Hope for Women with Obstetric Fistula

Odo and Ogbuagu share their experiences

While about 150,000 Nigerian women suffer from uncontrolled urination and defecation, otherwise known as obstetric fistula, there seems to be a ray of hope for them, as those who have successfully been operated upon share their experiences. Martins Ifijeh reports

Ever imagined a health condition that makes its victim commit suicide or run away from people because of the humiliation, shame and mystery it brings to them? That was what Mrs. Nworogwu Odo from Oron’a, Amagu community of Ikwo Local Government Area of Ebonyi State was suffering for about 50 years before help came her way.

It was five decades of loneliness and a lost dignity. She could not sit among members of the community or attend women meetings because of the stench from her body. All Odo did was live a life of isolation and endurance, while wishing the mystery ends soon. She lost her pride to obstetric fistula, a condition where a woman urinates and/or defecates from her vagina uncontrollably.

“Immediately after I gave birth to my second child before the civil war, I noticed I could no longer hold urine. It came out uncontrollably, leaving me leaky, smelly and embarrassed. It had been like that until help came my way few years ago.

“Before I was taken to the National Obstetric Fistula Centre, NOFIC, Abakaliki, I never thought I could ever live without this shame,” says an elated Odo, who would probably be in her 70s. She could not remember her exact age.

The Daughters of Virtue and Empowerment Initiative (DOVENET), with the support of the United States Agency for International Development’s (USAID’s) Fistula Care Plus Project managed by Engender Health, referred her to NOFIC for free fistula repair. “Now am dry and can attend meetings and wear my wrapper gorgeously,” she said.

Not adhering to family planning almost destroyed my life
For Carolina Ogbuagu, a 41 years old indigene of Ekpaomaka community, also in Ikwo LGA in Ebonyi State, who is a mother of nine children, it was missed feelings. She regrets not taking decision on time on when to stop childbearing, but she is happy the fistula that came down with her ninth childbirth has been fully repaired.

“I started leaking immediately after giving birth to my ninth child, and that became a source of sadness for me and the entire family. It reduced my pride and dignity, as I could no longer stay in the midst of people. I didn’t know not adhering to family planning could cause this issue until it happened to me. Fistula almost destroyed my life,” Ogbuagu said.

Doctors say one of the predisposing factors for obstetric fistula is the lack of family planning and too frequent childbirth. They say this weakens part of the reproductive system and during childbirth may lead to fistula.

Unlike many women suffering from the scourge, who have either been sent packing from their marital home or outrightly ostracised from their communities, the family of Ogbuagu stood by her. The efforts led her to get treatment just one year after the fistula started. “My children told me about the free treatment programme in NOFIC,” she noted.

“Today, I am happy people are no more running from me. I am now dry and in control of my health. I have learnt my lesson. I will no longer go through childbirth again, as I am now on one of the family planning commodities,” she said.

Many women with obstetric fistula have committed suicide from depression and shame
The Chief Medical Director, NOFIC, Prof. Sunday Adeoye, in an exclusive with THISDAY, gave a narrative of how he had mixed feelings of happiness and sadness after the successful obstetric fistula repair of one of his former patients from Ebonyi State, who could not control her emotions after the treatment.

“She told me they were seven in her community that came down with obstetric fistula before the Biafra war, but that some of them committed suicide and the rest died from isolation and depression due to the constant embarrassment they faced from the condition.

“They must have lost the love of family members and friends, and then left at the mercy of the embarrassing health condition,” adding that, the ex-patient, who was the only one that survived from the slow killer among her peers, told herself she was not going to take her own life, but was going to see the end of the problem.

“And that is exactly how it went. She came here at an advanced age, but we repaired her. She didn’t believe she could stop leaking at any point in her lifetime. She was holding my legs and didn’t know how else to show her gratitude. I was also in tears as well. Money can’t buy the feeling I had that day, as her dignity was restored back. Feeling of richness and satisfaction was exactly how I felt,” the Professor of gynaecology added.

The Professor said, about three months ago, there was another woman from Anambra State who, out of ignorance about obstetric fistula treatment, lived with the condition for many years.

