Which further development over 15 years personal …...Humanitarian Medicine Which further...
Transcript of Which further development over 15 years personal …...Humanitarian Medicine Which further...
![Page 1: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/1.jpg)
Humanitarian Medicine
Which further Development over 15 years personal experience in
Obstetric Fistula surgery
C.H. Rochat
AECOM, New York
October 23, 2012
![Page 2: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/2.jpg)
« Man not being born only for himself or for his
own benefit, Nature gave him an instinct and
natural inclination to love other human being,
with this love, he tries to help him in his affairs,
to the point that this mutual affection became
the law, unwritten, but inscribed in our hearts:
be like this towards others as you would have
been in your place ».
Ambroise Paré
Surgeon 1509-1590
![Page 3: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/3.jpg)
Humanitarian Medicine
Objectives
Stakeholders
Poverty
Lack of access to
medical care
Catastrophes
War & conflicts
Local doctors
Expatriates
Cover real needs
Equipment supply
Training and mobilization
Participate in prevention
Individual commitment
NGOs
Organizations (Red Cross, ICRC, WHO, UNFPA, etc.)
Governments
![Page 4: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/4.jpg)
From Practice to Theory
Afghan Conflict 1983-1989
![Page 5: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/5.jpg)
Cambodian Conflict 1990
![Page 6: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/6.jpg)
Irak War 1991
![Page 7: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/7.jpg)
Objectives
Poverty
Lack of access to
medical Care
Catastrophes
War & Conflict
Local Doctors
Expatriates
From War Surgery to Urology
… or Sustainbable Development
Cover the real needs
Equipment Supply
Training and mobilization
Participate in prevention
![Page 8: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/8.jpg)
Needs for Urologic and
Gynecologic care
Training in endoscopy
Urethral stenosis and fistula in men
Anomalies
Onco-surgery
Obstetric Fistula
![Page 9: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/9.jpg)
Obstetric Fistula
Fetopelvic disproportion
Delayed access to Cesarean
Section
Tissue necrosis due to
compression
Iatrogenic lesions
![Page 10: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/10.jpg)
Atacora North Benin, Tanguiéta
![Page 11: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/11.jpg)
Major Health Problem
Affect >2,000,000 women worldwide
>100,000 new cases each year
Mortality / morbidity
Exclusion from the society
Obstetric Fistula
![Page 12: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/12.jpg)
The Obstructed Labor Injury
Complex
VVF / VRF
Stress incontinence
Vaginal scars
Infertility
![Page 13: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/13.jpg)
Medical and Social Problems
Associated with OF
Family Abandonment
Co-morbidity:
– Infections
– Bladder Stones
– Infertility
![Page 14: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/14.jpg)
Tissus souple
Accès facile
Fibrosis
Loss of tissue
Urethral involvement
Retracted bladder
Aberrant tract
Previous failed surgery
Simple fistula
Complicated fistula
![Page 15: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/15.jpg)
67 sec http://www.gfmer.ch/Video/Extrait_fistules.wmv
![Page 16: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/16.jpg)
7:28 http://www.gfmer.ch/Activites_internationales_Fr/Images/benin2003.wmv
![Page 17: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/17.jpg)
Treatment
Training
Prevention
Research
Web-based Database
The Model of Tanguieta, Benin
![Page 18: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/18.jpg)
Development in Treatment
1994 First fistula case, self-educated
1996-2001
> 2002
Martius Flap 30% 10%
Cutaneous Flap 12% 0%
![Page 19: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/19.jpg)
Martius Flap
![Page 20: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/20.jpg)
Symmonds / Falandry
![Page 21: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/21.jpg)
![Page 22: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/22.jpg)
Development in Treatment
Circumferential Dissection
Urethral reconstruction
Diversions
– Ureterosigmoidostomy
– Mayence II
![Page 23: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/23.jpg)
Circumferential
Dissection
![Page 24: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/24.jpg)
![Page 25: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/25.jpg)
![Page 26: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/26.jpg)
![Page 27: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/27.jpg)
![Page 28: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/28.jpg)
![Page 29: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/29.jpg)
![Page 30: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/30.jpg)
![Page 31: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/31.jpg)
![Page 32: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/32.jpg)
![Page 33: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/33.jpg)
![Page 34: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/34.jpg)
