The mobile surgical outreach program for management of patients with genital fistula in the Democratic Republic of Congo.
OBJECTIVE
To describe components of the mobile surgical outreach (MSO) program as a model of care delivery for women with genital fistula; present program results; and discuss operational strengths and challenges.


METHODS
A retrospective observational study of routinely collected health data from women treated via the MSO program (2013-2018). The program was developed at Panzi Hospital in the Democratic Republic of Congo to meet the needs of women with fistula living in remote provinces, where travel is prohibited. It includes healthcare delivery, medico-surgical training, and community sensitization components.


RESULTS
The MSO team cared for 1517 women at 41 clinic sites across 18 provinces over the study period. Average age at presentation was 31 years (range, 1-81 years). Most women (n=1359, 89.6%) presented with vesicovaginal fistula. Most surgeries were successful, and few women reported residual incontinence postoperatively. Local teams were receptive and engaged in clinical skills training and public health education efforts.


CONCLUSION
The MSO program addresses the backlog of patients awaiting fistula surgery and provides a template for a national strategic plan to treat and ultimately end fistula in DRC. It offers a patient-centered approach that brings medico-surgical care and psychosocial support to women with fistula in their own communities.
['Maroyi|Raha|R|', 'Keyser|Laura|L|', 'Hosterman|Lauren|L|', 'Notia|Amisi|A|', 'Mukwege|Denis|D|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000554:Ambulatory Care Facilities D002648:Child D002675:Child, Preschool D015023:Democratic Republic of the Congo D005260:Female D006801:Humans D007223:Infant D008875:Middle Aged D011203:Poverty D012006:Rectovaginal Fistula D012189:Retrospective Studies D014549:Urinary Incontinence D014719:Vesicovaginal Fistula D055815:Young Adult
Mobile surgical outreach Genital fistula Democratic Republic of Congo Community outreach Surgical training