Sierra Leone

International Medical Corps’ Vesicovaginal Fistula Program Leaves Lasting Legacy for Women in Sierra Leone

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By: Joe Thompson

During the brutal war in Sierra Leone frequent sexual assaults, coupled with the shortage of birthing attendants, left many women suffering from fistulas - a medical condition that International Medical Corps quickly identified on its arrival in country in 1999. By 2000, International Medical Corps designed and implemented the Vesicovaginal Fistula (VVF) program – the first of its kind in Sierra Leone. Today, a decade on, its resounding legacy continues to transform women’s lives across the country.

VVF is a severe gynecological rupture of the wall between the vagina and the bladder which can occur during an obstructed labor or violent rape. The condition often causes the sufferer to leak urine or feces, and carries a debilitating social stigma. Women in need of fistula repair are often depressed, abandoned or divorced due to their condition.

As part of the VVF program, International Medical Corps designed a national obstetric fistula treatment center at the Princess Christian Memorial Hospital (PCMH) in Freetown, providing equipment, medicine and most importantly expert training for doctors and nurses in surgical fistula repair.

“Before the program started, women had been living with VVF in secret for many years,” said Dr. Ibrahim Thorlie, an integral partner in the VVF program’s implementation and Chief Medical Director at PCMH. “They were ashamed to come out and admit they were suffering. They feared they would be shunned.”

Dr. Thorlie continues to use the specialist skills he learned through International Medical Corps VVF training to repair fistulas in the hospital today. He says the program enables women to admit they are suffering from the condition and guarantees they can be treated - for free.

International Medical Corps brought in specialist, expatriate VVF surgeons to train local doctors and nurses in Sierra Leone to comprehensively address the condition, from screening and diagnosis, to surgical techniques in repairing fistulas, to post operative care and psychological counseling to facilitate patient integration back into society. Nurses at the hospital were given performance-based incentives to partake in the program, and put on three month rotations within the VVF ward to ensure that every hospital nurse is able to diagnose and treat fistulas. In addition, the program’s doctors were sent on advanced VVF training courses at specialist clinics in Nigeria.

The VVF program’s original workforce has spread their skills country-wide. Dr. Alyona Lewis, who first encountered VVF on the program, was trained by International Medical Corps and is now the resident fistula surgeon at The Aberdeen Women’s Centre in Freetown. She is also teaching others in fistula repair surgery.

“Nurses who were at the hospital during the program are now working all over the country. They have the skill-set to identify fistulas and the structure of the program means they now have somewhere to refer the sufferers for treatment,” says Dr. Thorlie.

The program forever changed the status of VVF in Sierra Leone, illuminating the extent of the suffering it was causing women countrywide and breaking down the social stigma surrounding it. Through primary healthcare clinics across the country, International Medical Corps screened for the condition and actively sought sufferers.

“International Medical Corps’ program exposed the problem of VVF, and institutionalized a system of dealing with the condition which the Ministry of Health has maintained and developed,” says Dr. Thorlie.

He is hopeful of teaming up with International Medical Corps in the future based upon his past experiences: “I have great memories of working with International Medical Corps the legacy of their work is there for all to see throughout the country. Our ambition is to provide free healthcare to all at PCMH, and to do that we need to partner with an NGO - a system that has proved successful at other hospitals here in Freetown. I have spoken to the Ministry of Health about this strategy and specifically recommended that we partner with International Medical Corps.”

Amid a brutal civil war in Sierra Leone, International Medical Corps arrived in 1999 to deliver lifesaving emergency medical services - and remained as a key player after the war ended to help rehabilitate the health care system. The organization’s services in the country have included primary and secondary health care, nutrition, maternal/child care, mental health care, water/sanitation and training.

Since its inception more than 25 years ago, International Medical Corps’ mission has been consistent: relieve the suffering of those impacted by war, natural disaster, and disease, by delivering vital health care services that focus on training. This approach of helping people help themselves is critical to returning devastated populations to self-reliance.