Urethral reconstruction
A. Destruction of urethra after the first attempt to repair.
B. U shape profound incision of anterior vaginal wall that overflows the lower part of fistula.
C. Tubulization on Ch14 catheter.
D. Neo-tubulized Urethra. The suspension points are sliped in either side of new bladder neck.
E. Slipping the right suspensions string on the tendinous arch with 5/8e needle.
F. Elevated new bladdder neck up to the tendinous arch (Key to ensure continence).
G. Suture of anterior vaginal wall in inversed U shape over urethral repair (without interposing Martius in
this case).
![Page 35: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/35.jpg)
Mayence II Diversion
![Page 36: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/36.jpg)
![Page 37: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/37.jpg)
2002 colposuspension by vaginal flap
2005 TOT (African Tape)
2010 trigonisation and endopelvic fascia elevation
2012 colposuspension with tape of « rectus fascia »
Development in Treatment
Stress Incontinence
![Page 38: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/38.jpg)
Trigonisation with the plicature of pubocervical
fascia.
Elevation of bladder neck to endopelvic fascia
after large opening of the periurethral spaces.
![Page 39: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/39.jpg)
2.47
« rectus fascia sling»
![Page 40: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/40.jpg)
Durée 1 min
http://www.gfmer.ch/Video/Reconstruction_cervico-uretrale.wmv
![Page 41: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/41.jpg)
Development in Training
1996 First « Fistula Mission » to TGTA
2002 Creation of GFMER
2003 Launching of UNFPA « Campaign to End Fistula », Geneva
2005 IOFWG
2007 FSS, Benin
2008 FIGO fistula committee
2008 Diploma in vaginal and fistulogy surgery (Prof. R.-X. Perrin)
2009 AECOM, New-York
2010 First « Fistula Mission » to TGTA, organized by African doctors.
2012 Geneva University Hospital
![Page 42: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/42.jpg)
![Page 43: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/43.jpg)
Development in Prevention
Women for Women Initiative
2001 Porga Maternity Hospital (Benin / Burkina Faso border)
Awareness in the villages
![Page 44: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/44.jpg)
Development in Recruitment,
Follow up and
Social Re-integration
1996 Diocese of Fada n’Gourma (Burkina -Faso)
2004 Sentinelles (Burkina Faso)
2008 ESSOR Benin
![Page 45: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/45.jpg)
Development in Infrastructure and
Technical Support (GFMER)
Porga Maternity Hospital
2 residences for expatriates
2 residences for patients with
VVF
Operation theater
Minibus
![Page 46: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/46.jpg)
Development in Research and
Awarness Activities
GFMER website
fistula.group.org (website)
Database for « fistula »
Articles, communications and congress
Film « Noélie or Forgotten Reality »
![Page 47: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/47.jpg)
www.fistulagroup.org
![Page 48: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/48.jpg)
![Page 49: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/49.jpg)
![Page 50: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/50.jpg)
![Page 51: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/51.jpg)
![Page 52: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/52.jpg)
![Page 53: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/53.jpg)
Fistula database
optical pen
![Page 54: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/54.jpg)
![Page 55: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/55.jpg)
Development in International
Activities Madagascar AFOA
Guinea Conakry MSF
Cameroon Engenderhealth
Burkina Faso UNFPA
Benin
Côte d’Ivoire
Chad
Mali
![Page 56: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/56.jpg)
![Page 57: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/57.jpg)
Doctor in 21st Century:
Privilege and Duty
Witness and / or actor of technology revolution.
Unlimited access to information.
The possibility of commitment that expands at global
level.
The duty to transfer technology and
knowledge to settings with limited resource.
![Page 58: Which further development over 15 years personal …...Humanitarian Medicine Which further Development over 15 years personal experience in Obstetric Fistula surgery C.H. Rochat AECOM,](https://reader034.fdocuments.in/reader034/viewer/2022042104/5e8180c591c8c36d2d51f36d/html5/thumbnails/58.jpg)
Everything has a price, even humanitarian
actions. (Claude Fournier)
Let’s experience humanitarian commitment