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  • Fourth social rehabilitation and reintegration

    2019-05-22

    Fourth, social rehabilitation and reintegration of patients with fistula along with ubiquitin conjugating enzyme sensitisation (to prevent the occurrence of fistula, as well as to mitigate against stigmatisation of fistula survivors) will be crucial to eliminate obstetric fistula. Many women might not seek surgical care for fear of stigma in the community. Studies show many surgically repaired women serve as volunteers to identify and refer other cases in the community for surgical treatment. Access to treatment, social support, and rehabilitation will profoundly improve their physical and mental health, and provide a second chance of family life and a life of dignity, hope, and healing. We must break the cycle of poverty, vulnerability, and exclusion that renders women and girls susceptible to fistula in the ubiquitin conjugating enzyme first place. As the global community mobilises around the Sustainable Development Goals and recently launched (2016–30), ending preventable maternal and newborn deaths has moved from a seemingly distant dream to a concrete, actionable goal. When we speak of ending preventable deaths, including stillbirths, let us not forget the human rights imperative of ending the egregious suffering of those women and girls with fistula.
    Global health initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President\'s Emergency Plan for AIDS Relief (PEPFAR) have, at present, no explicit or formal internal capacity to respond to the overarching diplomatic or foreign policy concerns of either their donors or the broader global community. To the utilitarian, this respect for professional boundaries is to be welcomed. To the cosmopolitan, the increasingly connected nature of both the causes of, and solutions to, poverty, disease, ill health, and health security—in the context of associated considerations of world peace, non-health security, conflict prevention, and international stability—implies that all entities, individuals, and policies are interconnected, and cannot operate in isolation of each other. As former President of the USA John Fitzgerald Kennedy remarked to the UN during its early idealism: “the long labor of peace is an undertaking for every nation—in this effort, none of us can remain unaligned. To this goal, none can be uncommitted”. Most recently, the blurring of the line of institutional responsibilities to advance and protect global and international health has been shown by an expansion of military purviews in response to such emergencies as the west African Ebola outbreak. Correspondingly, and in parallel, rationales exist for global health professionals and organisations to work, wherever possible, to resolve diplomatic and foreign policy issues beyond health—with the that health outcomes, access to services, and “health for all” remain primary operational goals. Where collateral or downstream effects—of, for example, health systems strengthening initiatives—can advance non-health international affairs to the benefit and satisfaction of both donor and recipient countries, as well as the broader global community, there seems to be no reason why such an expanded and remit should not be encouraged. This has, of course, been happening since the very beginning of global health and international development efforts. What distinguishes a 21st century approach—an era of increasing levels of transparency, technology, education, interdigitation, and accountability—is the evolution of the implicit to the explicit; of a shift away from the covert use of aid to advance foreign policy and diplomacy (often in suboptimal ways) to an overt system of programme design, delivery, and evaluation that optimises both health and non-health goals in tandem with each other, in the mutual interests of both donors and recipients, and leveraging all available synergies. These considerations inevitably have implications for the type of interventions that are used; if in no other way than by ensuring that cost-effective approaches are also adaptable and responsive to local needs, cultures, religions, and other country ownership considerations.