Figo newsletter march 2012


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Figo newsletter march 2012

  1. 1. International Federation ofF Gynecology and Obstetrics IFIG March 2012 GOFIGOOCountdown to Rome 2012 excellent hands-on workshop – ‘Basic and Advanced Clinical and Laboratory Training Course in Infertility, including ART, for Developing Countries’ – in Cairo, December 2011, in collaboration with the International Islamic Center for Population Studies and Research, Al Azhar University and ICMART, with support from ESHRE. This fruitful event was attended by participants from Egypt, Qatar and Nigeria. Subsequent evaluation revealed the candidates’ great satisfaction, with most attendees signing up for more training, according to their needs. I would like to thank IBSA international for its support of these valuable activities.Professor Serour (centre) at the FLASOG Congress (September 2011)Dear Colleagues Pre-Congress courses, sessions organised by member societies, regional federations andSince last October, FIGO has been actively subspecialty societies and committees, and livescaling up its efforts in preparation for its World surgery transmission from several countries.Congress in Rome (7-12 October 2012), andcontinuing to play a major role in global efforts to Please note that the Congress ‘Earlyaccelerate the achievement of the health-related Registration’ fee deadline has been extended toMillennium Development Goals (MDGs). 15 April 2012. Additionally, FIGO has always endeavored to provide special assistance toCongress plans coming to fruition colleagues from lower-resource countries, so a ‘Basic and Advanced Clinical and Laboratory TrainingThe various Congress Committees, together with decision has been taken to offer to delegates Course in Infertility, including ART, for Developingthe FIGO Secretariat, have been working hard to from countries classified as ‘low-income Countries’, Cairo (December 2011)finalise arrangements. Professor William Dunlop, economies’ and ‘lower-middle-income economies’ (by The World Bank), that are An attendee, Dr Chris Agboghoroma, SecretaryChair of the Scientific Programme Committee, General of the Society of Gynaecology andhas put together an outstanding programme members of FIGO, the opportunity to register at a specially reduced ‘Early Registration’ fee of €600 Obstetrics of Nigeria (SOGON), discussed withwhich meets the needs of all levels, from basic me strengthening collaboration with FIGO, andmaternal and newborn health through to ‘cutting – a substantial saving of €150 on the standard ‘Early Registration’ fee of €750. A full list of the the plans to launch the African Federation ofedge’ knowledge in our field. The President’s Obstetrics and Gynecology at FIGO’s RomeSession will incorporate a stimulating debate countries and territories to which this offer applies is available on We Congress.between the presidents of various professionalorganisations and heads of several UN hope that this will encourage attendance from the The first FIGO training centre for Minimallyorganisations, with active audience participation. countries concerned. Invasive Surgery – in Soba Hospital, KhartoumThere will be new landmarks, including hands-on University, Sudan – held its first course from 28 Keeping the focus on education February-1 March 2012; another centre in the and training Ukraine will start its first course in March 2012. I FIGO’s education and training programme is would like to thank Olympus Surgical making excellent progress with more emphasis Technologies Europe for its staunch support of on hands-on training: the FIGO Committee for this programme. Capacity Building in Education and Training – Following the success of recent ERC-RCOG and chaired by Professor Luis Cabero-Roura – has FIGO workshops on the prevention and held high profile workshops and sessions in treatment of post-partum haemorrhage, held in national and regional conferences over the past Egypt during 2011, I am pleased to report that few months. similar workshops have taken place from 28 The Committee for Reproductive Medicine – February-1 March in Cairo and Alexandria.FLASOG Congress (September 2011) chaired by Professor David Adamson – held an continued on page 2 Latest on FIGO’s 2012 World Congress in Rome | Interview with CEO of Fistula INSIDE: Foundation | WSRR Committee news | Spotlight on our Mozambique membersInter national Federation of Gynecology and Obstetrics | March 2012 1
  2. 2. Countdown to Rome 2012 Continued from page 1 FIGO and global partners – furthering urgent action on the MDGs Last October, the FIGO leadership participated in the second FIGO LOGIC (Leadership in Obstetrics and Gynecology for Impact and Change) Initiative Annual Review Meeting in Mumbai, where discussions were held with representatives from the Bill & Melinda Gates Foundation, chairs of the country projects and the evaluation team on the current successes and challenges of this major project. There has been tremendous progress, aided by a new project team, increased enthusiasm from country directors, close monitoring by FIGO leadership and the establishment of a special Technical Advisory Group. Religious leaders (December 2011) Strengthening relationships I recently participated in many national society and regional federation meetings – my commitments ranged from giving presentations, chairing discussions and workshops, and 2011 International Conference on Family Planning, Dakar, meeting with key representatives to discuss Senegal (December 2011) collaborative efforts. In November, I represented FIGO at the Events included: ‘International Conference on Family Planning’ in – Congress of the Federation of Latin American Senegal. The President of Senegal, four African Societies of Gynecology and Obstetrics First Ladies, UNFPA’s Executive Director and top (FLASOG), September 2011 A highlight was a UN and NGO representatives were in attendance. productive breakfast meeting with Presidents The FIGO President at a meeting of religious leaders from FLASOG member societies (IICPSR-UNFPA, December 2011) I delivered a presentation in the opening plenary session on ‘Family Planning’s Dividends for – XXII Asian and Oceanic Congress of that there have been some obstacles that have Global and National Health’, highlighting the role Obstetrics and Gynecology (AOCOG 2011), been a barrier to the adoption of some policies, of FIGO as an important professional September 2011 I met representatives of the mostly related to the lack of credible information organisation. I also participated in the member societies on the Asia & Oceania surrounding population problems, reproductive ‘Postabortion Family Planning: What’s Working in Federation of Obstetrics & Gynaecology and sexual health and gender issues. In Africa’ workshop organised by USAID and (AOFOG) Council to discuss regional activities collaboration with UNFPA and UNICEF a number RESPOND, delivering a presentation on of workshops and ‘training of the trainers’ – 87th National Congress of SIGO and National ‘Postabortion Family Planning: Professional workshops for Imams, religious leaders and AOGOI Congress, September 2011 This Associations Support Universal Access’, and policy makers in Afghanistan and Egypt were