UNFPA embarks on a rescue mission
Surgery is out of reach for most women afflicted with the Vesico Vaginal Fistula (VVF), a condition brought about mainly by prolonged obstructed labour during childbirth. Sufferers leak urine and sometimes faeces or both uncontrollably as a result of injuries sustained to their bladder by the prolonged pressure of the baby's head on the mother's bladder during obstructed labour.
According to medical experts, surgery and rehabilitation of a VVF patient costs about 300 U.S dollars, way above what an average Nigerian VVF victim can afford. More than 75 per cent of Nigeria's over 120 million people live below the UN poverty line of one dollar per day.
Studies by the World Health Organisation (WHO) show that Nigeria may have one of the highest fistula prevalence rates in Africa. An estimated 400,000 to 800,000 Nigerian women are living with fistula, with 20,000 new cases added each year, according to a WHO document.
WHO estimates that two million women in developing countries are living with fistula while additional 50,000 to 100,000 new cases occur each year. The figures are based on women seeking treatment. It is most common in poor communities in sub-Saharan Africa and South Asia where access to obstetric care is limited.
Worried by this prevalence especially in northern Nigeria, the UN Fund for Population Activity (UNFPA), in collaboration with the Nigerian government and some local and foreign non governmental organizations, recently held a two-week free treatment programme tagged ''Fistula Fortnight'' during which hundreds of Nigerian women in four endemic northern states of Sokoto, Kebbi, Katsina and Kano were repaired surgically. Funding was from Sweden and Finland. At the end of the exercise in the four centres, 545 VVF patients received free surgery.
The first international effort to address the problem of VVF was in 2003 when UNFPA and its partners launched a global campaign to end fistula. The campaign is now active in more than 30 countries in sub-Saharan Africa, South Asia and the Arab states.
The attraction during the exercise was at the Maryam Abacha Women and Children Hospital VVF centre in Sokoto, where more than 200 women queued on the first day of the programme to be registered, when nine-year old Miss Masauda Garba, joined the older women on the queue to also seek remedy for her ailment.
Masauda, unlike most women who thronged the centre and who are VVF patients through prolonged labour during childbirth, got afflicted through a harmful traditional practice. The innocent girl, while still a toddler had a lump removed from her genital organ by a local barber or untrained traditional birth attendant known locally as Ungozoma. “She has since that operation leaked urine uncontrollably,” explained her mother who accompanied her to the clinic.
However, 30-year old Mrs Luba Maiwaki’s case is different. She had lived with the VVF condition without treatment for 15 years because of high cost of surgery: ''I became afflicted after my first pregnancy at 15 years and since then, I have not had peace physically or mentally''. Maiwaki lives with her husband,but he did not accompany her to the clinic.
Mrs Amina Alli, a mother of two, who had lived with the condition for five years, had a successful surgery and was recuperating on her hospital bed. She thanked God and the organisers of the free treatment project for restoring her dignity.''''I thank Allah for this day and I thank those who made it possible for the operation to take place,'' she said.
She had also come to the hospital alone following an enlightenment campaign programme on radio and television. She vowed not to go back to her matrimonial home after leaving the hospital. But one cannot blame Amina as most often, women with VVF conditions are abandoned by their husbands and families because of the foul smell that is usually associated with the sufferers..
However, health officials assured that the programme will help break the silence and stigma associated with the devastating condition. At the campaign in Katsina, the Minister of Women Affairs, Mrs. Rita Akpan called for collective effort in addressing the scourge, which she said was a major threat to the dignity of women especially in the northern part of Nigeria. She declared as alarming the recorded increase of
VVF patients annually,hence the need to launch a campaign that will eradicate the scourge in the country.
The Fistula Fortnight project which is part of the global campaign to end VVF, was a free treatment as well as a training project which addressed the problem of obstetric fistula in the West African country. For the first time, national and international volunteer doctors joined forces to treat hundreds of women suffering from fistula and train health personnel in fistula surgery, rehabilitation and counselling of patients after surgery.
At the end of the exercise, 12 Nigerian doctors, four international volunteer doctors were trained in fistula surgery; 40 nurses trained in pre and post operative care and 40 social workers trained in counseling and caring for fistula patients.
Dr. Ishaq Lawal, an Abuja-based medical doctor, explained that the causes of VVF in Nigeria include early marriage especially in the northern part of the country, small pelvis in women, overweight embryos, prolonged obstructed labour, poor maternity healthcare services, poverty, poor nutrition and hygiene.
''Women do not necessarily have to suffer from VVF. This societal illness can be prevented and checked through free medical care, moral support, public enlightenment and through building the capacities of local communities to improve healthcare services,'' Lawal said.
Describing the provision of adequate maternity care for pregnant women as the best way to prevent the scourge even in the event of early marriage, the health official said, though surgical repair is the best cure of VVF, most patients cannot afford it. He therefore called for the provision of soft loans, food and nutritional supplements as well as essential drugs and contraceptives to women.
UNFPA also confirmed that fistula could be prevented through save motherhood practices. ''The best strategies to prevent VVF include the provision of skilled medical care for all women in labour; timely medical care for women who develop complications during labour and family planning services to prevent unintended pregnancies and spacing of children''.
''The long-term challenge lies in confronting deeply rooted cultural and social practices that deprive women and girls of appropriate medical care that may endanger their health. Early pregnancy, for example, puts young girls at greater risk of complications during childbirth. Girls under 15 are five times more likely to die in childbirth than women in their twenties”.