On Wednesday, August 14, 2024, the Faculty of Medicine of the University of Goma (UNIGOM) in Goma, Democratic Republic of the Congo, hosted a major academic event: “The defense of the PhD Thesis by Dr. Justin Paluku Lussy. Dr Paluku, obstetrician-gynecologist and fistula surgeon at HEAL Africa Hospital, presented his work entitled “Characterization of obstetric fistulas and prognostic aspects of their surgical repairs in the Democratic Republic of the Congo”.

This thesis explored in depth the epidemiological, anatomo-clinical and therapeutic profile of obstetric fistulas in the DRC. It not only assessed the knowledge of obstetric fistula (OF) and its associated factors among women of childbearing age in the province of North Kivu, but it also identified the predictive factors for the failure of surgical repair of different anatomo-clinical entities of obstetric fistulas, such as vesico-vaginal, urethrovaginal and recto-vaginal fistula, as encountered in the DRC.

Dr. Paluku developed specific scores adapted to the realities on the ground in the DRC to predict the failure of surgical repair of the various obstetric fistula entities. In addition, he assessed patients’ quality of life before and after fistula repair surgery. The thesis includes studies from 1,267 patients who received repair for their obstetric fistula, 467 women of childbearing age who were interviewed about their knowledge of OF, and 158 survivors of sexual violence who were surveyed about their quality of life before and after surgery, across seven provinces (North Kivu, Haut-Uélé, Kasaï Central, Kwilu, Maniema, Nord-Ubangi, Sankuru) of the DRC, from 2017 to 2023.

Among the results of this work, it can be noted that the average age of patients at the surgical
treatment time was 33.2 years. The youngest patient was 15 years old and the oldest was 77 years old. The average age of the fistula at the time of repair was 10 years. The timeframe from trauma to repair varied from 3 ½ months (most recent) to 56 years in duration. This thesis developed predictive scores for the failure of vesicovaginal, urethrovaginal (HEAL Africa score) and rectovaginal (LUSSY score) fistula surgical repair.

In his work, Dr. Justin Paluku revealed that knowledge of obstetric fistula is low overall among women of childbearing age. In addition, he demonstrated that the quality of life of patients with obstetric fistulas is severely affected before surgery but improves significantly after successful repair. Recovered patients regain their dignity, reintegrate into society and contribute to the development of their community. This thesis, carried out within the framework of the University Consortium for Postgraduate studies in Medicine comprising the University of Goma (UNIGOM), Official University of Bukavu (UOB) and Catholic
University of Graben (UCG), was supervised by Professor Juakali S. Jean-Jeannot from the University of Kisangani (UNIKIS) and by Professor Mpoy W. Charles from the University of Lubumbashi (UNILU).

The jury in charge of examining this thesis was composed of eminent professors from the universities of
Kinshasa, Lubumbashi, Kisangani, Mbuji-Mayi and the Official University of Bukavu, who sanctioned the defense of the candidate Dr. Justin Paluku Lussy with the mention “the highest distinction”. To close the session, the Rector of the University of Goma (UNIGOM) awarded the applicant the title of “Doctor of
Philosophy in Medicine”.

It should be noted this is the very first study to comprehensively address obstetric fistula in the DRC. The predictive model and tools from Dr Paluku’s research, available to all clinicians and policy makers, will undoubtedly be of significant help in the planning and management of fistula surgery, and of unmeasurable benefit to those women who rely on our care.