Australian surgeons answer FIGO’s battle call for fistula women

Australian surgeons are soldiers in an international humanitarian battalion heeding the desperate plea of a worldwide NGO to consign the world’s most catastrophic childbirth injury to history.

Fistula - the abnormal opening between the vagina and the bladder or rectum - is the scourge of millions of women in sub-Saharan Africa and South Asia, triggering a loss of urine and faecal control after prolonged, obstructed labour.

Leading the charge is the International Federation of Gynaecology and Obstetrics (FIGO), an NGO helmed by two Australians - Professor Ajay Rane and Dr Andrew Browning - a rare pairing for an international aid agency.

More unusually, both medicos hail from regional communities - Professor Rane from The Townsville Hospital, and Gosford-based Dr Andrew Browning - and both are united in their passion to change the lives of women in 19 of the world’s least-developed nations.

Professor Rane, current Chair of FIGO, described the lives of women afflicted by fistula as ‘shattering’.

“Not only do they suffer a catastrophic injury during labour, 94 per cent deliver a stillborn baby,” he said.

“They also suffer enormous emotional trauma and end up divorced, separated and cast out of their communities.

“We’re talking about a societal structure where there is no place for a woman unable to control her bladder or her rectum; she has no use, no fitness and, ultimately and tragically, no place.”

Professor Rane, a urogynecologist, surgeon, author, academic, and humanitarian, started a one-man crusade more than 20 years ago to galvanise the global medical community to help women with fistula.
And he knew he couldn’t do it alone.

“I knew it was a matter of connecting with colleagues, medical and surgical colleges, governments, and NGOs, to get more surgeons trained and for those surgeons to train yet more surgeons.

“I also wanted to shine a light on the size and scale of the problem; the world needs to get angry about the plight of these women and demand change,” he said.

“2017 was a watershed year for us; it was the year we celebrated 6,000 repairs since the project began with a success rate which meant the fistula closed and patient was continent - of 82 per cent.

“FIGO has helped bring this curse out of the darkness and onto the international stage.”

FIGO deputy chair Dr Browning said the NGO recognised fistula as a neglected public health and human rights issue that needed urgent attention.

“There are now 52 trainee fistula surgeons who are full-time urologists, gynaecologists, general surgeons, or obstetricians,” he said.

“They are known as the ‘FIGO Fellows’ and because of their ongoing training and mentoring they can treat more women in some of the world’s most challenging operating rooms, many of whom have highly complex fistula.

“They are amazing men and women but they are a small army; we need to build their ranks.”

Dr Browning said many of the surgeons sacrificed their safety and comfort to operate in countries like Yemen and Somalia.

“There is great team spirit and goodwill but these alone will not help a 20-year-old woman in Burkina Faso who spends her life in a puddle of her own wee, cut off from her children and family.”
Professor Rane conceded fistula was not a particularly saleable cause.

“It’s dirty and smelly and uncomfortable to think and talk about,” he said.

“But think and talk about it, we must.”

Professor Rane said the aim of the FIGO training initiative was more and better care to bridge the treatment gap. “We must keep this momentum going. For FIGO, this is a long-term commitment,” he said.

“We need more surgeons capable of performing fistula repair who can then mentor and teach others.

“We have made ground, there is no doubt about that, but so much more needs to be done.”

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