meeting enabled me to convey sincere thanks participating in the panel discussion on policy held in December 2011. These workshops to our Italian colleagues for hosting the FIGO and scale up. dispelled misconception among religious leaders 2012 Congress, and to call for generally closer I also attended the Postabortion Care (PAC) collaboration with all Italian obstetricians and concerning population policies, and helped them Consortium organised by Pathfinder International, gynecologists and their various associations revise and modify their religious addresses to the EngenderHealth and the Population Council, masses in the most remote areas of their – XII All-Russian Scientific Forum, Moscow, countries. These activities have been evaluated highlighting FIGO’s role with particular reference September 2011 I encouraged the Russian by an independent body and their effectiveness to its own statements on family planning. I briefed Society of Obstetricians and Gynaecologists has been proved. participants on the FIGO Misoprostol for Post- to have a session at FIGO’s Rome Congress Partum Haemorrhage in Low-Resource Settings FIGO is currently engaged in preliminary Initiative, and the FIGO guidelines on the use of – International Annual Congress of the negotiations with various UN organisations to misoprostol in various gynecological and Lebanese Society of Obstetrics & Gynecology, strengthen the role of FBOs. obstetric conditions, including postabortion care. November 2011 This provided a valuable In May, FIGO will again collaborate with the opportunity to discuss collaborative interests China to greet Executive Board in 2012 Population Council on a consultation on the with the General Secretary of the Arab The next FIGO Executive Board meeting will be unmet needs of family planning and the provision Association of Obstetrics and Gynaecology held in Beijing, in May, and arrangements are well of long-acting effective contraception. Societies advanced. In addition, two educational and Early 2012 took me to Geneva, participating in a – Saudi Arabia Ob/Gyn Conference (SAOGC) training workshops will be held in Beijing and special WHO Infertility Global Research and and ACOG Congress, Riyadh, January 2012 Chengdu. I would like to offer sincere thanks to Guidance Meeting, as well as attending its I encouraged the Saudi Society to have a the Chinese Society of Obstetrics and Executive Board meeting. session at FIGO’s Rome Congress, and also Gynecology for hosting these events. discussed support for the global MNCH I wish you a prosperous 2012, full of happiness FIGO recently joined forces to condemn the programme and joy. medicalisation of Female Genital Mutilation (FGM) in one Asian country, and I also sent a letter to its Faith-based organisations (FBOs) – Best wishes Minister of Health drawing attention to FIGO’s ethical guidelines on FGM, as well as the accelerating the achievement of the International Islamic Center for Population health-related MDGs Studies and Research Al Azhar University FIGO is well aware of the major role that FBOs guidelines in the international book: ‘Children in can play in this regard – for example, more than Islam. Their Care, Development and Protection’, 50 per cent of healthcare in Africa is being developed in collaboration with UNICEF. provided by such organisations. We recognise FIGO President Gamal Serour2 Inter national Federation of Gynecology and Obstetrics | March 2012
  3. 3. CHIEF EXECUTIVE’S OVERVIEWCongress 2012 ‘open for business’Dear Colleagues Federation of Obstetric and Gynaecological the current and planned efforts of FIGO and the Societies of India (FOGSI) for their generous RCOG; an assessment of possibilities forWarm greetings for 2012! support of this event. collaboration on new activities of sharedA new year brings with it new challenges and our interests; and a provisional plan for movingfocus for 2012 is very obvious – our forthcoming forward. I look forward to updating you on this inWorld Congress in Rome! Planning, organising, due course.and finalising continues apace, and we hope thatas many of you as possible will join us for this FIGO and post-partum haemorrhagehigh profile and hugely important global event. If – valuable work on guidelinesyou have not done so already, please visit In November, a special Technical for comprehensive Meeting, organised by FIGO, on FIGO Guidelinesinformation on every aspect. We are pleased to on Misoprostol for the Prevention and Treatmentreport that our ‘Early Registration’ fee deadline of Post-Partum Haemorrhage (PPH), provided ushas now been extended to 15 April 2012 – I with the opportunity to meet with experts fromurge you to book early to avoid disappointment! the WHO, the Universities Liverpool andPlease turn to page 11 for more details, and put Stanford, the International Confederation ofthe dates 7-12 October 2012 firmly in your Professor Rushwan at LOGIC’s Annual Review Meeting (October 2011) Midwives (ICM), FIGO’s Committee for Safediaries. Motherhood and Newborn Health and GynuityUN puts women’s and children’s MDG focus in run-up to 2015 Health Projects. It was decided that there was Shortly afterwards, I attended a special Board sufficient consensus in key areas to movehealth centre-stage forward with the development of Guidelines. meeting in Paris of the Partnership for Maternal,In September 2011, I attended the UN General Newborn and Child Health (PMNCH), the Please see the latest updates on FIGO’sAssembly in New York – where a special session purpose of which was to approve its 2012 misoprostol initiative on page seven.was held to discuss the UN Secretary General’s workplan and to reach alignment on key issues. In December, I was invited to Yokohama, Japan,Global Strategy for Women’s and Children’s The main aim is to co-ordinate efforts towards to present on FIGO’s global role at a special FIGOHealth – and a special meeting of the Global strengthening the UN Secretary General’s Global workshop held during the 56th Annual Meeting ofLeaders Council for Reproductive Health. As Strategy for Women’s and Children’s Health the Japan Society for Reproductive Medicine. Italways, my visit to this vibrant city proved a (mentioned earlier), as it is essential that global was an excellent opportunity to touch base withvaluable opportunity to touch base with UNFPA partners continue to strive towards the our Japanese friends on many pertinent issues,and EngenderHealth, both collaborative partners achievement of MDGs 4 and 5. It was agreed and to meet also with Professor Takeshi Maruo,of FIGO on fistula and Adolescent Sexual and that healthcare professional organisations – FIGO’s Vice-President.Reproductive Health (ASRH) activities. including FIGO – will play a major role in trainingIn October, I travelled to Maputo to discuss and in the dissemination of essential interventionmatters in relation to the formation of the African packages.Federation of Obstetrics and Gynecology(AFOG). Participants included the WHO’s office in Seizing initiative – new talks withAfrica, the Presidents of ECSAOGS, SAGO and ACOG and the RCOGour Mozambique member society, and a At the end of October, a high-level meeting ofrepresentative from the Nigerian Society representatives from the American