Restoring Dignity to Women

About 200,000 Nigerian women are suffering from obstetric fistula, with 12,000 new cases added every year. Martins Ifijeh chronicles the lives of those who have successfully undergone surgeries, giving them a new lease of life

Ever wondered going to the hospital to treat a certain ailment only to end up leaving the hospital with an even worse illness? Well, that was the case of Grace Sunday, a 30 years old woman from Obudu, who willingly went to a hospital in her home town to remove a little fibroid; a benign tumor of muscular tissue typically growing in the wall of the uterus, but got more than she bargained for.

She left the health facility not only with her internal organs muscled up in the course of removing the fibroid, she got home leaking urine and faeces from her vagina uncontrollably; a condition that kept her isolated from her community members for six years. She almost totally lost the dignity of womanhood as everyone around her began to consider her a scum who must be given arms length because of the stench and mystery associated with the condition.

“I couldn’t understand how going to remove a little fibroid that was altering my menstrual flow, could end up giving me a strange sickness. I blamed myself for ever believing I would live in peace if I removed the fibroid. In fact, when this leaking started, I deliberately decided not to seek hospital care because I wasn’t sure what worse sickness I may even end up coming out with. I stayed these whole six years because I lost faith in our healthcare system. I even believed if I sought for surgery, I may die in the process,” she explained.

Grace’s condition, according to health experts is described as iatrogenic fistula, which is obstetric fistula caused unintentionally by a healthcare provider often during surgeries like caesarian section, removal of fibroid, among others.

But by the sixth year, Grace’s health challenge wasn’t only about the leaking of urine and faeces, the fibroid she had removed by the doctor who caused her fistula, had come back. This time, she could pass for a woman due to deliver. The stomach was big as though she was going to give birth to twins.

When the stigma associated with the condition, along with the huge ‘pregnancy’ began to overwhelm Grace, she took all manner of concoctions and herbs, but the more she took them, the more the incontinence intensified and her stomach protruded; leading her to eventually succumb to pressure by her husband and other family members to access orthodox treatment; an approach she was running from because of her past experience.

“One of my aunties eventually told me about free surgery at the Fistula Centre here in General Hospital, Ogoja. I didn’t have a choice because I could feel I was slowly dying. First, I felt heavily pregnant, and then the incontinence.”
She added that many times people who do not know her often referred to her as a pregnant woman. Some jokingly called her ‘mama twins’.

Grace, who spoke to THISDAY during a recent pool effort by the United States Agency for International Development (USAID) Fistula Care Plus Project implementers, Engender Health, at the Fistula Centre in the General Hospital in Ogoja, said she was eventually scheduled for operation at the centre during the pool effort.

The fistula surgeon who led the pool effort, Dr. Idris Sa’ad said when Grace was examined, the team decided to first remove the tissue mass in her body, and then repair her.

THISDAY correspondent, who was granted access to witness the surgical procedure on Grace, observed that the fibroid removed from her body weighed 3.79kg, a weight that could pass for a two-month-old child on the average or a big baby at birth. The iatrogenic fistula was also repaired in a procedure that lasted several hours.

Speaking with Grace days after the surgery, she told THISDAY that she was no longer leaking, and that the feeling of pregnancy had disappeared. Her heavily built stomach could be seen to be flat like a woman who had just given birth.

“I know when I now fully leave here tomorrow my loved ones will be very happy for me. They would be happy that a lot of things have changed in me. Right now my confidence and dignity is back. I can now stand or sit among my fellow women, whom I used to run from because of the stigmatisation I experienced from them,” she added.

Sa’ad, who was the Commissioner for Health in Zamfara State in the last dispensation said women, like Grace were to avoid certain activities for months, so that they would fully heal. “Sex, hard labour, farming, and the likes should be avoided immediately after surgery because the body needs to heal. Our women who have been operated upon should also help the process by abiding by these conditions,” he added.

The case of Irene Isa, a 22-year-old girl from Cross River was not any different, only that her obstetric fistula was caused by a combination of ignorance on her part and a touch of quackery by a traditional birth attendant, who is notorious for performing surgery on his ‘patients’.

Irene, all through her pregnancy did not access ante natal care at any point. By the time she was ready to deliver, she was taken to the TBA in Ukwango who, according to her gave her all sorts of concoction so she could have her child at ease.

