After FIGO 2003

The seventeenth World Congress of the Federation Internationale de Gynecologie et Obstetricque (FIGO) took place in the first week of November 2003 in Santiago, the capital of Chile, almost at the other end of the world as seen from the Nordic countries. Chile, extending from the subtropical deserts to the southern arctic, has enormous variety and beauty to offer to those who visit the country. As Ricardo Lagos, its president, noted in his speech at the opening ceremony, Chile is today a relatively prosperous society, committed to democracy. This was a huge meeting with in all 8500 registered delegates, accompanying persons and exhibitors coming together. The five Nordic countries were quite well represented, where for instance 10% (4/40) of the Icelandic practicing obstetricians and gynecologists attended the meeting! The inaugural ceremony took place in an imposing setting in front of the Fine Arts Museum of Chile's capital, while the actual congress proceedings were held in a meadow an hours drive from the center out through the capital's chaotic traffic. In the bright and warm sunshine of a southern spring, this was on the whole an enjoyable and interesting five days as it goes for such mega-meetings, even though the conference center was only half finished and some of the meetings took place in meeting-rooms that resembled aeroplane hangars or were actually large tents. One had to choose a good place in the lecture hall to be able to get the best acoustics and we often had to listen to translations from Spanish or to varyingly good English. There were early problems in organizing enough transport in the mornings and access to light food at the congress area but these were sorted out efficiently. Given the fact that the congress had to be rescued from scanty preparations about one and a half years ago, the organizers including Dr Mercedes Ruiz-Flores president of the Chilean Society of O & G, Lord Naren Patel, chair of the organizing Committee and Prof Luis Cabero-Roura, chair of the scientific committee, had achieved quite a lot. Perhaps a certain tone was set on the first night by the moving presentation from Catherine Hamlin, an Australian doctor working in Ethiopia, who was honored in absentia by FIGO for her 40 years of unselfish work to help sufferers of vesico-vaginal fistula in one of the poorest parts of the world. It reminded those of us who hardly ever see such a complication, of the good luck we have in the Nordic countries to be where we are, among the richest nations on earth and with some of the very best health services. We have to go back well beyond the memory of the oldest of our profession to remember fistula formation as a result of labor, and even 150 years ago we never had quite the same situation in the Nordic countries, because we never had the enormous problems associated with very early childbearing so common in many parts of the world, not the least in sub-Saharan Africa. FIGO has for the last two years been part of an initiative to deal with this. The enormous suffering in terms of mortality and morbidity that women with fistulas and their families have to endure, is probably unimaginable to those who have never worked in those countries. A particularly strong plea for assistance, not the least in assisting with building up infrastructure, providing fair trade agreements and in keeping peace treaties in the developing countries came from the prime minister of Mozambique, Dr Pascoal Mocumbi, a general practitioner who gave one of the most memorable lectures of the congress. It was equally extraordinary to listen to one of the great men in third world gynecology, Dr Pravin Metha from India, who has himself done over 476 000 laparoscopic sterilizations in his 30 years of practice in rural India. His figures show that in well organized circumstances remarkable results can be achieved, with maximum safety even in very basic circumstances. On the same note, one of the main themes of the congress was to introduce a new alliance with the International Confederation of Midwives to make a worldwide effort to reduce post partum hemorrhage by the use of active management of the third stage of labor. This involves teaching three simple steps to all midwives and obstetricians and others who deal with deliveries, namely early administration of an oxytocic drug (oxytocin, ergometrine, misoprostol) immediately after delivery of the baby, ensure uterine contraction through massage of the uterine fundus and early expulsion of the placenta by properly executed controlled cord contraction (Brandt–Andrews method). Mortality and morbidity from postpartum hemorrhage is one of the greatest dangers to women everywhere in the world. Even in the Nordic countries, with very low maternal mortality, there will hardly be an obstetrician who has not had several frightening experiences with this problem, even if death was avoided. All the Nordic countries pledged their written undertaking to work for these goals on a large billboard posted at the FIGO General Assembly. Simple guidelines, issued by FIGO and ICM, are now being disseminated and have to be discussed in all our countries. Obstetricians should take this initiative to our colleagues, obstetricians and midwives, without delay and implement these evidence-based simple and effective rules in our hospitals. There was much emphasis on womens' sexual and reproductive rights and violence to women. This is a worldwide problem, even worse in underdeveloped or developing countries. Good contributions came from the Nordic countries on these issues. Many aspects of violence against women do not receive enough attention, for example the often obvious exploitation of the female body for commercial purposes which, alas, was evident in a couple of commercial exhibits by the pharmaceutical industry at the conference. In our own part of the world, and as relates to our own speciality, we must make sure that this is nonexistent, including at the upcoming NFOG congresses. There were sessions on almost everything imaginable in obstetrics and gynecology, from high technology to basic epidemiology and patient care. Most of the major sessions were well attended, while attendance at the free communications was less and the posters received probably far too little attention. There were major sessions on fibroids, postgraduate education, hysteroscopy and laparoscopy, termination of pregnancy, preeclampsia, birth-spacing, nutrition, multidisciplinary unit organization, advances in molecular biology, current and future management of gynecologic cancer, assisted reproduction, medical diseases in pregnancy, intrapartum monitoring and asphyxia, obstetricians and the Internet, various aspects of contraception, preterm delivery, multiple pregnancy, chronic pelvic pain and endometriosis, the worldwide differences in use of cesarean section, breast tumors and surgery (done by many gynecologists around the world), incontinence, sexually transmitted diseases and teenage pregnancies, to name but a few of the many subjects that were addressed at the congress. Much of it was not necessarily new, but this was an excellent opportunity to look afresh at some important issues. The FIGO general assembly took place at the same time as the congress. After admitting nine new member societies, including the Palestinian Society, there are now 110 member Societies of FIGO. In addition to the statement on post partum hemorrhage the general assembly passed a new resolution on women's sexual and reproductive rights. After the elections of officers the Nordic countries are well presented at FIGO as Jerker Liljestrand from Sweden was elected as the next treasurer of FIGO and Sweden is also represented by Elisabeth Persson on the executive board, while Unni Kirsti from Norway completed her term. On FIGO's governing body are now: the President, Prof Arnaldo Acosta from Paraguay; Vice-president Prof Luis Cabero-Roura from Spain (he is a member of ACTA's international editorial board); President-elect Dr Dorothy Show from Canada, who will therefore, in three years time, be the first woman president of FIGO; Dr Liljestrand as Treasurer; Secretary General Prof Sabaratnam Arulkumaran from the UK; and the Past-president Dr Shirish Sheth from India. There was, of course, an opportunity to meet many of ones' friends from around the world and to get to know someone new, particularly from the South-American countries. Although there may be many smaller specialized meetings, conferences and congresses closer to our homes, which may be educationally superior to a FIGO meeting, the value of attending a FIGO congress lies not the least in experiencing a sense of belonging to a great profession and to feel that together we can do more to achieve something beneficial for the world we live in. We do hope that as many obstetricians and gynecologists will be able to attend the next FIGO Congress in three years time in Kuala Lumpur in Malaysia.

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