College of(SOGON). There was firm agreement to establish Obstetricians and Gynaecologists (ACOG), thea regional Federation for Africa, and the meeting UK’s Royal Society of Obstetricians andpinpointed the necessary steps to be taken – Gynaecologists (RCOG) and FIGO was held tomost importantly, the finalisation of its explore collaborations and partnerships for Professor Rushwan in Yokahama (December 2011)Constitution. As we go to press, arrangements dramatically accelerating progress in preventing Front row: Yorino Sato PhD, Mrs Maruo, Mrs Hsueh, Dr Okutsu, Dr Nanba; back row: Seido Takae, Dr Ishizuka,are in hand for a special launch meeting to be maternal and newborn deaths globally. The Professor Rushwan, Dr Hsueh, Dr Kawamura, Dr Yoshiokaheld during our World Congress. outcomes were: a better understanding of howOur LOGIC Initiative Annual Review Meeting in the College, FIGO and the RCOG areMumbai (see page six) was a great success, contributing to current and planned globaldrawing together the many strands of this far- initiatives for maternal and newborn health; anreaching project. We are most grateful to the assessment of possibilities for ACOG to support Young people high on agenda at AICOG 2012 Chief Executive Hamid Rushwan was a guest speaker on ‘Adolescent Sexual and Reproductive Health (ASRH): the Global Issues’ at a workshop hosted by the Adolescent Health Committee of the Federation of Obstetric and Professor Rushwan presenting at the ICM meeting Gynaecological Societies of India (FOGSI). The event – (January 2012) held during January’s All India Congress of Obstetrics and 2012 has started as briskly as 2011 ended, and Gynaecology (AICOG), Varanasi – was organised by so far has taken me to Rome (World Congress Chairperson Dr Roza Olyai. meeting), Geneva (WHO’s 130th Session of the ‘These issues are vital to address,’ said Professor Rushwan. ‘Promoting healthy practices and Executive Board), the Hague (a Multi-Stakeholder taking steps to better protect young people from risks is critical to the future of countries’ health Midwife Education Providers Meeting, organised and social infrastructures and the prevention of problems in adulthood. This excellent workshop by the ICM), and Varanasi, India (55th All India provided a clear overview of the challenges facing health professional organisations.’ Congress of Obstetrics and Gynaecology). The Professor Rushwan was accompanied by FIGO next few months will be fast-moving, as we President-Elect Professor Sabaratnam prepare for our annual Executive Board meeting Arulkumaran, who participated in a special in Beijing, China, among other important FIGO session focusing on Indian ASRH issues. Dr P K commitments. Shah, FOGSI President, inaugurated the My best wishes for the hard work ahead as we workshop. approach Congress 2012. FOGSI’s Committee will be organising workshops and Continuing Medical Education (CME) throughout 2012 in 24 FOGSI societies, which will include a Public Forum. It will also inaugurate the Young Women’s Club in each FOGSI society. The overall aim is to sensitise gynecologists and Dr Olyai; Professor Rushwan; Dr Shah; Professor the general public on ASRH issues. Arulkumaran; Lord Naren Patel; Dr Purandare FIGO Chief Executive Hamid RushwanInter national Federation of Gynecology and Obstetrics | March 2012 3
  4. 4. PEOPLE Q and A with Kate Grant, MPA, BS Kate Grant is the CEO mentoring for new fistula surgeons. To of the Fistula paraphrase Humphrey Bogart from the classic Foundation, based in film Casablanca, I hope this is just the beginning the heart of Silicon of a beautiful partnership between FIGO and the Valley, San Jose, Fistula Foundation! We want the programme to California. The thrive and expand. Dr Suzy Elneil, who wrote the Visit Foundation is the Manual and serves on the FIGO Committee for whatisfistula/faqs.html largest charity focused Fistula, joined the Foundation’s Board of globally on the Directors this January. We are going to benefit (Source: treatment of obstetric greatly from her expertise, helping solidify our • Fistula used to be present in the US and fistula, funding fistula partnership with FIGO. FIGO’s leadership – in Europe, but was largely eliminated in the latter programmes at 38 ensuring more surgeons receive high quality part of the 19th century and early 20th century Kate Grant sites in 15 countries. competency-based training – will result in many with improved obstetric care in general and the more women, suffering needlessly from obstetric use of c-sections in particular to relieve Kate joined the Foundation as its first Chief obstructed labour. Executive in 2005 and has led the board and fistula, getting treatment that will change their lives. That’s why I’m so thrilled to be working with • The World Health Organization estimates there staff team that have expanded the Foundation may be as many as 50,000-100,000 new from supporting one institution in one country, FIGO and supporting this important programme. cases of fistula each year, yet the global Ethiopia, to its current global reach. The What do you find most satisfying/ treatment capacity is less than 20,000 cases a Foundation raises funds from donors in the year. There is a large unmet need for treatment. United States, Europe and Asia and does not challenging about your work? Fistula is most prevalent in sub-Saharan Africa accept funds from any government; it I am inspired by the dedication of the surgeons and Asia. advances its mission by forming close we support and the courageous fistula patients • The root causes of fistula are grinding poverty partnerships with doctors and hospitals in they treat – women who have suffered more than and the low status of women and girls. In developing countries, funding their provision of any woman should have to suffer simply for trying developing countries, the poverty and fistula treatment. Collaboration is at the centre to bring a child into the world. It is immensely malnutrition in children contributes to the of its work. rewarding to work in partnership with others who condition of stunting, where the girl skeleton, Before joining the Foundation, Ms Grant held I respect so greatly to bring care to women with and therefore pelvis as well, do not fully mature. several senior positions, including Deputy Chief such profound need. In many ways, fistula This stunted condition can contribute to of Staff at USAID in the Clinton Administration. treatment is still in a nascent stage, and the obstructed labour, and therefore fistula. She’s lived and worked in Tanzania and challenge of getting treatment for all women who • Fistula is both preventable and treatable. For Senegal, and travels frequently to consult with need it is both daunting and motivating. instance, the Addis Ababa Fistula Hospital has partners in the field. Ms Grant brings to her treated over 35,000 women over 33 years. current role a long-term commitment to Their cure rate is over 90 per cent. Fistula can advancing the reproductive health of women be prevented if labouring women are provided that began as a volunteer for Planned with adequate emergency obstetric care when Parenthood two decades ago, and led her to complications arise. earning a MPA from the Woodrow Wilson The Fistula Foundation: in focus School at Princeton University. She is a • The Foundation funds 38 facilities in 15 countries contributor to the Huffington Post, writing on • It has invested $1.1 million in new hospitals maternal health and motherhood. and equipment between 2009-11 Kate, how did your relationship with • It has managed $11 million in worldwide grants Fistula Foundation Board of Directors for fistula projects between 2006-11 FIGO evolve? • It made 3,416 fistula surgeries possible The single biggest obstacle to treating the great between 2009-11 backlog of fistula patients in Africa and Asia is a The Fistula Foundation website – • It runs patient recruitment campaigns in 12 lack of trained fistula surgeons. FIGO, in – provides a wealth countries collaboration with UNFPA, stepped forward to of information on this grave women’s health • It has trained 44 surgeons in fistula repair and address this critical deficiency. I’ve certainly been issue, including the latest facts and figures. 