Saving Nigerian Women from Vaginal Fistula

Many Nigerian women are silently suffering the pain of obstetric fistula, commonly known as Vesico Vaginal Fistula and Recto- Vaginal Fistula. But there is a way out, through preventive care and adequate treatment. Kuni Tyessi reports

By the end of today, at least 32 women will come down with obstetric fistula in Nigeria, which means every year, about 12,000 mothers, sisters, wives and daughters nationwide will suffer from a condition that causes women to leak urine and/or faeces from their vagina uncontrollably. If available reports are anything to go by, over 200,000 women are already suffering from the health condition nationwide.

Unfortunately, despite the high prevalence of obstetric fistula in the country, only about 5,000 cases are treated every year – leaving behind at least 7,000 unattended cases yearly plus the backlog of 200,000 cases already existing in the country; a calculation that suggests the prevalence rate is still on the rise, since most of the backlogs still remain untouched.

To address this imbalance and prevent more cases, Founder and Chief Executive Officer, Fistula Foundation, Nigeria, Musa Isa, is advocating more enlightenment on what can be done to prevent the scourge from arising in the first place. Isa believes if women know what causes the abnormality, they will be able to prevent it.

Prevention
Speaking with THISDAY recently, Isa said it was highly important that mobilisation and creation of awareness are carried out not only in the media but also with people at various community levels. He stressed that those educated at the local government areas were very close to the people at the grassroots and can communicate with them better.
If possible, he said, fistula survivors should be included in campaigns against the anomaly. He cited the example of some local government areas mobilised by the Fistula Foundation in Kano and Katsina states, where many women came out for diagnosis, and the health condition reduced in those areas.

According to Isa, “We trained 60 people, of which 40 are women and 20 are men. Out of the 40 women, 20 are fistula survivors. This is a good combination. We train the fistula survivors so much so that they could stand before anybody and speak as well as deliver lectures on their experiences with obstetric fistula. They usually do this in women gatherings, wedding ceremonies and so on. In those mobilised areas, men now escort their wives to get fistula treatments.

“In forestalling fistula, I will advise men to support their wives during pregnancy and child birth. They should allow them attend antenatal and should also allow them deliver in hospitals. In situations where their women come down with fistula, they should not divorce them, but rather encourage and show love by taking them to where they can get free surgical intervention.”

Causes
Explaining that surgical procedures for the ailment were free in Nigeria, he said women should avoid staying at home during labour and going through prolonged obstructed labour, which he stressed was the major cause of obstetric fistula.

“They should avoid gishiri cut, among other unhealthy practices,” he said. “But for the long obstructed labour, they should be supported to reach health facilities where they can deliver safely. Where they have fistula, they should drink lots of water, and avoid living in isolation. When they fail to drink lots of water, there will definitely be a lot of issues including vagina stenosis, urine dermatitis, itching and so many infections, and this will cause serious problems when it comes to surgery.”

Advocacy
Call him a fistula advocate and you won’t be far off from the truth. Isa said he was the first person in Nigeria to talk about incurable obstetric fistula after working with the Ministry of Health in Kano State in 1984. He explained that he had at the time seen cases of obstetric fistula including the incurable ones and wondered if there could be anything that could be done.

He said, “I became passionate about the plight of sufferers and this gave me the opportunity to become a member of the international working group. I was the first person to introduce the case in an international conference that took place in London, and this won the attention of the policy makers there, and they said something had to be done to the inoperable. I had seen cases whereby some of the affected patients came to the hospital and got treated, while the inoperable are left behind. While some of them were left to their fate and many went into aggressive begging on the streets of Kano, some others went into other social vices. Still yet, some fell into psychiatric conditions and ended up in psychiatric hospitals.

“These are some of the things that prompted me to be a fistula advocate and I felt there was the need to do something about it. In 1988, we started with the Association of Fistula Clients and later changed the name to Fistula Foundation Nigeria, not knowing that there is a fistula foundation, California. When this was discovered, I was told to change the name and I said I didn’t know that there was a fistula foundation like that and thanks to God Almighty, this same fistula foundation in California now supports us with funds.”

Isa said he had been working with fistula patients and survivors for close to 38 years, a reason why he is often called ‘Baba’. According to him, during the course of his work, he learnt a lot from women, communities and husbands.
“The women are respecting more of our projects than the men. Whatever we ask them to do, they comply. During the commemoration of the Fistula Day, we organised a rally and I thought only the patients will come out, but we had 220 fistula survivors that graced the rally in the streets of Kano carrying banners and talking about obstetric fistula.”

Challenges
As expected in the course of advocating against this anomaly, challenges abound. Citing some of those challenges, Isa said, “In the course of our work, we have realised that most often than not, some of the consumables are missing. And sometimes, when we ask for the list of those who are serving, they give us a list of those who are not working, instead of giving us the actual names of the nurses that are working.”

Role of Government, Stakeholders
Isa called on state governments to establish fistula centres, especially because many states still live in denial that there are no fistula cases in their states. He said, ”Obstetric fistula exists in all the states and it is not a northern phenomenon which has been associated with early marriage. When they make announcements through the mass media they will realise that there are fistula cases in all states.

”They should establish desk officers in ministries of health and at the same time establish fistula repair centres which will be dedicated to fistula cases. With this, foreign donors, as well as other partners will see the need to support them with doctors so that they will be able to perform fistula surgeries. For wealthy individuals, this is where they can put in their money and quickly get a reward, because this is tangible. When a patient has been repaired, supporters will be able to see where their monies have gone to and what they have been used for. If they can give support and organise surgeries, definitely there will be a lot of success stories.”