Désalliers Julie, Paré Marie-Eve, Kouraogo Salam, Corcos Jacques
Department of Obstetrics, La Salle Hospital, McGill University, LaSalle, Québec, Canada.
Clinique Espace Santé, 8 Place du Commerce, Verdun, QC, Canada, H3E1N3.
Int Urogynecol J. 2017 Jul;28(7):1091-1100. doi: 10.1007/s00192-016-3235-x. Epub 2016 Dec 26.
Obstetric fistula, caused by traumatic delivery and patient lack of access to obstetric care, is an important public health concern in developing countries, particularly in Sub-Saharan Africa. This research focuses on the experience of women living with obstetric fistula in Burkina Faso as well as their reintegration into community after surgery.
This project was funded by the Mères du Monde en Santé (MMS) Foundation and conducted in collaboration with the Boromo Hospital. A qualitative approach based on grounded theory and using the principles of participative action research (PAR) was used with semidirected interviews prior to surgery and follow-up interviews 1-2 years after surgery directly in the women's village of origin. Thirty-nine participants were recruited between 2012 and 2015.
The results point to circumstances leading to obstetric fistula development: poverty, gender inequality in terms of decision making, healthcare-system deficiencies, and lack of services for referral and treatment of this condition. Our results reinforce the knowledge about the social and psychological repercussions of fistula by exploring the concepts of gossips, shame and self-exclusion as powerful mechanisms of exclusion, but they also show that social support was conserved for several women through their journey with this disease. There was complete social rehabilitation within the community after surgery; however, persistent barriers in term of anxiety regarding obstetric future and economic insecurity were present.
Early recruitment for surgery and prevention are the main objectives when attempting to reduce the impact of obstetric fistula and facilitate patient reintegration. Improvements in local and governmental public health policies are required.
由分娩创伤和患者无法获得产科护理导致的产科瘘管病，是发展中国家尤其是撒哈拉以南非洲地区的一个重要公共卫生问题。本研究聚焦于布基纳法索患有产科瘘管病的女性的经历以及她们术后重新融入社区的情况。
本项目由世界母亲健康组织（MMS）基金会资助，并与博罗莫医院合作开展。采用基于扎根理论的定性方法，并运用参与式行动研究（PAR）原则，在术前进行半定向访谈，并在术后1至2年直接在女性的原籍村庄进行随访访谈。2012年至2015年期间招募了39名参与者。
结果指出了导致产科瘘管病形成的情况：贫困、决策方面的性别不平等、医疗系统缺陷以及缺乏针对该病的转诊和治疗服务。我们的研究结果通过探讨流言蜚语、羞耻感和自我排斥等作为强大排斥机制的概念，强化了关于瘘管病社会和心理影响的认识，但同时也表明，一些女性在与这种疾病抗争的过程中得到了社会支持。术后社区内实现了完全的社会康复；然而，在对未来产科情况的焦虑和经济不安全方面，持续存在障碍。
尽早安排手术和预防是试图减少产科瘘管病影响并促进患者重新融入的主要目标。需要改进地方和政府的公共卫生政策。
