Ambulance by Chair takes you where? Nyatende Hospital, where fistula is rare.
Where does that Kalagane Ambulance Chair take you? Nyatende Hospital – 4 km away.
Site Visit Nyatende Hospital (referral hospital for Kalagane Health Center)
We spoke with the senior surgeon, Dr. Vincent Cibavunya.
He has been there for 10 years. He has 6 MDs working with him at Nyatende now.
This is a Catholic hospital, beautifully constructed and impeccably maintained with a stately, separate maternity building.
When Dr. Cibavunya arrived, almost all deliveries happened at home with high infant mortality and stillborn rate and many fistulas.
He did a study to determine that the major factors were cultural bias against hospital birth, ignorance of the benefits of obstetric care, and financial barriers (all over Congo, women pay on average 7 USD for vaginal birth and 15 USD for Cesarean Section).
He instituted an outreach program with his doctors and nurses and local churches and pastors going village to village and house to house, to explain the benefits of obstetric care and hospital birth. This continues with monthly staff meetings with the regional health center clinicians.
He also worked with some group to create a sort of health care credit union that allowed a reduction in all OB fees.
Today, 85% of births in the Nyatende cachement area occur in Nyatende, infant mortality is very low and fistulas are a rare occurrence. Another MD who has been there 3 months states he has yet to see a fistula. When they do have a fistula, he states they always refer to Panzi Hospital www.panzihospitalbukavu.org.
Prolapse is more common, with about 10 cases per month at Nyatende.
Incontinence is also reportedly rare.
Most surgeries performed at Nyatende Hospital currently are partial thyroidectomy for goiter, and lots of ENT, nasal polyps etc.
Kiel Bonhomme, Dr. Tina Amisi, Dr. Cibavunya, Dr. Tchango, Dr. Romanzi
WHO, UNFPA, USAID and any number of fashionable Stateside and European fundraisers are throwing millions of dollars with the attendant beauracracy and fanfare at the seemingly unstoppable tragedy of fistula caused by lack of basic obstetric management in third world settings around the globe. Seems Dr. Cibavunya forgot to read these myriad reports, having singlehandedly recognized and dealt with this exact problem in his cachement area with a few dollars, a few local institutions, and a lot of common sense. Hmmm.
Within 40 years of the advent of general anesthesia in the mid-1800’s, the world’s first fistula hospital, founded in New York City by Dr. J. Marion Sims, was rendered obsolete, razed, and replaced by the current Waldorf Astoria Hotel in 1893.
Well into the 21st century, it is time, and as demonstrated by Dr. Cibavunya, it is well within possibility, to implement the rudiments of modern obstetric care that will preclude the need for expensive, stigmatizing, tragic, single-focus fistula centers – we need only apply the obstetrical practices and standards of care available in North America and Europe at the end of the 19th century.
Hats off to Dr. Vincent Cibavunya and Nyatende Medical Center, South Kivu, Democratic Republic of Congo.
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