Equatorial Guinea - Campaign to End Fistula

16. How do you live with your fistula?..............................................................................…………
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Possible comments of the pollster:
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17. What do you think as the cause of your fistula? ………….……….............................................
18. Have you ever seek for a medical or traditional treatement? Yes No
If yes, which? ……………..................................................………….......................................
And where? ...................................................................................……….....................……..
19. Have you ever be operated? Yes No
If yes: where? ……………….......................................................................………..................
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and how many times? ...................................................................................................……
20. What was the result? Good Bad
If bad, why? ………........................................................…………...........................................
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21. What is your family’s reaction face to this situation?:
Housband: rejection assistance indifference
Family: rejection assistance indifference
Environmet: rejection assistance indifference
22. Do you know something about fístula? Yes No
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23. Do you know that it can be treated? Yes No
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24. In order to be well, do you accept to be operated? Yes No
If not, why? ..........……................................................................................…………………..
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25. What is your actual desire? ................................................................................................……
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Pollster’s signature,
Date:....…………...............................…………...
Supervisor’s signature,
Date:..................…………......................
Annex 5:
49