Uganda Childbirth Injury Fund

Overall goals

Work with our Ugandan colleagues to prevent and treat childbirth associated injuries and to broaden the activities to include other initiatives as requested by Ugandan colleagues.

Work in progress includes setting up elective programs for nursing and midwifery students, partnership programs for fistula prevention, and possibly outpatient initiatives around other health problems e.g. diabetes, hypertension.
We also have a sister charity “School lunches for Kamuli” sponsoring lunches in the local girls’ school as part of fistula prevention.

Key UK Colleagues and Partners

Surgical Colleague: Dr Kate Darlow, consultant in Obs and Gyne, Borders General hospital
Anaesthetist: Dr Richard Burnett, St John’s hospital, Livingston
Senior Nurse: Ishbel Campbell, currently ANP in Forth Valley
Senior Midwife: Christine Wood, Royal Infirmary of Edinburgh
Other colleagues past and present: Dr Honest Honest, Good Hope Hospital, Birmingham, Dr Glyn Constantine, Good Hope Hospital Birmingham, Dr Brian Hancock, retired Colorectal surgeon from Wythenshaw hospital, Manchester
Accompanying visitors: Dr Julie-Clare Becher paediatrician, Ruth Paterson and Robin Hyde, Lecturers in Nursing from Napier University, Alpana Mair Pharmacist Scottish office and Napier University.

International Partners

Longer term relationship with Kamuli Mission hospital, Kitovu Mission hospital and various government hospitals in Uganda. Currently, we work with Kamuli Mission hospital, Mebende Regional hospital, Hoima Regional Hospital, Kitovu Mission hospital.
We visit each hospital annually (twice to Kamuli Mission hospital) to collaborate on surgical camps to repair childbirth injuries.

Sustainable development goals

• SDG 2 - Zero hunger
• SDG 3 - Good health and well-being
• SDG 4 - Quality education
• SDG 5 - Gender equality
• SDG 10 - Reduced inequalities

Funding source

Fundraising, Donations, The Fistula Foundation

Project origin

The charity was formed to endorse and expand work on fistula surgery which Dr Brian Hancock had been doing intermittently since being a house officer in Uganda in the 1950s. He then worked as a medical officer at Kamuli Mission Hospital for a couple of years before taking up higher surgical training and consultant work in Manchester. He developed a surgical interest in fistula patients when in Uganda, and continued to develop surgical expertise over his career, working also with the Addis Abbaba Fistula hospital and writing a globally admired textbook. I travelled and worked with Dr Hancock on many occasions and eventually have taken over the surgical practice and chair of the charity. Women with childbirth associated fistulae are generally poor, disenfranchised from medical care, ostracised from society and very unfortunate indeed. Surgical repair of fistulae is complex requiring a long term commitment to training and practice. Most surgeons learning fistula surgery need to spend at least 2 weeks per year working in a concentrated surgical camp and undertaking over 20 repairs per year. My personal practice is to undertake, assist or teach in at least 50 repairs per year, spread over an average of 3 camps. This regular practice is vital to developing and maintaining surgical skills.

Evidence of need

Women with childbirth associated fistulae are generally poor, disenfranchised from medical care, ostracised from society and very unfortunate indeed. Surgical repair of fistulae is complex requiring a long term commitment to training and practice. Most surgeons learning fistula surgery need to spend at least 2 weeks per year working in a concentrated surgical camp and undertaking over 20 repairs per year. My personal practice is to undertake, assist or teach in at least 50 repairs per year, spread over an average of 3 camps. This regular practice is vital to developing and maintaining surgical skills.

Project areas

The focus of the work is the surgical repair of childbirth associated injures. There are associated areas of work including nursing care of the patients intra and post operatively, fistula prevention work in the community and a labour ward and sharing of general surgical skills. There is also a project sponsoring school meals for girls in the adjoining school, to promote education, health and wellbeing and hopefully reduce early pregnancy which carries a high risk of fistula and other injuries.

Project activities

Run surgical camps 2-3 times per year where 30 to 50 women are operated on and have a cure rate of over 80%
Ugandian fistula surgeons and nurses have been trained and we have worked together to improve the running of the ward.

Changes

To build a team of international surgeons and nurses skilled in the treatment of fistula, and to have us integrated with our Ugandan colleagues – working together, developing improved skills and treatment together and treating more patients. There are still 1500 new fistulae in Uganda per year as well as a backlog of patients. Each of these statistics represents a woman with severe problems, and often a ruined life.

Next steps

We want to continue to undertake fistula camps, working with our Ugandan colleagues and providing support or training where appropriate.
We will let our international team grow and develop so that more camps can be attended by more professionals. We will continue to work to raise funds to enable the camps to go ahead.
We will share our experiences with colleagues in the UK and support other health-related initiatives in the host hospitals.
We will keep working on a phone based universally available data collection system.

Challenges

It is best to be integrated with local doctors, to be registered in the country you are visiting and to have official letters inviting you to visit. Taking equipment (sutures etc) into the country can also be problematic.
There are challenges also in ensuring the work undertaken is necessary and does not interfere with or prevent training of the doctors in the host country.
At home, it is difficult to arrange time away and cause inconvenience to colleagues, family etc during the trips.
It costs money and lost earnings to travel abroad, even with charity sponsorship. There is a risk of becoming unwell, and it is important to be vaccinated and protected, and to be ready with a plan to deal with any needle stick injury.

Mitigating challenges

1. Annualising job plans to allow the making up of some of the time abroad during the course of the year rather than taking it as annual leave. This facility could be extended to other healthcare workers without any loss of service to the NHS.
2. Having a structured flexible week in junior doctors’ timetables would allow junior doctors to join trips, and would be very popular leading to improved future recruitment potential. The rotas could be organised such that the time was made up over their 12-week block.
3. Endorsement of work and recognition of its relevance and quality would help future relations with host countries who are keen to be seen to be health partners rather than recipients of aid. This official endorsement with bespoke trusts/ charities for a twinning type program between boards or hospitals in Scotland would improve equity of access to global projects for all healthcare workers. It could include central endowment fund type organisation of funds. This would make it easier to raise funds over time and to release them to pay for various health initiatives. It also facilitates a transparent transfer of funds to host hospitals abroad. Having charitable status for these centrally held funds would allow perks such as applying for gift aid, receiving increased luggage allowances and special fares and would provide a focus for efforts across the board/ trust. This runs beautifully in the Borders General with the whole hospital and indeed town involved and proud of the joint efforts made (organised by Brian McGowan).
We hope that schemes facilitating time spent on voluntary work at home or abroad for all health professionals can be developed, e.g. linking the provision of services in rural Scotland to enabling time abroad.

Partnership principles

• strategic
• harmonised
• effective
• respectful
• organised
• responsible
• flexible

Project gains

• leadership
• teamwork
• clinical
• awareness
• academic
• patient
• resilience