144 nurses and anaesthetists an admirer of the important work done by FIGO globally, and, over the last year, I’ve been honoured to become acquainted with FIGO’s Chair of FIGO Working Group receives 2011 Chief Executive, Professor Hamid Rushwan, and Lord Naren Patel, the Chair of the FIGO Allan Rosenfield Award for Lifetime Contributions Committee for Fistula, and to learn more about to International Family Planning FIGO’s pioneering work on fistula treatment. Dr Anibal Faúndes – Professor of Obstetrics at the State University of FIGO’s new Global Competency-Based Fistula Campinas, Sao Paulo, Brazil, and Chair of the FIGO Working Group for Surgery Training Manual and the new Fellowship the Prevention of Unsafe Abortion – has been awarded the 2011 Allan Training Programme are critical steps in helping Rosenfield Award for Lifetime Contributions to International Family increase the quantity of fistula surgeons, while Planning at the North American Forum on Family Planning (held late last ensuring high quality clinical training. year in Washington, DC). I was delighted that our Foundation could provide The Allan Rosenfield Award for Lifetime Contributions to International initial funding for the FIGO Fistula Fellowship Family Planning was created in 2007 to pay tribute to the authority and Programme. dedication of its first recipient, the Society of Family Planning’s (SFP) founding board member Dr Allan Rosenfield. It is an award ‘given yearly to individuals who have made invaluable contributions to international Dr Anibal Faúndes family planning through their research, writing, teaching, institutional leadership, and/or policy contributions. The recipient of this award will have contributed to the health of women worldwide through activity in the field of family planning and will have demonstrated commitment to the importance of women in society, their equal treatment, and their right to autonomy in reproductive decision-making. In doing so, the awardee will have enhanced the lives of men and women now and in the future.’ FIGO President Professor Gamal Serour said: ‘This is highly deserved, prestigious recognition for a scientist who has contributed enormously to our profession and who has cordially served FIGO for many years. His contributions and dedicated efforts to save the lives of women and newborns and improve the quality of their lives, particularly in low-resource countries, have been outstanding. How do you see your work with ‘The FIGO leadership and staff are immensely proud of his achievements, and are grateful for his FIGO progressing in the future? continuing unfailing dedication and expertise.’ The FIGO Fistula Manual and Fellowship Training For more information, visit: and Programme are truly visionary, providing competency-based training and ongoing4 Inter national Federation of Gynecology and Obstetrics | March 2012
  5. 5. COMMITTEE NEWSIntegrating Human Rights and Women’s Health – an educational approachA project of the FIGO Committee for Women’s Sexual and Reproductive Rights (WSRR)By Professor Lesley Regan, Committee Chair This exciting project dissemination and implementation in medical our materials. Do join us at the FIGO plenary and has the potential to schools globally. Workshop sessions, and encourage your transform women’s In May 2011 the list of 10 human rights and colleagues to attend. healthcare globally by healthcare competencies was finalised. A final ensuring that a clear The way ahead document was produced alongside plans and a understanding of dissemination timetable, and these were This transformational project is still evolving, and women’s sexual and presented to the FIGO Executive Board in June aims to move womens health and reproductive reproductive rights 2011, and further approved. needs from a marginal position in most curricula becomes an integral to more mainstream thinking. We aim to turn the part of the core Following on, draft outlines for case studies to tables on traditional approaches and ensure that, educational training illustrate the human rights and competencies in the future, sexual and reproductive healthcareProfessor Lesley Regan programme delivered checklist were proposed by the Committee. A teaching and practice has a central focus basedto undergraduate medical students throughout workshop was held in January 2012 to review on human rights principles.the world. The goal is to educate future doctors and complete the editing for eight of the 10to practice in such a way that Women’s Rights clinical case studies, which now include the caseand Reproductive Healthcare become narrative, questions specific to each and Integrated Human Rightsinseparable. references. and Women’s Health: We have deliberately weighted the references Checklist to DetermineHuman rights as main focus more heavily towards human rights standards on the assumption that medical teachers and their Competencies for ClinicalMillions of women and children suffer illness orinjury every year because their fundamental students have more ready access to texts and Practicehuman rights have been denied. In 2012 we references describing the health conditions than Physicians must be able to apply theexpect that nearly 500,000 women will die in they do human rights literature. There is a principles of human rights to the dailychildbirth and 80 per cent of these deaths will be common theme to the questions beginning with practice of women’s health care.avoidable within the fiscal resources of the the medical dilemma and the threat to rights, 1. Right to life: Everyone has the right tosocieties in which they live – no-one cares then progressing to explore the complexities of life.enough to ensure that their human rights are the relationship of health and rights for the case 2. Health: Everyone has the right to theprotected. scenario and for the general healthcare system highest attainable standard of physicalOur Committee is developing a generic medical which is in place locally for that student and and mental curriculum that is designed to integrate teacher. 