Hajole Audu, a 25-year-old housewife in a Fulani settlement in Ningi, Bauchi State, arrived at the Ningi Fistula Hospital a very unhappy woman. Her woes are multifarious. She had lost her baby during delivery, and because of the trauma she suffered to her reproductive organ, she leaked urine uncontrollably – a situation that turned her into a social pariah, because she stank.
In the case of Asetuh Ibrahim, she was just 16 years old when she visited the hospital to be delivered of her first baby. A young school girl who was married off at 15 to her dad’s 48-year-old business partner, Asetuh was ignorant of what childbirth was all about.
Her case was worsened by the fact that, as a religious woman, she could not fathom why a male doctor would ask her to take off her underwear for medical examination. Unfortunately, by the time her husband agreed that the male physician on duty could attend to her, the worst had happened.
Her physician, who would not be named, explains the problem: “Because she had a prolonged labour, the unborn child was tightly pressed against her pelvis, cutting off blood flow to the vesico-vaginal wall. Consequently, the affected tissue necrotised (died), leaving a hole that is medically known as a fistula.”
In the case of 44-year-old Gladys, her Vesico-vaginal fistula was as a result of the violent rape she went through when armed robbers unleashed terror on her neighbourhood in Ijegun area of Lagos. And because of the multiple numbers of assailants, she suffered injury to her bladder and urethra, and needed major gynaecological procedures to correct the injury.
The Medical Officer of the General Hospital, Ningi, Bauchi State, Dr. Adamu Mohammed, describes VVF as a subtype of abnormal female urogenital fistula that extends between the bladder and the vagina, which allows the continuous involuntary discharge of urine into the vaginal vault.
While experts say the magnitude of the fistula problem worldwide is unknown, though believed to be immense, they say obstetric fistula affects girls and women almost exclusively in resource-poor settings, especially when a woman is unable to deliver her baby safely and cannot access a Caesarian section.
They say the devastating condition affects more than two million women worldwide, with an estimated 50,000 to 100,000 additional cases each year – a figure some believe to be an underestimation.
According to the Country Manager of the United States Agency for International Development Fistula Care Project, Mr. Iyeme Efem, not less than 200,000 women in Nigeria are currently suffering from VVF, which represents about 40 per cent of global burden of the scourge.
Veteran fistula surgeon, Dr, Said Idris, who leads the team of doctors that treat women with fistula at the Ningi hospital under the sponsorship of the USAID Fistula Care Plus, laments that culture and tradition are strong factors responsible for the condition in the country
He says people must be given accurate and useful information about the condition.
The global concern for VVF is such that in 2003, United Nations Population Fund and partners launched a global campaign to end fistula, with the goal of making obstetric fistula as rare in developing countries as it is in the industrialised world.
The target date for fistula elimination is 2015, and the campaign is now working in more than 40 countries in Africa, Asia and the Arab region.
So far, Nigeria has 12 fistula centres scattered across the country, courtesy of the American government through the USAID Project managed by Engender Health.
The USAID supports medical facilities all over the country where women with VVF receive surgery and post-surgery care absolutely free of charge.
There are 10 fistula centres in the country supported by Fistula Care Plus. The centres are located in Katsina, Sokoto, Birnin Kebbi, Ningi, Ilorin, Abakaliki, Ogoja, UCH Ibadan, Gusau and Kano.
Mohammed says centres in Jigawa and Adeoye Hospital, Ibadan, will soon join the list. There are also fistula centres in Zaria, Ibira Ibitam in Akwa Ibom State and ECWA Hospital, Jos though they are currently not being supported by Fistula Care Plus.
Mohammed says fistula is a condition that should not happen in the first place. As such, he says, the hospital educates the public on its prevention, especially in the area of family planning.
“This is because we can reasonably say that if a woman does not come down with pregnancy, she will not come down with fistula,” he says.
Describing the trauma suffered by VVF sufferers, Mohammed says, “The baby almost always dies as a result of the long labour, and the mother is left leaking urine and/or faeces uncontrollably from the vagina. In addition, fistula can lead to ulceration of the genital area. It may also cause a condition known as “foot drop,” which makes it difficult or impossible for women to walk due to extreme nerve damage to the lower limbs.
“Beyond these physical consequences, fistula often exacts a severe social toll, resulting in divorce or abandonment and varying degrees of social isolation. It is not uncommon for women with fistula to work alone, eat alone, and sleep alone.”
The Consul-General of the United States Embassy in Nigeria, Mr. Jeffrey Hawkins, during a working visit to one of such centres recently, says the American Government spends about $500m annually in health programmes in Nigeria through the Federal Ministry of health, especially in the area of HIV.
Hawkins assures fistula patients in Nigeria of the continued support of the American government, saying, “United States remains committed to the fistula treatment and prevention programme of the Nigerian Government.”
Hawkins says if the health care needs of women, especially pregnant ones, are adequately catered for, the future of the country is better assured.
“This is because it is the women that will give birth to the future of Nigeria,” he says, pointing out that “it is really very important to the government at the federal and state levels, as well as friends of Nigeria, to do something about this health challenge,” he notes.
Hawkins says the VVF centres form part of the partnership between the United States Government and the government of Nigeria in the area of health.
Head of Nursing Services in the Ningi centre, Ahmed Musaru, says VVF repairs are done every three months.
“We organise a number of patients to be operated upon and so far, the hospital has carried out surgical procedures on patients 11 times since 2011. On each occasion, we operated on 50 cases,” Musaru declares.