Pilot shows promising results for holistic fistula care

Female genital fistula is a debilitating injury affecting an estimated 500,000 women, mostly in sub-Saharan Africa. Fistula is primarily due to prolonged obstructed labor combined with a lack of high-quality emergency obstetric care access or an injury resulting from medical care.

Fistula is associated with significant physical, psychosocial, and economic consequences. Surgery to repair the fistula is often transformative, yet post-repair symptoms may delay social and emotional recovery. These factors limit women’s ability to resume their previous roles despite successful surgery, especially if they are also experiencing economic hardship.

Targeted rehabilitation efforts may substantially impact recovery and quality of life. Despite the need and recognition that holistic approaches to fistula care may improve recovery, most fistula services incorporate little complementary or follow-up care.

A study co-led by Bixby researcher Alison El Ayadi sought to address the gap in evidence-based practice for reintegration following female genital fistula surgery through the development and pilot test of an intervention at Uganda's national referral hospital. The intervention had multiple components including health education, psychosocial counseling, physiotherapy and economic empowerment.

They found that the program was feasible and acceptable to both the patients and the people who ran it. All 12 patients were very satisfied with the intervention. They gave feedback on each of the 4 components:

  • Health education. Participants generally reported understanding the health education content well and remembering key content areas such as how a fistula occurs and their discharge instructions.
  • Counseling. The women felt that counseling was useful for them, motivated them, and met their needs. Some preferred group counseling, while others preferred individual.
  • Physiotherapy. Participants found the physiotherapy content and exercise training helpful and appropriate, and appreciated the physical improvements and stress relief that resulted.
  • Economic incentive. All participants appreciated the $150 economic incentive. Most started small businesses and reported that the amount of money was adequate for small business start-up. 

This research contributes to the limited evidence base on holistic fistula care, which supports the need for reintegration programming addressing the unique physical, psychosocial, and economic needs of women recovering from fistula and fistula repair surgery.

Holistic approaches to genital fistula programming are important for supporting women to overcome significant physical and psychosocial disabilities associated with this condition. Continued research on reintegration programming effectiveness is important to quantify the additional benefits achieved from holistic fistula care.