title: Healthcare providers' perspectives on the social reintegration of patients after surgical fistula repair in the eastern Democratic Republic of Congo.
abstract: OBJECTIVE
  To understand perspectives of local health providers on the social reintegration of patients who have undergone fistula repair in the eastern Democratic Republic of Congo.
  
  
  METHODS
  In a qualitative study, semi-structured individual interviews were conducted with patient-care professionals working with women with fistula at HEAL Africa Hospital (Goma) and Panzi Hospital (Bukavu) between June and August 2011. The interviews were transcribed and themes elicited through manual coding.
  
  
  RESULTS
  Overall, 41 interviews were conducted. Successful surgical repair was reported to be the most important factor contributing to patients' ability to lead a normal life by all providers. Family acceptance-especially from the husband-was deemed crucial for reintegration by 39 (95%) providers, and 29 (71%) believed this acceptance was more important than the ability to work. Forty (98%) providers felt that, on the basis of African values, future childbearing was key for family acceptance. Because of poor access and the high cost of cesarean deliveries, 28 (68%) providers were concerned about fistula recurrence.
  
  
  CONCLUSIONS
  Providers view postsurgical childbearing as crucial for social reintegration after fistula repair. However, cesarean deliveries are costly and often inaccessible. More work is needed to improve reproductive health access for women after fistula repair.
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: nichole.young-lin@ucsf.edu.
authors.forename: Nichole
authors.initials: N
authors.lastname: Young-Lin
authors.affiliation: Hôpital Général Régional de Panzi, Bukavu, Democratic Republic of Congo.
authors.forename: Esperance N
authors.initials: EN
authors.lastname: Namugunga
authors.affiliation: HEAL Africa Hospital, Goma, Democratic Republic of Congo.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Lussy
authors.affiliation: Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Nerys
authors.initials: N
authors.lastname: Benfield
mesh_terms: D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000191:economics; D015023:Democratic Republic of the Congo; D005190:Family / Q000523:psychology; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011247:Pregnancy; D012917:Social Adjustment; D012944:Social Support; D014624:Vaginal Fistula / Q000523:psychology* / Q000601:surgery
keywords: Obstetric fistula; Provider perspectives; Social reintegration