Adeoye: Women with Obstetric Fistula Can Access Free Surgery

The Medical Director, National Obstetric Fistula Centre, Abakaliki, Professor Sunday Adeoye, is a seasoned obstetrician and gynaecologist with a bias for obstetric fistula repairs. In this interview with Martins Ifijeh, he speaks on the dearth of fistula repair surgeons in the country, lack of awareness on treatment, why no woman deserves to suffer the shameful illness when there is free surgery for the ailment, among others

How did you come about championing intervention for Fistula Obstetric in Ebonyi State?

I could trace it to when I was a resident doctor in the University of Benin Teaching Hospital (UBTH). My consultant then was into fistula repair and that is how I developed interest. Subsequently I took my leave, then went for Vesico Vaginal Fistula training in Akwa Ibom State. Subsequently, I was employed as a consultant in Ebonyi State Teaching Hospital here in Abakaliki because of the expertise I had in VVF repair.

They then sent me on a further training in Katsina. On my return, with the assistance of the hospital management in 2002, a VVF unit was established in the hospital where we repaired over 150 patients before the wife of the then Governor, Josephine Elechi picked interest in it.

So I told her what the vision was and what we need to do to achieve it, and that is how we got to where we are today. The South-east Fistula Centre was established. Years after, it was converted to the first National Fistula Centre in the country. Remember that we started as being a unit in ESTH, then became the South-east Regional Fistula Centre under the Mother and Child Care Centre by Mrs. Elechi, and then the National Obstetric Fistula Centre, as it is now.

While you were doing your residency in UBTH, were there VVF issues back then?

There were VVF cases, even though they appeared to me to be very complex, but right now they are not really as complex as I thought they were, having been in the job from then till now. But we didn’t have quite a number of VVF cases then at the teaching hospital.

Most doctors prefer to major in lucrative specialties. Is specialty in fistula repair one of such?

It is not a lucrative area at all. You must develop passion to help the women before you can major in this area. I don’t even have a private hospital as I speak to you now. That’s because I am committed to this intervention.

One of the reasons why I took my leave and sponsored myself to Akwa Ibom for further VVF training was because of the plight of our women. They are the vulnerable and poor. I developed the passion to be able to help them. I transported myself, and facilitated my stay in Akwa Ibom financially because I knew these women needed help. The women are usually the poorest of the poor. Sometimes, after treating them, you will still be the one to pay for their transport home.

Unlike other areas of gynaecology, like Invitro Fertilisation (IVF) where you make money. For me, am committed to this work 100 per cent, and that is because of the passion. You can imagine a woman leaking urine, and by the time you have succeeded in repairing her. Just the joy on her face that you have restored her dignity is more than any money anyone can give you.

Since it’s not lucrative, do you have scarcity of doctors in this area?

There is apathy on the side of younger doctors to go into this area.
When I was supposed to go for training in Akwa Ibom, I spoke to some of my fellow colleagues doing residency to see if they will also be interested. They told me outrightly they were not. One reason they gave was that it will mean they will be working with the poor.

How do you encourage young doctors to go into specialty in fistula repair?

I remember when I came back from Akwa Ibom, a colleague of mine told me, Adeoye are you crazy, how can you go into this kind of area? I just laughed. But in retrospect, that same friend told me two years ago that probably my decision to go into the area of specialty was divine.

Young doctors do not want to go into this area as they will end up not only providing free treatment, but may also provide transport for the woman to go home. No patient will give you hamper or Christmas card.

Working for these women is beyond material things. That is one thing we have been trying to get the younger ones to understand. Now that we have national centres, some younger ones are beginning to develop interest. That interest wasn’t there some years back. But now we have national centres and there seems to be some career path. Because the truth of the matter is that if you don’t have passion for this work you can’t work everyday in the midst of urine and faeces without any financial reward.

Do we have shortage of fistula surgeons in Nigeria?

There is an acute shortage of competent fistula surgeons in the country. They are very few. We are hoping the genuine interest of those who want to major in this area will not be dazzled by the razzmatazz of other areas. That is often times the challenge because we have trained a significant number of fistula surgeons. How many of them are still in the field.