3. Privacy: Everyone has the right tothe teaching of women’s health and human We have now completed the last two cases and respect for privacy in the field of healthrights, and which will produce a framework that reference materials and will start designing the care.each medical school will be able to adapt to its format of the teaching materials guide and 4. Confidentiality: Everyone has the rightlocal and national standards, health policies, laws curriculum assessment tools. Every opportunity to confidentiality in relation toand conventions. This will help to ensure that will now be taken to disseminate the project in information on health care and healthevery graduate doctor has the necessary clinical the form of presentations and interactive status.and communicative skills and knowledge base to workshops. 5. Autonomy and decision-making:help women protect their sexual and reproductive Everyone has the right to autonomousrights. Doctors educated in this approach are FIGO World Congress, Rome 2012 – decision-making in matters concerningmore likely to deliver quality healthcare, advocate the next steps their health.effectively for patient rights and participate in the A plenary session, ‘Integrating Human Rights and 6. Information. Everyone has the right todevelopment of healthcare systems that integrate Health – introducing the FIGO project to receive and impart information relatedavailable technologies with quality processes and transform women’s healthcare’, scheduled for to their health.respect for human rights. Monday 8 October 2012, aims to attract global 7. Non-discrimination: No one shall be leaders in women’s health and human rights, subject to discrimination on anyThe Committee’s history representatives of ob/gyn specialist societies, grounds in the course of receivingThe Committee was founded in 2001 under the and education and ethics teachers. health care.leadership of Dorothy Shaw. During her FIGO 8. Right to decide number and spacing of The Committee will demonstrate how the children: Everyone has the right topresidential term (2006–2009), Dr Shaw worked checklist of human rights can be applied to antirelessly to raise the profile of reproductive rights decide freely and responsibly on the individual case study and so easily incorporated number and spacing of children and toand women’s health. When the Committee met in into daily teaching on women’s reproductive2008, under the chairmanship of Dr Kamini Rao, have access to the information, health. This will be followed by a panel discussion education and means to enable themFIGO had already agreed to produce a booklet with audience participation. Attendees will bethat could be used by medical students to raise to exercise these rights. invited to use the educational materials available 9. Freedom from inhumane and degradingawareness of reproductive rights issues and to on and to register for an treatment: Everyone has the right to beclarify the terminology in use. interactive Workshop to be held the next day, 9 free from torture or cruel, inhuman orFollowing FIGO’s 2009 Congress, I was invited to October 2012 – ‘Integrating Human Rights and degrading treatment or punishment inchair the Committee in its next developmental Women’s Health into your educational and clinical the field of health care.stage: the design of the curriculum. practice’ – designed for leaders from national 10. Benefit from scientific progress: societies and training colleges. Everyone has the right to enjoy theThe project in progress benefits of scientific progress and its We hope to recruit a cadre of future trainers whoIn March 2010 the new Committee working party will help us disseminate the project globally, and applications.(four ob/gyn clinicians, a medical educator and a we will actively encourage feedback to help refinereproductive rights lawyer) met to determine howbest to produce the curriculum. An outlinedocument was drafted describing 10 universal The main questionshuman rights and the healthcare competencies 1. What is the nature of the health carethat are necessary to ensure them in the course problem?of daily medical practice. Each statement of 2. What is the threat to human rightsrights would be accompanied by a case study or posed by the scenario?exemplar, references to relevant medical, ethical 3. How does the health care systemand legal literature and followed by a list of support or infringe human rights?specific discussion questions that would guide The Committee (January 2012) 4. What are the local regulations L-R: Professor PC Ho – Hong Kong (OBGYN); Professorthe student and teacher to consider local governing delivery of care? Lesley Regan – London (WSRR Chair, OBGYN ); Dr Dianepractices, laws and governance. 5. How can the health care system be Magrane – Philadelphia USA (Medical Educator, OBGYN);It was recognised that guidelines for the Professor Anibal Faúndes – Brazil (OBGYN, Contraception improved to respect human rights and and Safe Abortion care expert); Ms Adriana Lamackova –curriculum’s teachers would need to be ensure health care? London (Reproductive Rights lawyer); Dr Stephen Munjanjaproduced, along with recommendations for – Zimbabwe (OBGYN, Domestic Violence expert)Inter national Federation of Gynecology and Obstetrics | March 2012 5
  6. 6. FIGO IN THE FIELD… Setting the agenda for 2012 – LOGIC looks ahead developing their overall organisational capacity to implement projects in 2011. Successful workshops were held on Basic Financial Management for NGOs, Project Management Skills, and Advocacy. Many of the MAs received support from the Society of Obstetricians and Gynaecologists of Canada (SOGC) to help them develop strategic and operational plans. The year in focus The meeting discussed plans for LOGIC in 2012. Meeting participants L–R: FIGO President-Elect Professor Sabaratnam The MAs will continue to focus on strengthening Arulkumaran; Chairperson Adolescent Health Committee, FOGSI, Dr Roza Olyai; FOGSI President Dr P K Shah; FIGO their organisational capacity to implement MNH Chief Executive Hamid Rushwan; LOGIC Project Director projects and to secure additional funding for such Professor David Taylor activities. The improvement of MNH clinical practice, including the implementation of MDRs and MNH policy, will continue to be a major theme in 2012. In summary, Professor David Taylor commented: ‘The LOGIC meeting was, once again, invaluable for all parties, and set the scene for a confident move into 2012 activities. I would also like to extend my very sincere thanks to FOGSI for its organisational help with this meeting, and its robust support of all aspects of our work.’ TAG – looking forward to 2012 LOGIC’s Technical Advisory Group (TAG) – President Gamal Serour (right) in discussion with FOGSI The LOGIC team meets with the Bill & Melinda Gates comprised of global experts from fields such as Past-President Dr C N Purandare Foundation and the Society of Gynecologists and public health, advocacy, and midwifery – met on Obstetricians of Cameroon (SOGOC) 14 October in Mumbai to discuss a wide-ranging The FIGO LOGIC (Leadership in Obstetrics and agenda of issues, including the development of Gynecology for Impact and Change) Initiative in an electronic toolbox to help strengthen the Maternal and Newborn Health (MNH) – funded organisational capacity of health professional by the Bill & Melinda Gates Foundation – held organisations; the future implementation of its Annual Review Meeting in Mumbai, India, MDRs; and plans for disseminating the Initiative’s from 12-13 October 2011. successes and lessons learned to key external LOGIC’s aim, over five years, is to help enable audiences. member associations (MAs) in eight low-resource African and Asian countries to play a catalytic role New addition to LOGIC in making positive changes in policy and practice The LOGIC team was and improve maternal and newborn health delighted to welcome services for under-served populations. The Charlene Bruneau to countries involved are Burkina Faso, Cameroon, the role of LOGIC Ethiopia, India, Mozambique, Nepal, Nigeria and Administrative Officer in Uganda. late 2011. The meeting was hosted by the Federation of Charlene joined FIGO Obstetric and Gynaecological Societies of India from the Department of (FOGSI). Representatives of FIGO LOGIC MAs Health in the UK, where from the participating countries and high-level she worked as a representatives from FIGO and other partners Personal Assistant and were in attendance. Charlene Bruneau administrator for the Professor Gwyneth Lewis (right) and Professor Dorothy The countries presented on key achievements, Shaw engage with a Working Group on Maternal Death International Clinical Lead for Maternal Health, challenges and lessons learned in 2011, Reviews supporting her on the Confidential Enquiries into including those in relation to organisational Maternal Deaths; as well as an administrator for and/or developing relationships with key capacity development, implementation of the Maternity and Newborn team and senior civil stakeholders such as Parliamentarians and other Maternal Death Reviews (MDRs), and policy servants, overseeing key administrative and health professional organisations, and are influencing and advocacy. secretarial support. engaging with the media on MNH issues. Professor David Taylor, Project Director, She also has over 15 years’ experience of explained: ‘This meeting prioritised three critical Improving maternal health practice working in the UK’s NHS, including accident and objectives: to review the progress of project through MDRs emergency departments and the ‘out-of-hours’ activities in 2010/11; to share the experiences of, The majority of MAs are now implementing MDRs GP service. and the lessons learned from, 2010/11; and to in selected hospitals in their respective countries. Charlene said: ‘I have really enjoyed my develop and agree final 2011/12 workplans.’ The aim is to improve the quality of maternal experiences so far with the LOGIC team – I am health care by collecting relevant data on the looking forward to the challenges and providing a Engaging; influencing; causes of maternal deaths, and in some cases positive contribution in our efforts to ensure the innovating near-misses, so that future deaths and project’s continued success.’ morbidities can be prevented. Professor David Taylor said: ‘Charlene made a Improving maternal and newborn significant contribution to the success of our health policy Organisational capacity 2011 Annual Meeting, and we are looking Most FIGO LOGIC MAs are engaging in policy development forward to working with her as we approach a influencing and advocacy activities with the aim Several of the MAs have made significant busy year for the team, in the run-up to the of improving MNH policy. The MAs are liaising progress in developing strategic plans and Rome World Congress in October 2012.’6 Inter national Federation of Gynecology and Obstetrics | March 2012
  7. 7. FIGO taking the lead onpost-partum haemorrhageprevention and treatment– an update on the Misoprostol for Post-Partum Haemorrhage inLow Resource Settings InitiativeGlobal experts refine new blinded randomised non-inferiority trials on thePPH guidelines efficacy of misoprostol 800mcg sublingual compared to 40 IU IV oxytocin for treatment ofA new set of FIGO guidelines on misoprostol for PPH in hospitals where oxytocin prophylaxis isPPH prevention and treatment are under provided during thedevelopment, and will be ready in time for the third stage of labourFIGO World Congress in October 2012. and in others where itIn recognition of the paucity of up-to-date and is not provided.evidence-based guidelines on the use of Further sessionsmisoprostol for PPH care, the guidelines will are planned for thereflect the current best available research, Royal College ofaddressing important areas such as Obstetricians andrecommended dosages and routes of Gynaecologists’ 10thadministration, contraindications, precautions, International Scientificcourse of treatment, and side effects. Meeting (Malaysia, June 2012), and the AbstractThe decision to develop simple and conciseguidelines, which will be available in French and Mexico Society’s 63rd ‘Clinical and operational evidence indicatesSpanish translation, was taken following a Professor Sabaratnam Congress (Guadalajara, that misoprostol is a safe and effectivetechnical consultation meeting convened by Arulkumaran August 2012). technology for addressing postpartumFIGO to assess the evidence and to ascertain hemorrhage, a major cause of maternalwhether there was sufficient group consensus in death. This research has not yet beenkey areas. The meeting, held in New York translated into effective policies, programs,(November 2011), was attended by an invited and practice in many parts of the of experts from FIGO’s Committee for Safe Efforts to expand evidence-based use ofMotherhood and Newborn Health, Gynuity Health misoprostol are often complicated byProjects, the International Confederation of misoprostols range of indications, insufficientMidwives (ICM), the World Health Organization, availability, a lack of evidence-basedthe Universities of Liverpool and Stanford, and guidelines and provider training, andFIGO. misconceptions about the drug. The medical and health policy communities need to workIn accordance with standard practice, the draft together to translate research findings intoguidelines will undergo a process of internal and changes in policy, knowledge, and clinicalexternal consultation before final endorsement at practice so that we can deliver on thethe next FIGO Executive Board meeting in May. worlds promise to improve maternal health.’FIGO will work towards securing a joint statementon PPH with other authoritative internationalbodies. FIGO’s formal position regarding the use ‘The Product Problem: Pathways forof misoprostol for PPH care was last outlined in Making Misoprostol Available forNovember 2006 in a joint statement with the ICM Postpartum Hemorrhage’– FIGO and ICM Joint Statement: Prevention andTreatment of PPH. New Advances for Low A report summarising a meeting to discussResource Settings. pathways for making misoprostol more widely available for PPH indications is available online atAdvocacy key focus at regional the Gynuity Health Projects website:conferences for-making-misoprostol-available-for-As part of an ongoing initiative to increase access postpartum-hemorrhage-en/ Some 50to evidence-based clinical and operational international experts from the programmatic,research to a global audience of obstetricians policy and pharmaceutical arenas gathered inand gynecologists, FIGO continues to sponsor New York in March 2011 to discuss