“But everything he gave me never worked. That was how I laboured for three full days in his house without success. I was reeling in pain, but no one told me hospital would be able to help me out. It got to a time I was no longer feeling the movement of my baby. It was obvious he was dead, but delivering the body out still remained a problem,” she narrated.

While Nigerians are advised to use health facilities during pregnancies and deliveries, in places where TBAs are encouraged, they are often advised to refer their patients to health facilities if prolonged labour or other complications are observed. But like a man on a mission to totally wipe out a mother and son, the TBA decided to put Irene under his knife. He cut her open and removed the dead baby boy. Unfortunately, he severed some of her organs, while the area of cut began to bleed infection.

“After he cut me open, my pain intensified. It wasn’t healing, but rather I began to feel a more intense pain than the surgery. The stitch he put on me all fell off, and I could see my bladder, womb, intestine and other organs. I began to fear for my life.”

She said by the third day, the TBA hurriedly packed his belongings from the house and ran way. It was at that point Irene knew the real damage he had done to her. She was taken back home by her mother and husband with the hope of a miracle.

At that point, leaking urine uncontrollably was the least of her problem. She was deteriorating, while the odour from her stomach was likened to the stench of a dead goat.

“Luckily for me, we had about the pool effort being done at the fistula centre in Ogoja General Hospital. That was how we came here, and they told me they would not only work on the fistula, but do other procedures to correct what the quack ‘doctor’ had done during the ‘surgery’ he did on me.

The Head of Nursing, General Hospital, Ogoja, Mr. Paul Njagu told THISDAY that when a finger or a tool is passed from Irene’s vagina, a mere look at the stomach could reveal the finger or the tool because of the way the stomach was open.

But like others before her, Irene was surgically operated on, the wound dressed, while the obstetric fistula was also repaired by the Engender Health team of fistula surgeons.

“I was operated on yesterday. Since then the uncontrolled urination has stop while the wound in my stomach had been dressed and stitched. I no longer feel pain as I used to. Now I am very sure I will live again,” Irene added.

She said she has realised that if she had gone for ante natal, she wouldn’t have undergone such prolonged labour, because the causal factor would have been treated even before she started labour.

Grace and Irene are among the few lucky Nigerian women who had suffered the health condition and have come out of it.

Statistics show that there exist over 200,000 Nigerian women currently suffering from obstetric fistula in the country, with about 12,000 new cases added every year, thereby increasing the burden of the disease in the country.
But the Project Country Manager, USAID Fistula Care Plus, Chief Iyeme Efem, says his organisation was currently making concerted efforts geared towards reducing the disease.

He said the Federal Ministry of Health has directed all teaching hospitals in Nigeria to embark on fistula repairs free of charge as part of efforts to reduce the backlog of the number of women living with the health condition.

According to him, the directive to the tertiary hospitals in the country will help in increasing the number of fistula repairs from 5,000 to 12,920 every year. “Nigeria currently has a backlog of between 150,000 to 200,000 Nigerian women living with obstetric fistula, with 12,000 new cases added every year. This alarming figure is still worrisome even though our organisation repairs not less than 2000 cases yearly, in addition to the 3000 cases repaired by other organisations in the country; totaling 5000 repairs per year.

“Assuming we have 44 teaching hospitals, and each of them repairs 15 women every month, this will amount to 660 repairs, and in one year, it would mean this government’s directive has helped in repairing 7,920 women alone across the country,” he said.

Analysing the arithmetic, Efem said if the 7,920 repairs were added to the 5,000 repairs done by Fistula Care Plus and other organisations, it would mean a total of 12,920 repairs are being done yearly, a result, he said would be a step in the right direction in clearing backlogs and reducing the burden of new cases.

While commending the Minister of Health, Prof. Isaac Adewole for making such a bold step, he said Fistula Care Plus would continue to champion repairs in the country, adding that they were presently involved in fistula interventions in 12 states, including Zamfara, Sokoto, Kebbi, Katsina, Kano, Bauchi, Oyo, Cross River, Osun, Yobe and Kaduna.

On his part, a Consultant Gynaecologist, College of Medicine, University of Ibadan, Prof. Oladosu Ojengbede said prolonged obstructed labour remains a common cause of obstetric fistula, noting that any labor that goes beyond 12 hours was at risk of not just infection, but obstetric fistula if no alternative means of childbirth is suggested and used.
“Obstetric fistula can be prevented if our women go for ante natal, give birth through skilled birth attendants in hospitals, get quality health services and education, among others,” he added.