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Report of the joint SYNGOF-UPIGO meeting
Hammamet, 01/10/2011
The UPIGO and the SYNGOF (Syndicat National des Gynécologues et Obstétriciens de France, the French National Gynaecologists and Obstetricians Union) had a joint meeting on 1 October in Hammamet (Tunisia). The presentations were very interesting and the exchanges fruitful.
Prof. Guy Schlaeder, UPIGO President, recalled the history of the UPIGO and its place among the other international organisations by way of introduction. In line with the spirit of its founders, the UPIGO was to be the professional counterpart of the FIGO which was founded one year later in Geneva and whose focus was primarily scientific.
UPIGO activities have long been limited to Europe: the UPIGO played a key role in the creation of the UEMS (Union Européenne des Médecins Spécialistes, the European Union of Medical Specialists) in 1958. In 1993 it drafted the first European recommendations for specialist training in GYN-OBS, with its pedagogical committee the EBGO. Finally, as an INGO with participatory status in the Council of Europe, it actively collaborates with the “Social, Health and Family” Committee.
The UPIGO has had close links with SAGO African organisations (a federation of approximately fifteen French-speaking obstetrics and gynaecology organisations) since 2000, particularly with the SOMAGO (société malienne de gynécologie et d’obstétrique, an obstetrics and gynaecology organisation based in Mali).
1st main topic: prevention of maternal mortality caused by post-partum haemorrhage.
Review of the situation in rural areas of Mali and proposals for improvements.
Dr. Mariame Diakité (Mali) stressed the high rate of post-partum mortality in Mali, despite some improvement in the statistics over recent years.
582 deaths/100000 births in 2001
464 deaths/100000 births in 2006
(These figures are however not totally reliable, given that a number of deaths are not declared)
The majority of rural deliveries take place unaided, or perhaps at best with a local “matron”. Reminder: for this country with such a huge surface area, there are only 84 gynaecologists, 947 general practitioners and 800 midwives.
The health system is based on a four pillar approach:
- The community health centre in the villages
- The health centre of reference
- Regional hospital
- National hospital
Professor Sy Assitatan Sow (president of the SOMAGO) emphasised that the centre of reference means a place to which a patient can be evacuated or referred. The main problem encountered is the means of transport!
She commented that caesarians are free and are financed by a National Solidarity Fund which receives its contributions from villagers, the State and the WHO.
Prof Bouraïma Maïga regrets the delay in admitting the at-risk patients (late diagnosis, state of the roads, means of transport, etc.)
He appeals for the use of uterotonics for staff operating in rural areas and the use of specific techniques such as gentle traction on the umbilical cord, uterine massage and uterine filling.
The situation in France and in Europe (Dr. Boyer De Latour)
The mortality by haemorrhage rate is 9/100000 in France compared with 1/100 in Africa.
In France, all complications of haemorrhage (extrauterine pregnancies, placenta praevia, retroplacental haematoma, post-partum haemorrhage, uterine rupture, etc.)
account for 25% of maternal deaths. After eliminating early pregnancy haemorrhage, strictly obstetric haemorrhages or post-partum haemorrhages are estimated to be the root cause of 15-17% of the total number of deaths. Retrospective case studies have estimated that the large majority of deaths were probably avoidable thanks to preventive measures having been taken, good care services, the application of recommendations and the implementation of protocols displayed in delivery rooms.
2nd main topic: the prevention of cervical cancer
Prof Baldauf (CHU Strasbourg) Prof Horovitz (CHU Bordeaux) Dr. König (Germany)
All 3 speakers insisted on the use of both vaccination and cytology screening (Pap smear).
Prof. Baldauf, in charge of the EVE cervical cancer screening programme in Alsace, stressed the advantages of an "organised" programme compared with" individual" screening, which is left to the initiative of the patient or her doctor. The EVE programme allowed for a 5 year coverage rate of 86% of the population. The annual organisational costs are 1.2€ per woman screened.
"Organised" screening is both more effective and more efficient than "individual" screening, which is why the HAS (Haute Autorité de Santé, the French High Health Authority) recommends "organised" screening for all French women between the ages of 25 and 65, through a smear test every 3 years.
Nearly 70% of cervical cancers are induced by the viruses HPV 16 and 18, for which vaccinations exist.
In France, the anti-HPV vaccination is advised for 14 year old girls who have not yet had sexual relations. However, it is worth noting that a number of cervical cancers are due to types of HPV which are different from those neutralised by the current vaccinations. Vaccination can in no case substitute screening, which remains essential whether or not the woman is vaccinated.
Prof. Horovitz pointed out that midwives in France have recently been authorised to carry out smear tests for screening. There is also a self-test available for the HPV virus.
Dr. König rails against the fact that in Germany there are those in favour of replacing cytology with an HPV test every 3 years.
He insists on the need for smear tests, colposcopies and biopsies.
Cytology is done once a year and is part of a full gynaecological screening programme which includes a clinical gynaecological examination, ultrasounds and the prevention of breast cancer.
3rd main topic: professional civil responsibility (Dr. Marty)
Dr. Marty gave a very clear and exhaustive explanation of the problems of PCR in France. France and Germany are the countries with the highest contributions, at between 20000 and 40000€ /year.
The concept of alea therapy exists in France but the Scandinavian no-fault compensation model is not yet very well-known and involves the notion of national solidarity.
Dr. Marty invites the delegates to take part in joint action with the European Parliament to obtain harmonisation of contributions at European level.
This proposal was very well-received.
4th main topic: the Directive on cross-border healthcare (Dr. Conzemius, Luxembourg)
The Directive on cross-border healthcare will be transposed in 2013. It will allow patients to go to a neighbouring country for treatment and be reimbursed at the levels in force in the country of residence.
This assumes good patient information concerning their rights, quality criteria, risks and legal regulation.
The challenges for Member States are multiple: harmonisation of quality assessment, harmonisation of nomenclatures, recognition of professional qualifications and continuing training, transfer of patient data through, for example, e-health, with data confidentiality, medical collaboration and financial investments in the larger regions, and the harmonisation of legal procedures.
The Directive came into force on 24/04/2011. Its application will be far from easy for its member countries.
UPIGO bureau meeting
After the cancellation of the last GA, the UPIGO should gather momentum. The bureau deplores the sporadic presence or absence of some members. Travel costs are too high for African countries.
New members must be recruited by writing to professional organisations, asking them about their concerns and encouraging them to send delegates. Since some countries do not have a professional body, information and addresses could perhaps be obtained through the UEMS.
Because of the economic crisis, it is very difficult to open an account in Greece.
Dr. Jacques Faidherbe will replace Dr. Petros Polymenakos in his role as UPIGO treasurer.
The next UPIGO general assembly will take place in Strasbourg, France (home to our president Guy Schlaeder) from 28-30 September 2012.
Proposed topics for discussion are:
- SOMAGO-UPIGO cooperation to prevent post-partum haemorrhage.
- Professional civil responsibility (in collaboration with Dr. Marty from Syngof)
- The complications with legal and illegal interruptions of pregnancy (coordinator: Dr. Faidherbe)
This list could be complemented by other proposals from delegates.
The day ended on a note of friendship and in a good mood, with a magnificent gala dinner, where we celebrated our friend Raymond Belaiche’s retirement and the end of his activities in the Syngof. We enjoyed a truly delicious fish couscous until late in the evening!
We look forward to seeing you in Strasbourg for new experiences!!
Dr Annik Conzemius
Secretary General of UPIGO
5, rue Edward Steichen
L-1540 Luxembourg
Tél : +352 26333 9470
Fax : +352 26333 9469
e-mail : goesconz@pt.lu
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