You don’t just do two months training and say you are a fistula surgeon. It is something you continuously learn on the job. It is something you get skilled on as you practise it. By the time you do the first 10, 50, 100, 500, 1000 cases, your level of competency increases by the day. That is only when you can actually refer to your self as a fistula surgeon.

Fistula surgeons are very few in the country, though we have very few people anyway who are still in training.

Could the dearth of fistula surgeons not be as a result of dearth of fistula centres in the country?

Like I said, we have trained quite a number. The people who come here for training are already gynaecologists who are working elsewhere. But the problem is when they are done with the training and go back to their hospitals, most of them don’t continue. That is why we keep talking about criteria for selection of doctors for trainings. If you fund yourself, it shows how passionate you are.

So what we see most times is that the selection criteria may be faulty. You find out that people who do not have genuine interest may be sponsored by organisations. Recently, we had a lady from Lagos University Teaching Hospital, LUTH, on her own sponsorship, and we commended her for that. But quite a lot of people get sponsored by one organisation or the other. So if you are being sponsored and you don’t have the passion, by the time you go back, you may not continue. We have a number of doctors who have been trained. But only few are doing the work.

What is the way forward to retaining trained doctors?

We should look at selection criteria of those coming for the programme. There should be a career path development. Not just coming for training and getting a certification, there should also be a Masters degree or PhD in Neuro-gynaecology. We are working that out with universities. So that when the young gynaecology come, they are actually building a career path. It will encourage them. It’s not just giving to the patients, but they are equally being enhanced in their careers.

Since it is not an area of specialty for now, could that not be why people are discouraged to major in it?

Seems you got it wrong there. It is an area of specialty. That is the neuro-gynaecology I talked about. The only thing is that for now there is no certification. That’ is why we are now talking about a career path, so that the doctor will emerge a masters or PhD holder in neuro-gynaecology. The discussion has gone very far at the national and West African level.

Since NOFIC was converted from state owned to federal, what has changed?

A lot has changed. I owe a depth of gratitude to the government for giving me the opportunity to express myself. One thing is to have the vision, another thing is to have the platform to express it. You can’t give what you have if the environment is not provided.

Like I said, a lot has changed in terms of infrastructure. This place was bushy before. But now you can see what is on ground. We now have seven edifices on ground. A lot has changed in terms of equipment, capacity, quality of services, volume of what we are now doing, and even in terms of quality of service.

Unlike before, it was just VVF repairs, now we have gone far into different areas of fistula repairs. I mean the smaller micro areas.

What is the success rate of the VVF surgeries from this centre?

We have done 2,287 obstetric fistula repairs since inception and we have had 84 per cent success rate. But this place is a referral centre so we have a lot of complex cases. People bring cases here that have been worked on without success before from other places.

One thing we must discourage is fistula tourists. They make things difficult. You find some people going to some private hospitals where the doctors collect the money and do all manner of sorts on the woman in the name of fistula repair, forgetting that the best attempt to VVF repair is the first attempt. Yet, the doctor will do one without success, do another one, and when they discovered there is no success, they will now refer the patient to NOFIC, Abakaliki. Why didn’t they refer the patient here the first time, as it is free anyways. They do this for greed, because doctors are aware it is done here free with professionals on ground.

Most Nigerians are still not aware of fistula repair and free treatment. What can be done on this?

When I tell people some of the things we have done, the first response we here is that people do not know about what you are doing. If Nigerians know what is happening here, we won’t be having women suffering from the scourge.

Awareness is powered by funding. One of our constraints is that we are unable to fund awareness on televisions, radios and newspapers. The hospital has no internally generated money because treatments are free. So how do we fund such? We need media to help do this.

I give you an instance of a woman who came from Lagos. She had gone to a private hospital that requested N700,000 to do VVF repair for her. She went back to her village, sold family lands, sold her properties, just to raise the money. The money just went into the pockets of some doctors. Yet, the surgery was unsuccessful. So she finally went online to seek help. She was then directed here, where we did the operation free and she went home dry.

She should have come here in the first case. So the issue of awareness is a big issue. That is why we are appealing to the media. Sometimes, when we talk to the media, the outrageous amount they tell us is not what we can afford. But we tell them this is a hospital that caters for the poor.

