Last month Gillian Slinger, MSF's Reproductive Health Advisor visited the project, affectionately known as 'Project Papillon'. The highlight of her trip was a very special event held on August 14 celebrating the 100th fistula repair operation to be performed this year. The event brought together key local dignitaries, partners, hospital and MSF staff, and of course the fistula patients themselves. 

In eastern Chad, with few hospitals and little access to caesarean section operations, obstetric fistulas occur as a direct result of problems in childbirth, where the labour may last for many days. Such unrelieved complications are the cause of significant maternal deaths.

For those who survive the ordeal, the baby will usually be stillborn and the woman will be left with a permanent injury to her birth canal. This injury, leading to continual, chronic leaking of urine and/or bowel waste, is called an obstetric fistula.

MSF has been running a fistula project in Abéché General Hospital in eastern Chad since January 2008, where a team performs surgical operations on patients to repair their internal injuries and provide a cure for their incontinence.

With an estimated 300 to 400 new obstetric fistula cases per year in Chad, a backlog of cases dating from many decades, and with more than 100 women already on the waiting list at Abéché Hospital, the team faced a challenging task when they launched the project. Moreover, in order to be close to the vulnerable communities, MSF opened a project in a testing environment with significant security constraints and with little access to health care for the population.

The women who arrive in the project with obstetric fistula frequently come from remote, distant areas of Chad and often present in a poor condition. They stay in the so called 'Women's Village', accommodating women waiting for surgical fistula repair, under the care of a dedicated team, including an expert fistula surgeon and physiotherapist. The surgical procedure usually lasts about one hour for a simple case, to several hours (and numerous subsequent operations) for the more complex cases. With a skilled fistula surgeon and excellent post-op nursing care, the outcome is very successful, with a cure rate of 90 percent.