joint-aus-us-gov-review-hamlin-fistula-ethiopia-final-report.doc

224 rehabilitation re integration and long term

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2.2.4. Rehabilitation, re-integration and long term support of patients HFE’s approach is along a continuum of care – preparing the patient for surgery, providing the surgery, providing the post-operative care and then the physical, emotional, social and economic rehabilitation. This holistic approach is difficult to replicate in the less-resourced government facilities. Information and training is provided both at the hospitals and in Desta Mender with the aim of helping women become more knowledgeable on a variety of topics, more empowered about their rights and more skilled to become economically independent. Some women – those who are ‘dry’ (about 82%) can return to their communities, and some are accepted back by husbands and families. Among those, some women become pregnant and are encouraged to return to the HFE centres for a safe Caesarean Section delivery. (A total of 152 women were delivered by C-Section in 2012 and numbers are likely to grow). It is hoped that these women can become ‘ambassadors’ to help in case detection and referral of women with OF. Data from Mekelle show that very few referrals are due to ex-patients possibly because of stigma. Discussions with women confirmed that they knew of few cases. The situation analysis reports that the fistula closure rate can be as high as 93% with experienced surgeons. However, post-closure urinary incontinence, from limited to complete, is still a formidable problem in the management of obstetric fistula. The 40 The Health Development Army (HDAs) is a network of five households and one model family to support the Health Extension Program reach the rural population with health messages through social mobilization, mutually influence one another in practicing healthy life styles, improved sanitation, nutrition etc. AusAID Health Resource Facility 17 Managed by HLSP in association with IDSS
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AID and USAID Review of Support to Hamlin Fistula Ethiopia (Ethiopia) 31/05/2018 Services Order 230 Draft report reported prevalence of post-operation incontinence varies widely and it is generally around 6%, but it can rise up to 57% for fistulas involving urethra and sphincter damage. Among the latter, many self-resolve in due course, but at least 10% of them will continue to suffer for the rest of their life. 41 Physiotherapy is therefore essential – especially for patients with ‘dropped foot’ who became paralysed as a result of long inactivity. During post-operative care in the Hamlin Fistula centres, the patients partake in various classes including functional literacy and income generation. How these classes provide long-term benefits is important to know – because this will inform planning in this area. Far more complex is the social reintegration of the women who have been abandoned by their communities, or left with medical problems requiring daily medical care. The future life and working capacity of those with ileostomal bags and derivations needing daily care that they may not self- administer is problematic. The small capacity of the fistula centres to employ ex-patients
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