Abstract
The vesico-vaginal fistula from prolonged obstructed labor has become a rarity in the industrialized West but still continues to afflict millions of women in impoverished Third World countries. As awareness of this problem has grown more widespread, increasing numbers of American and European surgeons are volunteering to go on short-term medical mission trips to perform fistula repair operations in African and Asian countries. Although motivated by genuine humanitarian concerns, such projects may serve to promote ‘fistula tourism’ rather than significant improvements in the medical infrastructure of the countries where these problems exist. This article raises practical and ethical questions that ought to be asked about ‘fistula trips’ of this kind, and suggests strategies to help insure that unintended harm does not result from such projects. The importance of accurate data collection, thoughtful study design, critical ethical oversight, logistical and financial support systems, and the importance of nurturing local capacity are stressed. The most critical elements in the development of successful programs for treating obstetric vesico-vaginal fistulas are a commitment to developing holistic approaches that meet the multifaceted needs of the fistula victim and identifying and supporting a ‘fistula champion’ who can provide passionate advocacy for these women at the local level to sustain the momentum necessary to make long-term success a reality for such programs.
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Wall LL, Arrowsmith SD, Briggs ND, Browning A, Lassey AT (2005) The obstetric vesicovaginal fistula in the developing world. Obstet Gynecol Surv 60(Suppl 1):S1–S51
Arrowsmith S, Hamlin EC, Wall LL (1996) Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstet Gynecol Surv 51:568–574
Danso KA, Martey JO, Wall LL, Elkins TE (1996) The epidemiology of genito-urinary fistulae in Kumasi, Ghana, 1977–1992. Int Urogynecol J 7:117–120
Wall LL (1998) Dead mothers and injured wives: the social context of maternal morbidity and mortality among the Hausa of northern Nigeria. Stud Fam Plann 29(4):341–359
Wall LL (2002) Fitsari ‘Dan Duniya: an African (Hausa) praise-song about vesico-vaginal fistulas. Obstet Gynecol 100:1328–1332
Murphy M (1981) Social consequences of vesico-vaginal fistula in northern Nigeria. J Biosoc Sci 13:139–150
Mafakhkharul Islam AIM, Begum A (1992) A psycho-social study on genito-urinary fistula. Bangladesh Med Res Counc Bull 18(2):82–94
Hodges AM (1999) The Mitrofanoff urinary diversion for complex vesicovaginal fistulae: experience from Uganda. BJU Int 84:436–439
Elkins TE, Wall LL (1996) Report of a pilot project on the rapid training of pelvic surgeons in techniques of obstetric vesico-vaginal fistula repair in Ghana and Nigeria. J Pelvic Surg 2:182–186
Martey JO, Elkins TE, Wilson MB, Adadevo SW, MacVicar J, Sciarra JJ (1995) Innovative community-based postgraduate training for obstetrics and gynecology in West Africa. Obstet Gynecol 85:1042–1046
Martey JO, Hudson CM (1999) Training specialists in the developing world: ten years on, a success story for West Africa. Br J Obstet Gynaecol 106:91–94
Klufio CA, Kwawukume EY, Danso KA, Sciarra JJ, Johnson T (2003) Ghana postgraduate obstetrics/gynecology collaborative residency training program: success story and model for Africa. Am J Obstet Gynecol 189:692–696
Loudon I (1992) Death in childbirth: an international study of maternal care and maternal mortality, 1800–1950. Oxford University Press, New York
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Brief Summary: To avoid becoming ‘fistula tourists,’ short-term expatriate surgical volunteers need special training and should work only in environments that facilitate long-term institutional development.
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Wall, L.L., Arrowsmith, S.D., Lassey, A.T. et al. Humanitarian ventures or ‘fistula tourism?’: the ethical perils of pelvic surgery in the developing world. Int Urogynecol J 17, 559–562 (2006). https://doi.org/10.1007/s00192-005-0056-8
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DOI: https://doi.org/10.1007/s00192-005-0056-8