One of WAHA’s main collaborators, Dr. Serigne M. Gueye, urologist and fistula expert, was invited to the annual conference of Obstetrician and Gynecologists in Paris last week to give a speech about the African perspective on incontinence. We sat down with him at WAHA’s headquarters in Paris to discuss the progress of reducing maternal mortality and morbidity in the world.

“The psychological effects of having incontinence can be debilitating for the patient and so it is extremely important for us in the medical profession to talk about this issue and find solutions.”

As a Professor of Urology at the University of Cheikh Anta Diop and Head of Urology at Grand Yoff General Hospital in Dakar in Senegal, Dr. Gueye has received numbers of honors, awards and fellowships for his contribution to medicine in Africa.

Dr. Gueye has been a key collaborator in various projects for WAHA International since 2009 and provided fistula surgeries and medical training in countries such as Senegal, Chad, Eritrea and Guinea-Bissau.

What was the topic of your discussion at the Obstetric and Gynecological Conference?

I was invited to give an African perspective on incontinence, which was one of the main subject this year. I talked not only about incontinence due to pelvic floor disorders, or prolapse, but I focused on the specific type of incontinence that can continue after a woman has had fistula repair surgery. Some patients who have obstetric fistula remain incontinent after surgery, i.e. despite the fistula being closed the competency of the system to hold the urine remains weak and the urine continues to leak, but through a different way. So it is like they were not treated. The psychological effects of having incontinence can be debilitating for the patient and so it is extremely important for us in the medical profession to talk about this issue and find solutions.

What are the possibilities of a treatment for a patient with this type of incontinence?

This type of incontinence is treatable, but it can be very difficult depending on how severe the damage is. For example the length of the remaining urethra and the extent of the sclerosis from the fistula has to be considered. Usually these patients need specialized treatment from very skilled doctors, but in many cases their access is very limited. There are different ways to manage cases and important to consider doing urodynamic tests when available to exclude conditions that are not due to urethral sphincter incompetence. Surgical procedures can include using natural materials like aponeurosis or muscular fascia to treat the patient.

Are we making progress in reducing obstetric fistula in Africa?

The number of new cases of fistula is going down – which is good – it should disappear completely from sub Saharan Africa. Most of the cases we are seeing now are women who have had fistula for years, women who have been operated on before or women who remain incontinent despite having undergone surgery that has closed the fistula.

The decrease in obstetrical fistula rate can be related to the fact that overall maternal mortality is decreasing. For every woman who dies during childbirth, 16-20 suffer from complications – and fistula is among the most serious complications. So if we are having a decrease in the rate of maternal mortality all over Sub Saharan Africa, we should have a decrease in childbirth related injuries like vesico-vaginal fistula.

In your view, what are the main activities that have contributed to the reduction of maternal mortality and
morbidity?

Many programs in Africa have contributed to the reduction in maternal mortality and morbidity. Since the international community came together and agreed to achieve the MDG 4 and 5 (reducing maternal and under-5 mortality), most of the countries involved have increased access to health services and more women deliver under skilled attendance.

It is worth mentioning also the many programs reducing poverty in Africa, because women’s economic independence is important to help achieve the MDG targets 4 and 5. In many places in Africa the woman has to seek the payment for her operation or antenatal care from her husband or mother-in-law, which delays her access to necessary healthcare. If the woman does not have access to consultation during pregnancy it is difficult to schedule a C-section for those women who need it. Even during an emergency when the woman needs a C-section, the process is slow, increasing the risk of maternal mortality and morbidity, and infant death. Therefore, programs reducing poverty in Sub Saharan Africa are important in addition to those focusing on reducing maternal and child mortality. Together they have contributed to the reduction of new fistula cases in Africa.

Is the strategic vision of the MDG’s and the partnership created around these global targets creating tangible progress on the ground?

Definitely, even though it is evident that not all the MDG’s will be achieved by 2015, but regarding MDG 4 and 5 many things are being done. Countries that have not achieved enough progress are usually the ones that are experiencing conflict and instability, like northeastern Nigeria, the Darfur region, South-Sudan, Chad, where WAHA has long-term projects, and many other places. But fortunately most countries are doing much better than they were 15 years ago.

What is your next step for WAHA International?

We will continue to collaborate and I will use my capacity to help the organization to grow. WAHA International has grown very quickly since it came to the field in 2009 and it is definitely doing very well. I am excited to see the implementation of the new project in Tambacounda region in Senegal, which will integrate the use of mobile technology, motorbike ambulances and capacity building to increase access to healthcare and fistula services.

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