Like now, when PHCN come with their bill, they don’t care if patients pay for treatment or not. Once bill is unavailable, they cut our lights. These are some of the challenges in running an establishment like this. To me it is a joyful thing helping our sisters and mothers. That is our motivation.

Since inception of NOFIC, has there been records to show fistula has reduced in Ebonyi State?

Prior to when we started, I went to 12 local governments in Ebonyi State to screen women for fistula, and physically examined them to confirm if they actually had fistula. About 56 per cent of the women screened were clinically confirmed to have fistula.

That was part of what motivated the wife of the former governor, Mrs. Josephine Elechi to champion what we have today.

Mrs. Elechi did a massive work in the area of prevention. Fortunately, the present First Lady, Mrs. Rachel Umahi is also doing a lot in prevention. The number of old cases of fistula women before the civil war has drastically reduced. And generally, the numbers have greatly reduced, owing to the work by the former and present first ladies. A lot is being done to bring these women out for repairs.

Here, the older cases are hardly seen now. What we are seeing now are new cases. Maybe patients who have had it for six months or one year. We are gradually getting awareness. But we need more awareness so that backlogs of persons with fistula can come forward and be repaired.

Records show Nigeria does 5,000 fistula repairs yearly, whereas 12,000 new cases come up every year. How do you tackle the backlog?

The federal government is doing a lot through this and other centres to cater for backlogs. For instance, apart from doing surgeries in NOFIC, we go for awareness so that women with the backlogs can cone out. I was in Akwa Ibom two weeks ago with my surgeons, and we repaired about 60 patients in one of the hospitals there.

From time to time we get invitations when they gather up patients. We go there, repair and train their doctors. We go to those states where there are patients, repair them there and develop the capacity of the doctors there so that in our absence they can repair the simple cases under our supervision.

What are the challenges in getting these women out for repair?

The major challenge is awareness. We have previously written to various state governments to help us mobilise patients in their states so that we can come do free fistula operations for them, even with our consumables, but unfortunately only few states have responded. Some tell us their women do not have obstetric fistula, that we should go to the North. But I keep telling them it is a national problem, and it behoves on them to bring these women out to access this free treatment. What if tomorrow the FG changes policy of free treatment. It will then be a bog shame to these governments that would have been able to help their women. I have even gone personally to some of the states to talk one on one with some of their personalities.

My belief is that even though we have enough competent surgeons in my hospital, we can’t just be hoping these women will find their way here for repair. Many women are out there suffering, yet they do not know we exist, and that their issues can be repaired free of charge for every Nigerian. Why should women suffer fistula when they can access free surgery?

One of the reasons we do the outreach is because some women can’t afford even transportation to this place. For instance, there was a woman we repaired, while leaving the hospital, she cried and told us it took her three years to raise N3,000 just to be able to transport herself to this place. So I said, we can’t continue to sit here and wait for these poor patients, but we need to go out, and the best thing is for these states to mobilise their wards because of the capacity they have. They can use their local media to pull fistula persons together and take them to a designated hospital where we can do the repairs, and as well build the capacity of their own doctors.

Where is NOFIC projecting to be in five years?

Despite the limited funding, I see a world class hospital in the next five years. You have seen our environment, we have developed an orchard and a park to create an ambience for our patients and staff. In terms of infrastructure, I see a world class hospital.

But our challenge presently is money. Despite government doing a lot even in this recession, organisations that have the money should invest in places where the money will show. I know we have a problem of trust in Nigeria, so I keep saying don’t give us money, but rather use the money to do what we are lacking. If you get to the compound, you will see a lawn tennis court. We haven’t finished it because of funds.

In terms of the service, we were doing free prolapse before. We did over 600, but we had to slow down because of financial challenges, so now the patients now pay a token to access treatment. That token might be a reason they will not come forward in the first case for treatment. Prior to now, it was free because we had a donor support which is no longer coming. Whereas we have over a thousand women who have been registered for prolapse operation, but we just put them on hold because of money. There are wealthy Nigerians and organisations out there that can provide us with the consumables and facilities so that we can call these women back to access the surgeries. Organisations and rich Nigerians can support to making this happen.