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Welcome to the first open forum.  Kate Ramsey will moderate this discussion.

Please respond to the following question:

How should social reintegration be defined?

Reintegration is an area of much concern but little information that is not anecdotal.  The WHO manual on obstetric fistula notes that:

"As with many other aspects of OF, little information is available on successful reintegration strategies. There is also a paucity of experiences in specific reintegration programmes upon which to draw, given the limited resources allocated to fistula care and the scarcity of people working on the long-term needs of these girls and women."

At a meeting of the OFWG on data in 2006, the group came to the following basic conclusions about social reintegration:

There is no universal definition of 'reintegration' and almost no evidence-base on 'what works' with this population of women in terms of reintegration.  Yet, it is generally accepted that some type of counselling service is needed for all fistula patients and that reintegration programmes should include both efforts with women as individuals and with the community

Reintegration should be defined by the expectations of the women themselves; service provision should be approached from the perspective of 'choice' - helping women to access different types of services based on their needs/wants

Reintegration is multi-faceted and should be considered in the context of physical and mental health and social and economic well-being.

To contribute to advancing the thinking in this area.  We have decided to open this discussion forum with a focus on reintegration.  In your responses, consider the following questions:

From your experience, what are the key elements that define social reintegration?  How do we measure it?
What are the interventions that might facilitate this reintegration? 
Are there other health or development areas that involve similar reintegration efforts that might inform or provide ideas for fistula programming?

1) Social reintegration of a post operative fistula patient may be defined as return to a normal life with hundred percent physical, social and psychological well being.

2) Following may be the key elements of social reintegration

• Post operative status in community
• Restoration of family
• Connection with social norms
• Physical, social and psychological status.
• Ability to make decision about her own life and day to day matter.

It may be measured by interview & answer the question related to above elements.

3) Following are the key intervention for social reintegration

• Complete restoration of normal anatomy
• Training in basic literacy & craft, sewing
• A repaired fistula patient usually has no problem in social reintegration. It is important to find jobs for these patients. It automatically raise their status in community. The value for their family.In case of divorce a job always helps them in friendly life partner.  

4) We have no knowledge about other programme in health sector for integration of patients in society.

The fistula patients are different in all means and we can not compare them with patients who are behind or victims of different kind of violence in society.

This is posted on behalf of Ibrahima Sankare, Mali.

DEFINITION DE LA REINTEGRATION SOCIALE

La réintégration sociale : c’est toute action qui permet à une femme malade ou guérie de fistule de retrouver d’une manière durable sa place, son épanouissement psychosociale, son identité et sa dignité dans sa communauté d’origine en particulier et/ou dans la société en général.  

Posted on behalf of Kadiatou Keita, Iamaneh Mali
 

La réintégration sociale d'une femme porteuse de fistule est la reprise d'une vie normale après le traitement, comme avant la maladie dans son milieu d'origine. C'est un ensemble d'éléments qui nous permettent de dire qu'une femme porteuse de fistule est réintégrée socialement : être acceptée par sa famille, sa communauté, bien être physique, mental, économique et avoir confiance en elle même.  

La réintégration sociale dépend surtout du résultat du traitement car avec la guérison totale, toutes les conséquences  de la maladie disparaissent aussi (rejet, isolement, manque de confiance en soi, impossibilité de mener une vie sexuelle normale....). Du coût elle est reprend goût à la vie, elle est tout suite acceptée par tous ceux qui l'ont rejetée pendant la maladie. Il n'est pas rare de voir certains maris reconquérir leurs anciennes épouses avec assiduité. C'est une fierté pour certaines femmes de retrouver leur foyer conjugal et faire des enfants comme leurs coépouses, par contre d'autres refusent de reprendre la vie conjugale avec celui qui n'a pas accepté partager leur souffrance et se remarie avec quelqu'un d'autre pour commencer une nouvelle vie.

C'est pour quoi  quand la femme est guérie, la réintégration est plus facile et immédiate car la femme est prête à refaire sa vie, à participer à la vie communautaire aux cérémonies sociales (baptême, mariages, réunions des femmes du village et autres activités). Elle est épanouie physiquement, mentalement, socialement et si elle a la possibilité de mener une activité génératrice de revenu lui permettant de subvenir à ses besoins alimentaires, de santé et autres sans avoir à quémander qui que ce soit, c'est seulement en ce moment qu'on peut dire que la réintégration sociale est totalement réussie. 

Par contre pour celle qui est partiellement guérie, la réintégration sociale prend plus de temps et elle a besoin de plus d'accompagnement sur le plan santé, psychosocial et économique.

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Social reintegration of a woman living with fistula is the resumption of a normal life after treatment, as before the condition in her original environment.  It is a combination of factors that allow us to say that a woman living with fistula is socially reintegrated: to be accepted by her family and her community; physical, mental and economic well-being, and self-esteem.

Social reintegration depends above all on the result of the treatment, because with a complete cure, all of the consequences of the condition disappear also (rejection, isolation, lack of self-confidence, impossibility of a normal sexual life...) She begins to have a taste for life again, she is right away accepted by all who rejected her during her time with fistula.  It is not rare to see some husbands quickly reclaiming the old wives.  It is with pride that some women recover their marital home and have children like their co-wives; in contrast, others refuse to return to marital life with a man who did not accept to share in their suffering and remarry with someone else to start a new life.

This is why when the woman is cured, the reintegration is easier and more immediate, because the woman is ready to retake her life, to participate in community life such as social ceremonies (baptisms, marriages, meetings of women in the village and other activities).  She blooms physically, mentally and socially and if she has the possibility to run an income generating activity, this permits her to cover her food, health and other costs without having to beg for what she needs.  It's only in this moment that one can say that the social reintegration has totally succeeded.

On the other hand, for a woman who is only partially cured, the social reintegration takes more time and she needs more accompaniment through the plans for her health, psychosocial health, and economic well-being.

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