Giving Hope to Women with Obstetric Fistula

Incontinence has taken away the dignity of about 200,000 Nigerian women. As the country, last week joined the rest of the world to mark this year’s International Day to End Obstetric Fistula, Martins Ifijeh chronicles the lives of women who have gone through the pain from the preventable scourge, but eventually got their lives back

During Gloria Nwaiboko’s hey days as a teenager, she told herself she was going to grow into a successful mother and wife. The type that would be referred to in Obeagu Ugballa community of Ebonyi State where she hails from as ‘mama doctor’ or ‘mama governor’. She had also wanted a loving husband who would be there to cheer her up when she wins, and comforts her when things go wrong.

But life served her lemons. She got married just before the Biafran war and then experienced a different reality altogether. Her first and only pregnancy was riddled with complications during labour until the baby died in the process, leaving her to grapple with obstetric fistula; a condition that causes uncontrolled urination and/or defecation from the birth canal, otherwise known as incontinence. Gloria couldn’t make lemonades from what life served her.

“I went home not only disappointed that there was no baby to show for my pregnancy, I noticed I was experiencing incontinence. They come out as they are formed in my body, leaving me continuously smelly. People started running away from me until I decided I could no longer stay in the midst of people because of the shame that comes with it,” said Gloria.

She lost dignity and the courage to bond with her friends. All she does was live all by herself, hoping one day succour will come her way as she wasn’t sure what kind of sickness she had come down with. People often tell her it was a spiritual problem.

“My husband believed it was a spiritual problem which must be solved spiritually. We went to several places without success. I could feel that my condition had gotten to him as he became unfriendly to me. He stopped sleeping with me as well.”

Gloria, who said she was very pretty at the time, suddenly became a loner. She was alone in the world as the love of her husband gradually wound down. There was no friend to lean on. “I even stopped attending women meetings because of fear of being embarrassed. I had resigned my fate to the miserable life the disorder had foisted on me before news came from our community leaders that all those who were experiencing incontinence should be ready, that government will take them to the National Obstetric Fistula Centre (NOFIC), Abakaliki, for repair.

“The news that there was a solution to my supposed ‘spiritual problem’ excited me. I had never felt like that in a long time. I also didn’t know the treatment of my condition was free in the country. That was how I got into NOFIC and was repaired against my husband’s wish who wanted it tackled only spiritually. The incontinence stopped. I went home dry. No smell, and no one was running away from me anymore. My life was back as I could go to the market and trade with people. I started attending women meetings again,” she said.

But as though her travails weren’t over, Gloria started noticing a decline in the quality of her sight. She didn’t access eye care immediately to know what was happening. Few months later she went blind.

“It was at this point my husband said it was the fistula repair that blinded me, and that he had warned me not to go for the treatment since it was a ‘spiritual problem’. He believed the gods were punishing me for not seeking spiritual help.”

That was where another bout of travails started for her. Blind Gloria was driven out of the house by her husband. The once beautiful woman with great dreams didn’t have anywhere to go. “I was back to square one. I started living alone. No money. No business. No husband. No child. I was practically living from hand to mouth in the small hut I stayed alone,” she said.

However, Ebonyi State Government heard about her plight and sent for her. While frowning at the stigmatisation from her husband because it is illegal in the state to discriminate against victims of obstetric fistula, the government trained someone who would be acting as a caregiver to her. The caregiver received various trainings on how to make soaps, insecticides and confectioneries.

Gloria, who is 68 years old now, said, “it’s the confectioneries and soaps sold by my caregiver that I now live on. Now I can buy foods, cloth my self,” she added.

Life may not have been fair to her, because in the end she couldn’t have a child of her own to elevate her status. No husband beside her to cheer her up. But she is grateful she still has her life and can feed herself.

The story of Dorcas Chukwudili from Enugu State is not any different. Obstetric fistula deprived her of making ends meet for herself and her children. It was 19 years of lost dignity and loneliness.

“I started having incontinence few days after I gave birth to my fifth child. Doctors said I was not doing child spacing, coupled with the prolonged labour I had while giving birth, as these may be responsible for the injury to my body,” she said.

Dorcas lived with the condition for 19 years before she learnt about interventions from government and organisations like Engender Health, DOVENETS, among others. She was taken to NOFIC where she was repaired successfully.

“I never thought I could ever live without this shame. It’s been five years now since the repair. The society no longer stigmatises me. I go to market now to trade, sit with fellow women to discuss, among others,” said Dorcas, who unfortunately lost her husband many years ago.
Gloria and Dorcas are among the lucky Nigerian women who had obstetric fistula and were fortunate to be aware of treatment, and subsequently benefitted from it.

Globally, the Executive Director, United Nations Population Fund (UNFPA), Dr. Babatunde Osotimehin says about two million women are suffering from obstetric fistula, while over 100,000 new cases are added yearly.

Country Programme Manager for the U.S.-funded project Fistula Care Plus, Iyeme Efem says in Nigeria, about 200,000 women are still suffering from what Gloria and Dorcas went through, with 12,000 new cases added to the piled up figures yearly.

Today, at least 32 Nigerian women will be added to the hundreds of thousands of women in the country who are experiencing incontinence.

“But the country is only repairing 5,000 cases yearly, thereby presenting a backlog of 7,000 un-repaired cases which are being piled into the number of cases currently in the country,” says Efem; a calculation which suggests the prevalence rate is still on the rise since most of the backlogs are still not repaired. The calculation also shows much is still needed for the repair of at least 12,000 cases yearly, while interventions must be put in place to aid in reduction of recorded new cases in the country.

Speaking during a walk to mark this year’s International Day to End Obstetric Fistula in Abakaliki, the Ebonyi State capital, tagged: Hope, Healing and Dignity for All, Efem said prolonged labour, female genital mutilation and early marriage are some of the factors responsible for the condition, adding that the society must jointly work to ensure these risk factors are not available.

He says obstetric fistula is not associated with cultural beliefs or witchcraft, but a preventable health condition.

Osotimehin, in his message to mark the day said the disorder was fueled by poverty, gender inequality, early marriage, child bearing and lack of education, adding that it remains a curable condition.

The Medical Director, NOFIC, Prof. Sunday Adeoye said for fistula to be completely eradicated in Nigeria, all existing cases must be treated and new cases prevented.

“Presently only about 5,000 cases are being treated yearly, but the backlogs and the remaining 7,000 cases yearly must be treated as well if we must have a country free from obstetric fistula.”

He called on state governments and stakeholders to put programmes in place to identify women with the condition and then bring them to NOFIC or other fistula centres across the country for free repairs.

“In Ebonyi State, the prevalence has reduced drastically because of various interventions by the state government and other stakeholders. But this passion must be picked up as well by other states, so that together we can stamp out obstetric fistula in the country,” he said.

The wife of the Ebonyi State governor, Mrs. Rachel Umahi, said the message of prevention should be told at any given opportunity, adding that childbirth with quacks should be discouraged. “Run for your life today and deliver only in hospitals to save yourself of fistula. All women, let’s take up this job and spread the word on fistula so that women can go out and get treatment,” she said.