Challenges in accessing post-operative physiotherapy services following discharge after obstetric fistula repair, Eldoret, Kenya

Abstract

Objective: To explore women’s challenges in accessing post-operative physiotherapy services post-discharge from Gynocare Fistula Center in Eldoret, Kenya.
Design: Exploratory design of qualitative method.
Setting: The study was conducted at Gynocare Fistula Center and Maternity Home in Eldoret, an organization that offers obstetric fistula surgeries and other healthcare services within the country and across East Africa.
Subjects: Women with obstetric fistula surgical repair referred for post-operative physiotherapy.
Ethical considerations were obtained from relevant authorities and informed consent was sought from the participants.
Intervention: Pelvic Floor Muscles Training /exercises (PFMT/E).
Main Outcome measures: Adherence levels to pelvic floor muscles training program following obstetric fistula surgical repair.
Results: All 32 participants (100%) suffered obstetric fistula during child birth. Of these participants 93.75% lost their babies, 96.9% stayed in rural settings, 90.63% suffered vesico-vaginal fistula (VVF) and had VVF repair, and 100% had been referred for post-operative physiotherapy. Some of the participants (87.5%) lacked knowledge and awareness of existence of physiotherapy services as an indication of inadequate interdisciplinary referrals and poor distribution of physiotherapists in the rural areas. Secondly, socio-economic challenges were cited by 97% of the participants as they had no money to afford transport and physiotherapy services due to poverty; as some 90.63% of participants were housewives and dependent on their husbands. While 96.9% of the participants lived in rural setting and had to travel several kilometres to access physiotherapy services in urban setting.
Conclusion: Inaccessibility to post-physiotherapy services following obstetric fistula repair continue to exist in Kenya.