productexpert panel sessions on the use of misoprostol regulation, the importance of quality products,for PPH care at regional conferences. registration, procurement, and the developmentIn January 2012, FIGO’s President-Elect, of effective service delivery and programmaticProfessor Sabaratnam Arulkumaran, chaired a models.session at the All India Congress of Obstetrics Dr M B Bellad at AICOGand Gynaecology in Varanasi, India, where expertspeakers presented on the role of misoprostol at Moving from evidence to practice:different levels of the health system in India; IJGO special communicationanalysed clinical indicators of post-partum (doi:10.1016/j.ijgo.2011.10.005)haemorrhage; and introduced new community- The January 2012 issue of FIGO’s officialbased research in India and Egypt comparing the publication, the International Journal ofeffectiveness of two strategies at the community Gynecology & Obstetrics (IJGO), featured alevel: the implementation of universal prophylaxis special communication addressing the challenges(600mcg oral misoprostol) versus the secondary to evidence-based use of misoprostol and theprevention service delivery model (whereby only strategies for expanding access to evidence-women who bleed 350 mL following delivery based care. The article, jointly authored by Annwould receive 800mcg sublingual misoprostol). Starrs (Family Care International) and BeverlyIn February 2012, during the Royal Society of Winikoff (Gynuity Health Projects), is also availableMorocco’s 30th annual meeting in Casablanca, online to IJGO subscribers and non-subscribersDr Mohamed Cherine, El Galaa Teaching Hospital at:, presented evidence from two double- article/pii/S0020729211005030Inter national Federation of Gynecology and Obstetrics | March 2012 7
  8. 8. New interactive video trainer set to revolutionise fistula repair The challenge of fistula on video recordings of a master fistula surgeon’s Hospital with Professor Serigne Gueye, in which actual cases and will be uniquely interactive, numerous fistula repairs were video recorded Obstetrical fistula remains a common and requiring input from the trainee in order to from start to finish using high definition demeaning affliction of young women in the proceed through the entire training course. It will endoscopic cameras and video equipment developing world, in part due to the lack of also provide virtual mentorship and a running provided by Stryker Corporation. sufficiently trained medical personnel. Training narrative throughout the programme, as well as Phase II (production) involves the laborious and medical professionals in fistula repair can be an assessment of the surgical trainee’s highly technical effort of separating the video of a costly and time-consuming, and many who have knowledge base via a comprehensive testing and fistula repair into individual steps, applying the successfully completed a training programme scoring system. interactive anatomic ‘hot spots’, and integrating lose confidence over time and do not continue repairing fistula. The project in detail curricula from the manual. Upon completion of Phase II (which will take approximately eight The most significant advance in the training of In the production of this programme, an entire months), a deliverable product will be available in fistula repair is the recent publication of FIGO’s fistula repair will be video recorded using high the form of a standard DVD that runs on a ‘Global Competency-Based definition endoscopic camera equipment. personal computer. Fistula Surgery Training Afterwards, the footage of the procedure will be Manual’, which, for broken down and the key images/video clips Phase III (implementation) involves the distribution the first time, has organised into a series of logical steps. A team of and implementation of the project, including a established a software engineers will then generate live ‘hot validation study and language translation. standardised spots’ within the video picture frame to highlight We will report on further progress with this educational the relevant anatomic locations in the surgical project very shortly – we are confident that our curriculum. field. In the final product, the trainee will be video trainer will prove an invaluable, truly Implementation required to choose the correct instrument from ground-breaking tool in the fight against fistula. of this manual is an animated Mayo stand using their computer’s a formidable mouse and place the instrument at the correct challenge and will *This article was prepared with the point of action (‘hot spot’) within the surgical field. assistance of Peter Melchert MD, who is a require a multi- Incorrect choices will be recorded as an error and modal training initiative. Paediatric/Internal Medicine Hospitalist at identify an area that may require more focused Abbott Northwestern Hospital, Children’s training. A technological solution Hospitals and Clinics of Minnesota. Since Once the correct choice is made, the video will 2004, he has been on the board of Simulation technologies have revolutionised the progress with running commentary of that Children’s Surgery International education of surgical trainees across the specific step. Step-by-step, the student will (, a developed world. These tools have yet to be progress in this fashion until completion of an humanitarian organisation that provides free utilised meaningfully in the developing world and entire fistula repair. At important intervals, quizzes surgical services to enhance the lives of may benefit the implementation of the manual at and tests of pre-op assessment, patient underprivileged children, and serves as its certified fistula training centres. positioning, instrument management, anatomy, Medical Director. In this effort, the FIGO Committee for Fistula has post-op management and awareness of requested the assistance of the US-based non- complications will appear in order to verify that profit organisation Children’s Surgery the core principles are being imparted to the International* and medical software company trainee. Red Llama, Inc. to develop and deploy a Upon completion of the trainer, a print-out of the simulation trainer that would communicate the student’s score is provided to identify areas key elements of this curriculum in an interactive needing additional attention. It is hoped that this video format. The final product is intended to run assessment will allow master trainers at certified on the surgical trainee’s own personal computer training centres to focus their educational efforts and provide a preparatory course with on the areas needing most attention. assessments of knowledge before a student begins a hands-on training programme at a Next steps: production and certified fistula centre. implementation Five master fistula surgeons from the FIGO Phase I (development) of the project has been Committee for Fistula have been appointed to the completed, including an initial on-location film authoring and editorial board of this unique Screenshot of video trainer shoot in Dakar, Senegal at Grand Yoff General (administering spinal anaesthesia) project: Professor Serigne Gueye, Dr Kees Waaldijk, Dr Mulu Muleta, Dr Andrew Browning and Dr Suzy Elneil. The benefits of the interactive approach It is believed that such an interactive video training programme would uniquely engage fistula trainees and allow them the opportunity to fully rehearse the steps of the procedure before practicing on a woman and potentially making a serious error. Utilising this tool, it is hoped that many more surgeons could be trained efficiently and safely at certified centres. In addition, upon returning to the trainee’s home hospital, this video trainer may provide a useful refresher and build confidence in those who may consider abandoning their newly acquired skills. The manual curriculum is divided into ‘standard’, ‘advanced’ and ‘expert’ levels. The intended audience for this video trainer project will be practicing surgeons who are entering at the ‘standard’ level of fistula repair and plan to attend a training programme at a fistula training centre. The trainer’s core software engine will be based Surgery in progress8 Inter national Federation of Gynecology and Obstetrics | March 2012
