Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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332 Surgery and Healing in the Developing World
than 50 Health Centres throughout the Province Orientale (and into North-Kivu)
within the framework of its activities organized by its Flying Doctor Services (FDS).
Methodology
A Study in North-Eastern DRC
In 1992 a study was conducted of all women who had a loss of urine per vagina
following a difficult delivery, regardless of duration of the illness, and who presented
for consultation during surgical visits in Province Orientale (see ‘location’ above).
All cases of VVF of surgical origin or other pathology were excluded.
The Experience of CME Nyankunde
In addition, a retrospective study was made from 1988 to 1998, showing the
experience of CME Nyankunde Hospital, with the VVFs in this hospital.
Results
A Study in the North-Eastern DRC
The VVF of obstetrical origin has been found in all the Province Oriental:
Bas-Uélé (Zones: Aketi, Ango, Bili and Bondo), Haut-Uélé (Zones: Aba, Dungu
and Pawa), Iture(Zones: Aru, Bunia, Mandima, Mambasa, Nyankunde and
Tchomia), and Tshopo (Zones: Bafwasende and Benalia).
In total, 80 cases of VVF were seen during the surgical visits made in 1992. This
number does not include patients seen within the Rural Health Zone of Nyankunde.
This study does not reflect the complete picture since no systemic research has been
done. It only concerns patients who came to outpatients consultations.
Of these patients 62 out of 80 (77.5%) had a fistula for more than 2 years. The
longest duration was found in a women of 46 years old in Bondo Zone who had a
VVF since 1962 (30 years) and who was operated on only in November 1992.
The Experience of CME Nyankunde
a. Annual frequency: From 1988 to 1998 (11 years) 96 patients were received
at the CME Nyankunde hospital with the diagnosis of VVF (a frequency of
8.7 cases per year).
b. The frequency of the associated rectovaginal fistula RVF: 12 of the 96 VVF
patients (12.5%) had an associated RVF.
c. Therapeutic methods used: Anatomical reconstitution by a vaginal plasty
was done in 94 cases, while ureterosigmoid transplantation was done for
the remaining 2 patiens.
d. Results of vaginal plasty (Table 1)
Comments
In 1992, we consulted 80 cases of VVF in certain Health Districts (Health Zones)
in the region of Province Orientale (15 of 47 Health centres). This partial study
does not reflect the real situation, as it concerns only patients who came for ordinary
consultations without an established organisation of systematic research of VVF. If
we suppose there is a minimum of 4 to 5 urogenital fistulae per year, per Health
Zone, we would expect to have about 200-250 new cases of VVF occurring in Province
Orientale each year. In addition to that number, there would be those who were