Dates for the services were changed on several occasions; once publicized, health personnel need to stick to the dates that services will be offered No place to sleep and eat for the women and accompanying person while waiting for surgery No place for the person accompanying to stay after the operation Medical personnel were not always highly sensitive to the needs and conditions of the women Women who were not served were not provided any educational information Insufficient information regarding their condition, appropriate care at the village level, and subsequent surgery was given to those women who were not repaired successfully and to the person accompanying them No mechanism to follow women who went home without being operated Accompanying people were not educated about post operative care and fistula in general No psychological counseling No reintegration services into community offered Fixed Approach Advantages Able to establish relationship with woman to understand her broader needs and develop a holistic approach to treatment Involve other specialized personnel who can address different needs and provide a packet of services; Complete medical attention for fistula care and co-morbidities Psychological care Reintegration services Carry out multiple surgeries if needed Address complicated cases Inform/sensitize a range of family members Establish a relationship with other women with fistula and share their problems and aspirations Disadvantages Expensive Unable to provide services to many women at one time Services are difficult to access from remote areas Require a separate building/pavilion that is somewhat distant from other wards Trained doctors leave for better paying jobs DISCUSSION
Dates for the services were changed on several occasions; once publicized, health personnel need to stick to the dates that services will be offered No place to sleep and eat for the women and accompanying person while waiting for surgery No place for the person accompanying to stay after the operation Medical personnel were not always highly sensitive to the needs and conditions of the women Women who were not served were not provided any educational information Insufficient information regarding their condition, appropriate care at the village level, and subsequent surgery was given to those women who were not repaired successfully and to the person accompanying them No mechanism to follow women who went home without being operated Accompanying people were not educated about post operative care and fistula in general No psychological counseling No reintegration services into community offered Fixed Approach Advantages Able to establish relationship with woman to understand her broader needs and develop a holistic approach to treatment Involve other specialized personnel who can address different needs and provide a packet of services; Complete medical attention for fistula care and co-morbidities Psychological care Reintegration services Carry out multiple surgeries if needed Address complicated cases Inform/sensitize a range of family members Establish a relationship with other women with fistula and share their problems and aspirations Disadvantages Expensive Unable to provide services to many women at one time Services are difficult to access from remote areas Require a separate building/pavilion that is somewhat distant from other wards Trained doctors leave for better paying jobs DISCUSSION