  9. 9. FIGO IN THE FIELD…Successes from the Saving Mothersand Newborns (SMN) InitiativeBy Moya Crangle, Project Manager, SMN InitiativeFIGO’s multi-faceted SMN Initiative came to full was directed to improve the supply of maternityconclusion in 2011. In this last feature, we services, and KOGS provided in-depth training inpresent the highlights of its work in Haiti and this method of audit. To increase the demand forKenya services, all sites reached out to civil society, andHaiti – ‘Setting up basic and comprehensive worked with it to distribute messages aboutemergency obstetric care in a health centre emergency preparedness, encouraging deliveryin the district of Croix-des-Bouquets’ with a skilled attendant and safe motherhood.(conclusion: 30 June 2011) The project provided a forum for health care providers to reflect on their working environmentSetting the scene and to identify areas to improve care to women First caesarean delivery at Croix-des-Bouquets (Dr LauréHaiti is the poorest country in the Western Adrien, Project Director) during the child-bearing year. Each site took onHemisphere: 70 per cent of its seven million different tasks relevant to its findings: eg thepeople live on less than one dollar a day, and it development and implementation of standardshas the highest rate of maternal mortality in the and protocols; in-service training in emergencyregion – 670 deaths per 100,000 live births. The obstetric care; and community sensitisation. InSociété Haitienne d’Obstétrique et de addition, some sites used project money toGynécologie (SHOG) recognised an ongoing need acquire essential equipment and supplies for theto provide quality and accessible obstetric care. improvement of the delivery of obstetric care eg sphygmomanometers, urine sticks, stethoscopesWork in action and partographs.In collaboration with other local partners such asthe Ministry of Health (MOH) and the Association Improved facilities Achieving the goalsdes Infirmières et Sages-Femmes dHaïti (AISFH), The project was successful in strengthening theSHOG worked to improve the physical technical capacity of health professionals toinfrastructure and the availability of health care conduct objective criterion-based clinical audit.professions in the maternity ward within a public This was achieved through recruiting juniorhealth centre located at Croix-des-Bouquets, 20 members of the society to provide support to thekilometres from Port-au-Prince. teams in the creation of measurement tools and in the evaluation of criteria.Achieving the goals At the project’s conclusion, it was discovered thatBefore the project, the centre at Croix-des- communication between referral levels hadBouquets offered only antenatal and postnatal greatly improved. Staff members havecare on an outpatient basis. Initially SHOG was Project staff (Dr Lauré Adrien, Project Director, is centre) experienced increased and improvedsuccessful in converting an outpatient unit into a communication with referral centres throughmaternity centre, offering basic emergency Kenya – ‘Improving the quality of maternal holding training sessions about the project, andobstetric and newborn care with referral for and perinatal health care services in four sharing standards and protocols.caesarean and blood transfusion to a nearby health facilities’ (conclusion: 31 Augusthospital. 2011)After Haiti’s catastrophic earthquake, the project Setting the scenedirector, with the support of Canadian With a maternal mortality ratio of 530 deaths percounterparts, was able to obtain funds in order to 100,000 live births, the Kenya Obstetrical andincrease the level of maternity services so that Gynaecological Society (KOGS) wanted towomen would have caesarean sections available improve the quality of maternal and newbornto them, if required. As a result of improvements health services. Building on its experience ofmade through this project, 24-hour care is now criterion-based clinical audit in a previous projectbeing provided with the availability of basic called ‘The Know-How Project’, the Societyemergency obstetric care and caesarean section. Training at Moi Teaching and Referral Hospital decided to implement this quality assuranceBlood transfusions are available on-site during method to four health facilities – in three hospitalsoffice hours and women are referred to another (Kenyatta National Hospital and Pumwanicentre outside of these times. Maternity Hospital in Nairobi, and Moi TeachingAlthough the SMN Initiative has been completed, and Referral Hospital in Eldoret), and in onethe MacArthur Foundation ( smaller health centre (Sabatia Health Centre,is now funding the project. The Society of Kakamega, Western Kenya).Obstetricians and Gynaecologists of Canada(SOGC) continues to support the project through Work in actionthe management of the MacArthur Fund, as well KOGS’ aim was to improve the supply of andas continually searching for future funds to keep increase the demand for maternal health care. Joyce Oduor (Project Manager), right, delivers supplies forthe maternity unit running. The main activity of criterion-based clinical audits Kenyatta National Hospital International Federation of Gynecology and Obstetrics FIGO House President-Elect: Administrative Director: Waterloo Court Sabaratnam Arulkumaran (UK) Bryan Thomas 10 Theed Street Past-President: Readers are invited to send all comments, articles and London SE1 8ST, UK Dorothy Shaw (Canada) reports (by email to or on Tel: +44 20 7928 1166 disk) to the FIGO Secretariat no later than 31 May Fax: +44 20 7928 7099 Vice President: Takeshi Maruo (Japan) 2012 for the next issue. Email: Honorary Secretary: The views expressed in articles in the FIGO Newsletter The International Federation of Gynecology and are those of the authors and do not necessarily reflect Obstetrics is a UK Registered Charity (No 1113263; Ian Fraser (Australia) the official viewpoint of FIGO. Company No 5498067) registered in England and Honorary Treasurer: Wales. The Registered Office is shown above. Wolfgang Holzgreve (Switzerland) Produced and edited by the FIGO Secretariat © FIGO 2012. President: Chief Executive: Gamal Serour (Egypt) Hamid RushwanInter national Federation of Gynecology and Obstetrics | March 2012 9