As a physiotherapist, I am delighted that there is an increasing body of published research supporting the role of physiotherapy in the management of women who have suffered an obstetric fistula. Most recently a team working in Benin, West Africa published positive results from an impressive one year follow-up of women who had undergone a program of pre- and post-operative physiotherapy (Castille et al. 2015). This was follow up to their earlier publication (Castille et al. 2014). Promising results were also reported following the intervention of physiotherapists in the Democratic Republic of Congo (Keyser et al. 2014).
In February 2015 I visited the Hamlin Addis Ababa Fistula Hospital,Ethiopia, where I offer on-going support and education to the well-established team of physiotherapists, nurses and support staff. Although my visits are limited to one or two per year, the hospital benefits from a fairly reliable Internet connection offering the opportunity for more regular email contact and support. The focus of my most recent visit was continuing education for a physiotherapist who joined the team in 2014. In addition to working with patients, there was plenty of opportunity for formal teaching, discussion and review of case studies. The physiotherapists of Addis Ababa implement a pre- and post-operative rehabilitation for the many women who require treatment for conditions such as foot drop and lower limb contractures which are other well-described complications of obstructed labor. In addition, the team aims to see every woman pre-operatively for assessment of their pelvic floor muscle strength and function. The patients are instructed techniques for pelvic floor exercises to practice before and after surgery. Compliance is monitored by ward-based aides. Further instruction is given prior to discharge home and at follow up clinics. Women who experience persistent urinary incontinence following successful fistula repair undergo physiotherapy instruction. The team also offers advice and on-going support for women with incomplete bladder emptying, those who go on to have further surgery for their bladder dysfunction, and women who have experienced a recto-vaginal fistula. Support staff of this nature are found in the renowned Hamlin Centers throughout Ethiopia.
If anyone would like to discuss the role of physiotherapy in all aspects of the care of women who have suffered an obstetric fistula, Gill Brook would be delighted to hear from you. Please email her at gill.brook@lineone.net
References
Castille Y-J et al. (2014) Impact of a programme of physiotherapy and health education on the outcome of obstetric fistula surgery. International Journal of Gynecology & Obstetrics. 124(1): 77-80
Castille Y-J et al. (2015) One-year follow-up of women who participated in a physiotherapy and health education program before and after obstetric fistula surgery. International Journal of Gynecology & Obstetrics. 128(3): 264-266
Keyser L et al. (2014) Analysis of a pilot program to implement physical therapy for women with gynecologic fistula in the Democratic Republic of Congo. International Journal of Gynecology & Obstetrics. 127(2): 127-131
Patient picture courtesy of Nigel Brennan