In May, a Belgian doctor arrived to train Yemeni doctors on how to operate on obstetric fistulas. Dr. Greet Morren said the one-month training included lecture and discussion sections for the first two weeks and practical, hands-on training for the second two weeks.

 Two teams were trained, one from Aden and the other from Sana’a. Each team consisted of two doctors and two nurses. The course was taught at the Al-Thawara Hospital in Sana’a.

Both teams were trained to recognize symptoms of the condition, as well as preemptive care options and all other aspects of caring for the condition.

“We need to train more doctors, nurses, social workers and community health workers,” Morren said.

Morren said other staff at the hospital also participated to learn more about fistulas.

“Over the past two weeks we have operated on 13 patients, all at the Al-Thawara Hospital.”

The Sana’a team is tracking the patients who have already undergone operations, and they are preparing to start solo-operating on less complex fistulas.

The Aden team has returned home, where they are also preparing to operate on less complex cases at the Al-Wahda Hospital.

There are two obstetric fistula centers in Yemen; one is in Sana’a at the Al-Thawara Hospital and treats cases from the northern area patients, and the other is in Aden at the Al-Wahda Hospital, for southern patients. Both centers are funded by the U.N. Population Fund.

The doctors were trained to evaluate fistula cases but not to operate on more complex cases. When such a case is diagnosed, the patient will be put on a waiting list until an expert, such as Dr. Morren, can perform the procedure, typically within a few months.

“When I arrive, these patients will be contacted, and I will operate on them together,” Morren said.

He said even with training, a doctor needs at least two years of full -time experience to be a specialist in the field; however, a standard three-month level of training is sufficient for most doctors.

The two teams are almost at that level now.

It will take the trainees a full year to reach an advanced stage, with the hope that at least one surgeon will choose to specialize in fistulas.

Morren said there is a lack of awareness in Yemen about fistulas.

“I am discovering that even medical staff (doctors, nurses and midwives) don’t know much about fistulas,” he said.

This reflects Yemen’s general population, he said, adding that  he’s found that many people don’t know about obstetric fistulas or their treatment.


Obstacles to the training

Morren said it was difficult to reach out to patients who live in rural areas or to those who’ve never seen a doctor for the problem. Reaching out to impoverished areas is a goal for the training course as they have little access to health care. The operation is often very simple but life-changing women.

“Most cases I’ve seen have already been consulted or operated on by another doctor, but three out of the 13 patients I operated on had never had the operation before,” he said.

They want to accept more patients, as 13 are not enough to complete the training.

He said media, especially radio, plays a prominent role in informing people of treatment options.

“Informing people in rural areas that there is free treatment available will make these patients come,” he said.

The second obstacle the training faced was a lack of nurses in the hospital, which has lost 400 nurses in the past few months. This lack of support has affected daily operations in the hospital.


Complex cases of Fistula:

Morren said the most extreme cases will be kept under careful watch, with the possibility of developing programs to support them. He will return in a few months to continue training doctors and helping them specialize obstetric fistulas.

“I’m trying to train doctors as fast as possible so they can work independently with their colleagues here,” he said.