Screenshot from webinar with MSSI. Features the four panelists smiling toward the camera.

Convening for care: UMN partners with Ghana NGO on obstetric fistula training

May 16, 2021

For over a year, the Center for Global Health and Social Responsibility (CGHSR) has partnered with the Medical and Surgical Skills Institute (MSSI) in Ghana to facilitate global capacity building activities. The MSSI, a health training center that provides medical and surgical skills training to advance health care in West Africa, has been pivoting their work to online training and activities in the wake of the COVID-19 pandemic.

In March, MSSI and CGHSR partnered again to co-host a two-day long virtual panel discussion and training on obstetric fistula, led by Rahel Nardos, MD, MCR, inaugural director of global women’s health at CGHSR. Nardos, who sits on the board of Worldwide Fistula Fund, used her network of fistula partners to bring skills from different countries together for a two-day virtual panel discussion.

“Obstetric fistula is a disease of poverty and inequity that should not exist, but continues to persist,” said Nardos. 

Obstetric fistula is a devastating birth injury that affects almost exclusively women in low and middle income countries. These women develop a traumatic injury to their bladder, vagina and/or rectum as a result of prolonged obstructed labor due to lack of access to timely obstetric care. It can be easily treated by surgery, but Nardos explains a more permanent solution needs to be focused on prevention taking into account the social and political determinants of health. 

MSSI logo

The MSSI has long wanted to focus on obstetric fistula—the institute had received numerous requests for a panel discussion on the topic in the past five years, according to Kwame Agyire, MSSI’s executive director. “MSSI in 2021 sought the assistance of the University of Minnesota to help plan and execute the panel discussion,” said Agyire. “With the UMN’s acceptance of the request, the university put together a team of highly respected top notch obstetric fistula experts, both from the African region and internationally to be on the panel discussion.”

"Training regarding obstetric fistula has been lacking in West Africa,” said Myron Aldrink, MSSI board chair. “But the two-day fistula panel was very successful, and over 400 medical professionals attended. We very much appreciate the UMN partnership and their proactive efforts to support healthcare training and our joint efforts to improve the local healthcare systems in West Africa."

During the two-day training, an interprofessional panel shared their experiences launching programs in their countries to support women living with fistula. MSSI often serves as a connector and facilitator in training and events in West Africa, and these webinars helped audiences recognize the complexity of fistula care and its impact on women. 

The four panelists each brought a unique lens to the issue. Sarah Omega, founder and executive director for Let’s End Fistula Initiative, is a passionate advocate for women empowerment after a successful surgical treatment ended her 12 years of living with fistula. Gabriel Yao-Kumah Ganyaglo is an obstetrician and gynecologist at the Korle Bu Teaching Hospital in Ghana and a fistula surgeon. 

Other panelists included Fekade Ayenachew, an expert fistula surgeon, a International Federation of Gynaecology and Obstetrics fistula trainer, a consultant for International Fistula Alliance and Worldwide Fistula Fund and provides clinical training and care across multiple countries in Africa. Also joining was Alice Imasu who has 19 years of experience in designing and carrying out obstetric social reintegration programs for fistula patients. She is the founder and executive director of Terrewode, a fistula reintegration program in Uganda and recently opened the Terrewode Women’s Community Hospital to care for fistula patients.

“We had a robust conversation with health care providers of all sorts in Ghana, with hundreds in  attendance—midwives, doctors, community health workers—people who want to help their patients by providing the best care,” said Nardos.

A Holistic Care Approach

Obstetric fistula impacts every aspect of a woman’s health and wellbeing. Many women do not have access to sanitation pads, and may deprive themselves of food and water which means they are chronically nutrient deficient  and dehydrated. Often, these patients are dealing with other issues—nerve injury, musculoskeletal disorders, anxiety, and depression. The majority have lost their baby in the process and are mourning.

In this training with MSSI, the group identified the biggest needs in Ghana, emphasizing a holistic care model to help women access treatment and prevent fistulas from happening. Vital to this care is community education around why fistulas happen in order to demystify the condition and reinforce the belief that it’s not the women’s fault. 

To center the needs of health care professionals in Ghana, CGHSR and MSSI work closely on the topics and contents of trainings from the beginning, creating a mutual and equitable partnership.

“All meetings before the event were held in the spirit of collaboration where the UMN team highlighted on the local perspective which MSSI calls 'Africanizing the program,’” said Agyire. “MSSI has in the past had collaborations with similar American institutions but what amazes MSSI staff with UMN team is their willingness to listen and exchange ideas with the MSSI.”

Continuing the Momentum

Following the success of the past obstetric fistula training and partnership, MSSI and the U of M will host another virtual training series for physicians and health professionals in West Africa. 

The next training will focus on diabetic retinopathy, a topic that is vital and underserved in the region. Hossein Nazari, MD, assistant professor in the Department of Ophthalmology and Visual Neuroscience at the Medical School will lead the session. MSSI plans to host two training days: one for ophthalmic nurses and the second for ophthalmologists and optometrists. 

“Our partnership with MSSI is an important one. We complement each other well,” said Shailey Prasad, MD, MPH, executive director of CGHSR. “MSSI has done such an amazing job of being the perfect nodal agency connecting with academia, Ghanian Ministry of Health and health practitioners across Ghana and West Africa that our work with them is amplified to a wider audience, and we’re eager to see the collaboration continue.”

This story was written by Gao Vang and Anna Pendleton.