“Her story was that she was usually the last person to attend Mass (catholic service) and the first person to leave. So her Reverend Father noticed it and took interest in her. That was when he discovered she was leaking urine and faeces, as she was running from people because of the embarrassment it poses to her.

“Apparently, she was sent packing from her matrimonial home, but her brother decided to build a small hurt for her in a remote area of the village, where she lived for decades all by herself.”

He said it was disheartening that the woman suffered for several decades because of an issue that would only take one hour plus to repair. “After her surgery, I felt bad because she had wasted many years of her life in isolation over something that ordinarily she can get intervention on within hours,” he added.

The scary statistics
Odo, Ogbuagu and the other two are not the only ones who have suffered from obstetric fistula in Nigeria, but they are among the few who are lucky to find solutions.

A Clinical Associate, Fistula Care Plus, Dr. Suleiman Zakariya says about 12,000 new cases of obstetric fistula are discovered yearly in Nigeria, amounting to an average of 33 women coming down with the disease every year.

He said about 150,000 Nigerian women were presently living with the condition in Nigeria, adding that, “what is more worrisome is that many of them are not aware there exist treatment to stop the leakage. Most of them are also not aware the surgical treatment is done in the country free of charge by the Federal Government.”

He said despite the new cases yearly, it was unfortunate that only about 5,000 cases were being repaired yearly, leaving behind a backlog of 7,000 victims per year who are either not aware there exist surgical interventions that can correct the health issue or are unaware there were centres for free treatment.

What causes obstetric fistula?
“A prolonged obstructed labour is the single most causal factor for Obstetric Fistula, but there are other factors, like female genital mutilation, surgeries, among others,” says a Reproductive Health/Family Planning Advisor, Engender Health, Mrs. Jumoke Adekogba.

She said a prolonged labour will cause the baby to be pressed or stuck at the birth canal, adding that if this occurs for long hours, it may cause injuries to neighbouring anatomical structures, and in many cases ruptures the rectal and/or vesicular wall, causing the woman to either urinate and/or defecate uncontrollably in her vagina.

She notes that other indirect causes of the disease remain poverty, illiteracy, underage pregnancy, among others.

Stigmatisation has done more harm
With lack of awareness still a major factor fueling the burden, experts believed women with fistula find help quicker if friends, families and their communities show love to them.

The wife of Ebonyi State governor, Mrs. Rachel Umahi, during her presentation at a media roundtable for journalists, organised by the Fistula Care Plus managed by Engender Health in Abakaliki, said psychologically, when a woman with fistula is stigmatised, it does more harm to her condition, adding that the state government has put laws in place to punish those who discriminate against such class of people.

The First Lady, who was represented by a Consultant for Family Succour and Upliftment Foundation, Dr. (Mrs.) Uzoma Agwu said; “Also, we should stop the myths that women with obstetric fistula are witches or are punished by gods for promiscuity. The causes are obvious, we should prevent prolonged labour, female genital mutilation, rape, among other,” she added.

Interventions and free treatment
Adeoye laments that despite the gesture of the federal government to reduce the burden of the health condition through free surgeries for any woman living with obstetric fistula in Nigeria, there was still apathy due to lack of awareness and denials.

He said there was need for various state governments to stop claiming their women do not have obstetric fistula, adding that, awareness should be taken to every nook and cranny of the nation to sensitise women with obstetric fistula to access treatment either at NOFIC or any other treatment centre providing free services.

“In Abakaliki here, the surgery is totally free. So, women do not need to suffer in silence, as the government has put interventions in place to address it. They should take advantage of this gesture because out there, we hear of fistula tourists (doctors who claim to do fistula repairs) collecting huge amount from victims, when as a matter of fact it is free here with the best experts available in the country.”

Adeoye, whose Centre has done 2,287 obstetric fistula repairs with 84 per cent success rate since inception in 2008, said they were ready to do more treatments as long as cases were presented.

While Engender Health, the FG and other organisations continue to make interventions towards prevention and treatment of obstetric fistula in the country, it is believed that soon the humiliation, shame and mystery from obstetric fistula will become history through reduced burden, and subsequently, eradication of the disease.