Curing Fistula, Changing Women's Lives

Dr. Ambereen Sleemi, MD, MPH, and her colleague Liz Santaniello, MSN, FNP-BC, traveled to Fond des Blancs to train medical staff in the OB/GYN department on pelvic reconstruction and fistula repair surgeries. Dr. Sleemi, the co-founder of the non-profit organization International Medical Response, specializes as a female pelvic medicine reconstructive surgeon and has been traveling to Haiti to perform these surgeries and train local providers since 2012.

The pair worked with Drs. Guerrier and Germinal from the SBH OB/GYN department and their teams on over a dozen surgical cases during their trip, including fistula repair, pelvic floor reconstruction, and reversing the cause and impact of long-term incontinence. This training opportunity was critical for the SBH team, as instruction in these procedures is not included in standard residency programs in Haiti. Using the skills they learned from Dr. Sleemi and Liz, OB/GYN staff at St. Boniface Hospital will be able to treat women suffering from birth-related and other reproductive complications at the SBH Surgical Center.

Women in rural Haiti are particularly vulnerable to the types of reproductive issues that Dr. Sleemi and her team encountered on their trip to SBH. In southern Haiti, three-quarters of women give birth at home without the benefit of a skilled birth attendant. This means long labor and birth trauma both occur at a higher rate and increase mothers’ risks for fistula and other painful complications.

Obstetric fistula is a hole in the birth canal caused by prolonged labor when a medical intervention, most commonly a cesarean section, is required but not available. Women in these situations often deliver a stillborn baby and are left with the physical trauma of a fistula, including chronic incontinence. The long-term side effects of fistula leave women ostracized and isolated from both their wider communities and their closest family and friends. The emotional trauma associated with fistula if often more painful for the women it affects than the physical stress of the condition.

Since 2003, the United Nations Population Fund Campaign to End Fistula has spearheaded global efforts to treat and reduce fistula for women in under-resourced settings. Working closely with partners in local government, the nonprofit sector, and in civil society, the UNFPA has heightened awareness and increased access to treatment and rehabilitation to women with fistula in more than 50 countries across Asia, Africa, and the Arab region.

Despite the progress made by the UNFPA and other actors globally, fistula and other reproductive health issues continue to impact women in Haiti, especially in rural areas. Given both her clinical specialty and intimate understanding of health care in the country, we asked Dr. Sleemi what she thinks the main barrier to getting this care is in Haiti.

Dr. Sleemi said she suspects that cases of fistula, in particular, are vastly underreported in Haiti, and that lack of infrastructure outside of settings like St. Boniface Hospital leads to large numbers of untreated cases and minimal awareness of common reproductive health problems. To better understand and respond to this issue, Dr. Sleemi and her team at International Medical Response have partnered with the Haitian Society of OBGYN, UNFPA, and the Haitian Ministry of Health to conduct a needs assessment on how incontinence, prolapse, and fistula impact women in Haiti.

Dr. Sleemi said she is hopeful that conducting trainings with medical professionals, including an ongoing partnership with HEI/SBH, will increase the visibility of fistula and other women’s health problems, and lead to greater access to care for the women of Haiti. We are grateful to Dr. Sleemi and Liz for sharing their skills with the SBH team and most importantly, with our patients!