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East and Central African Journal of Surgery

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VVF Treatment and Training through Outreach Services: AMREF Experience

Thomas Raassen

Abstract


Background: In the rural areas, where the obstetric services are poor, where the woman has no say over her own body and pregnancy, where the husband and the family decide, what will happen with her? AMREF did a study and found that less than 15% of the referred patients in actual fact
reach the referral hospital. For almost 50 years, (Flying Doctors Service) has been visiting remote government and mission hospitals all over Eastern Africa to bring specialist medical services to the sick.

Methods: Over 100 hospitals are visited each once to six times a year. This service is done by plane: Since most hospitals are in the rural areas, the AMREF plane carries up to 6 or more specialists and drops them in different places. In 1992 VVF-repair was included in the specialist services. During the visits, Genuinely interested doctors got hands on training while the nurses received training in the pre-operative, perioperative
and postoperative management of OF. Trained specialists take part in the Specialists Outreach Program and operate and train on their own.

Results: In 2004 over 1300 VVF/RVF-repairs and related operations were performed in Eastern Africa by AMREF and AMREF trained specialists with 1 visiting English gynaecologist. All the trained local specialists are performing VVF repairs.

Conclusions: Fistula treatment through Outreach Services preferably by plane and Training and continuing training (apprenticeship) works well. Almost all trained specialists continue repairing fistulas. The Way Forward is to train more personnel, especially in underserved areas




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