................................................................................................ vii Preface ..................................................................................................................................... ix Introduction for Trainers .......................................................................................................... 1 Module 1: Overview of Obstetric Fistula .............................................................................. 11 Module 2: Preventing Obstetric Fistula during Pregnancy, Labour, and Delivery ............... 67 Module 3: Management of Obstetric Fistula ....................................................................... 141 Module 4: Clients’ Rights, Information, Education, and Community Involvement ........... 241 Module 5: Counselling Clients with Obstetric Fistula ......................................................... 289 Module 6: Using Data to Inform Decision Making within Fistula Care Services ............... 335 Appendix A: Practica: Fistula Care Skills Checklists Use of the Partograph ..................................................................................................... 405 Urinary Catheterisation .................................................................................................. 407 Physical Assessment ...................................................................................................... 409 Preoperative and Postoperative Care ............................................................................. 412 Counselling First Contact ............................................................................................................. 415 Clinical Intake .......................................................................................................... 417 Admission and Preoperative Period ......................................................................... 419 Intraoperative Period, Spinal Anaesthesia ............................................................... 422 Intraoperative Period, General Anaesthesia ............................................................. 424 Postoperative Period ................................................................................................ 426 Discharge and Follow-Up ........................................................................................ 428 Appendix B: Training Evaluation Form .............................................................................. 431 Prevention and Management of Obstetric Fistula: A Curriculum for Nurses and Midwives iii ACKNOWLEDGEMENTS The East, Central and Southern Africa Health Community Heath Community (ECSA-HC) and the Fistula Care project at EngenderHealth acknowledge with sincere gratitude all those who contributed to the development of this curriculum. Several experts contributed to the original draft. They were as follows: Dr. Marrietta Mahendeka, obstetrician-gynaecologist, fistula surgeon, and content specialist, Bugando Medical Centre, Tanzania Stella M. Mpanda, preservice programme coordinator and curriculum designer, I-TECH, Tanzania Mary Nyawira Onsomu, education officer, Nursing Council of Kenya Roselyn A. Koech, examination officer, Nursing Council of Kenya Asteria L. M. Ndomba, lecturer, School of Nursing, Muhimbili University of Health and Allied Sciences, Tanzania Catherine Kamugumya, programme officer, research and policy analysis, Women’s Dignity, Tanzania Anna H. Mganga, nurse tutor, Ministry of Health and Social Welfare, Tanzania Kabugho Emmanuelina, nurse, Kagando Hospital, Uganda Dr. Isaac Achwal, senior medical associate, EngenderHealth Hassana Yusuf Jega, chief nursing officer, Maryam Abacha Women and Children Hospital, Nigeria Sheillah Matinhure, senior programme officer, East, Central and Southern African College of Nursing (ECSACON), ECSA-HC Doreen Marandu, programme assistant, Family and Reproductive Health, ECSA-HC Mary Charles Mhomi, programme assistant, Human Resource Development and Capacity Building Programme, ECSA-HC A team from ECSA and the Fistula Care project at EngenderHealth reviewed and revised the original draft and subsequent drafts. Team members from ECSA were: Sheillah Matinhure, manager, Human Resources for Health and Capacity Building Dr. Odiyo Odongo, manager, Family and Reproductive Health Dr. Josaphat K. Byamugisha, Makerere University College of Health Sciences, School of Medicine, Uganda Oslinah Gozo-Tagutanazvo, lecturer, Department of Midwifery Science, University of Swaziland, Swaziland Dr. Weston Khisa, obstetrician-gynaecologist, fistula surgeon, AMREF, Kenya Dr. Leah Wamuyu Kirumbi, principal research officer, Kenya Medical Research Institute, Kenya Dr. Marrietta Mahendeka, obstetrician-gynaecologist, fistula surgeon, and content specialist, Bugando Medical Centre, Tanzania Catherine Mubita Ngoma, head of Department of Nursing Sciences, University of Zambia, and chairperson of the ECSACON Faculty of Education, Zambia Dr. Tom Raassen, consultant fistula surgeon, Kenya Prevention and Management of Obstetric Fistula: A Curriculum for Nurses and Midwives v Team members from the Fistula Care project were Dr. Isaac Achwal, Betty Farrell, Dr. Joseph Ruminjo, Pamela B. Harper, Michael Dorn, Karen Beattie, Evelyn Landry, Celia Pett, Mieko McKay, Renee Fiorentino, and Dana Swanson. This book was copyedited by Christopher Caines and was designed and laid out by Elkin Konuk; Michael Klitsch provided overall publishing management. The image on page 41 appears by permission of The McGraw-Hill Companies, Inc. Permission to use the illustrations on page 44 was granted by Healthwise Incorporated, which owns all rights to these images; any use or copying and distribution of these images other than during the conduct of this curriculum requires the written permission of the copyright holders. The drawing on page 46 was created by Weronika Murray, EngenderHealth, based on an illustration developed by the United Nations Population Fund’s Campaign to End Fistula. The World Health Organization kindly provided permission to use the images on pages 99, 102, 121, 131, 134, 137, 176, 178, and 371. Paula Swisher created the image used on pages 185 and 229. ECSA-HC acknowledges, with special appreciation, the financial support provided by the United States Agency for International Development (USAID) Mission for East Africa (formerly REDSO) through Strategic Objective Grant Agreement (SOAG): Implementation Letter (IL) No. 4, Activity No: 623-SOAG6230011.02-60087. The Fistula Care project at Engender Health acknowledges, with special appreciation, the generous support of the American people as provided by USAID through Fistula Care, a five- year Associate Cooperative Agreement No. GHS-A-007-00021-00. The opinions herein are those of the publishers and do not necessarily reflect the views of USAID. vi Prevention and Management of Obstetric Fistula: A Curriculum for Nurses and Midwives FOREWORD Obstetric fistula is a significant and often neglected problem in East, Central, and Southern Africa. More than 2 million women around the world are living with obstetric fistula, most of them in Sub-Saharan Africa.1 This number may be an underestimate, because data about the condition are often limited. One study has estimated that at least 33,450 new cases of obstetric fistula occur every year in rural Sub-Saharan Africa.2 Obstetric fistula takes a heavy toll on women and society. The affected woman experiences constant leaking of urine and/or faeces; she may also face other complications, such
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