Obstetric fistula is a devastating childbirth injury that leaves women incontinent, stigmatized and often isolated from their families and communities. In Ethiopia, although much attention has focused on treating and preventing obstetric fistula, other more prevalent childbirth-related pelvic floor disorders, such as pelvic organ prolapse, non-fistula-related incontinence and post-fistula residual incontinence, remain largely unattended. The lack of international and local attention to addressing devastating pelvic floor disorders is concerning for women in low- and middle-income countries. The objective of this article is to highlight the need for a more comprehsive approach to pelvic floor care and to share our experience in addressing it.
Here, we share our experience launching one of the first formal training programs in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) in Ethiopia.
This fellowship program provides quality care while strengthening the health system in its local context. This program has positioned Ethiopia to be a regional leader by providing comprehensive training of surgeons and allied health professionals, building appropriate health system and research infrastructure, and developing a formal FPMRS training curriculum.
We hope that sharing this experience will serve as a template for others championing comprehensive pelvic floor care for women in low- and middle-income countries.
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We thank the following organizations that have made this work possible: Worldwide Fistula Fund, Hamlin Fistula Ethiopia, Hamlin Fistula USA, Mekelle University, OHSU’s Footsteps to Healing Global Women’s Health Initiative, Ethiopian Ministry of Health and Education, Tigray Regional Health Bureau, Tigray Women’s Association, Healing Hands of Joy, and various faculty from partner academic institutions and organizations who volunteered their time to teach.
Conflicts of interest
The fellowship program is funded by Worldwide Fistula Fund, Hamlin Fistula Ethiopia, Hamlin Fistula USA and Oregon Health & Science University Footsteps to Healing Global Women’s Health Initiative. Dr. Yibrah Berhe and Dr. Renate Roentgen get small salary support from the partners. Drs. Rahel Nardos, Christopher K Payne and Theresa Spitznagle are board members of Worldwide Fistula Fund, Dr. L. Lewis Wall is founder and consultant to Worldwide Fistula Fund, and Dr. Karen Gold is a board member of Hamlin Fistula USA.
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Nardos, R., Ayenachew, F., Roentgen, R. et al. Capacity building in female pelvic medicine and reconstructive surgery: Global Health Partnership beyond fistula care in Ethiopia. Int Urogynecol J 31, 227–235 (2020). https://doi.org/10.1007/s00192-019-04197-0
- Obstetric fistula
- Pelvic floor disorders
- Capacity building
- Medical training