This book comprehensively covers all aspects related to the clinical management of individual patients with obstetric fistula as well as how to set up a programme (both national and local) to deal with this problem at a group level. Its simple language, clear writing style, easy to read layout as well as good balance of detail and overall coverage support its winning the British Medical Association’s 2007 annual Medical Book Competition.

It starts by outlining the scale of the problem and social and economic factors contributing to obstetric fistula and detailing the impact it has on those suffering from it. These are later reflected in the communication with patients, who need considerable tact from the moment they arrive at the reception, as well as documentation of care, to ensure that patient management takes note of her circumstances, such as ability to travel. Then, it provides a framework for national and regional strategy to help dealing with the problem. This framework explores stages, options and requirements for a realistic approach that sets short, medium and long-term goals and action plans and covers prevention as well primary, secondary and tertiary control. It addresses training and staffing requirements to set up and maintain fistula service in areas with high incidence, including visiting surgeons. It also deals with the cultural barriers preventing women from seeking help. Special attention is given to sustaining services and monitoring progress.

The clinical care of individual patients is covered after that, with emphasis on multidisciplinary teams including nursing aspects, physical as well as social rehabilitation and psychological support. The principles, rather than technique, of surgical repair are outlined, with emphasis on building networks to refer complex cases to centres with appropriate expertise. Post-operative care and complications are addressed in a way that can understood by those likely involved in this part of patient care. A sample of data sheets, patient cards and check lists is provided as examples for those developing programmes.

The book is not meant to be a clinical or operative text book, and should not be used for this purpose. It is a comprehensive manual that outlines the various aspects involving in dealing with fistula at a national and regional level. It is meant for all those involved, including clinicians and non-clinicians. To that end, the book is an invaluable resource, particularly for clinicians who are used to dealing with individual patients and are thus unaware of the wider aspects of providing fistula service. The detail and practical stance of the book are impressive and can only help motivating people to get involved in fistula programmes worldwide. This book should be on the shelf of any professional committed to helping eradicating obstetric fistula.