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Fistula: How child spacing saves lives of women

By Chioma Obinna

For 63- year- old Mrs Lucia Ofoegbu, life took an ugly twist 50 years ago when she had her twins. Ofoegbu could not celebrate the birth of her twins because moments after they were delivered after a prolonged labour, she began to leak urine uncontrollably. She had developed Vesico Vaginal Fistula, VVF.

Mrs. Lucia Ofoegbu
Mrs. Lucia Ofoegbu

Married at 13, Lucia had no idea of what life held in store for her until she fell into labour. Like every pregnant woman, she was happy that the journey of nine months was coming to an end but it turned out to be the beginning of her woes.

“I was in labour for three days. Getting to the hospital my bladder burst, and that was the beginning of my problem I have managed for almost 50 years now.”

As it is usually the case for all women with VVF,  Lucia lost her babies.  Medical personnel describe Fistula an abnormal hole between the bladder or rectum and the vagina characterised by continuous and uncontrollable leakage of urine or faeces following childbirth.

Patient’s experience

According to these experts, the disorder has a profound effect on the patients’ emotional well-being. Lucia experienced all of it. First, she was thrown out of her matrimonial home by her husband because she was leaking urine and faeces. As if that was not enough, her husband married another woman a year after. Teary eyed, Lucia said the decision was taken without her consent.

Lucia who betrayed emotion several times during the interview at the National Fistula Hospital Abakaliki, Ebonyi state, said: “My husband and his new wife have been treating me so badly. They threw me out of the house. It was due to the intervention of other women that I am back to the house but since then, I do not have a child of my own”

Happy, she is no longing leaking urine or feaces after a successfully surgery at the hospital, she says she does not know what life will be like when she returns home.. “Now I have been discharged today. I am actually waiting for the priest to come and take me back. All the time I have been here, my husband never asked after me and my co-wife never asked of me. It has been hell for me all these years”.

The priest Lucia is talking about is her parish priest in Akwuzu in Anambra state who introduced her to the fistula hospital. “I am fine and no longer leaking. I will go back to the house and continue life the way God has designed it.” Family planning experts say if Lucia had adopted a family planning method, that is  available in hospitals, her children would be alive today.

Modupe Adekogba, a family planning advisor with Fistula Care Plus, a fistula project in Nigeria funded by USAID and managed by Engenderhealth, family planning exposes women to general safety information on what to do when pregnant. Grace Ossai, is also fistula survivor who spoke with journalists at the Centre. She says though  she is learning of family planning after her sad story with obstetric fistula, she is happy to known of its benefits now.

Recounting her story on an afternoon that can be described as “afternoon of tears and testimonies’, Grace said: “My greatest happiness today is that I am now on family planning.” This Warri born 37-year-old mother of three said: “the last three years have been hell for me.”

According to her, it all began when she was pregnant with her third child. Lucia said she laboured for many hours before being delivered of an already dead baby. The outcome of the long labour is uncontrolled leaking of urine. “Although, my family supported me but it has been hell. I have been to so many hospitals without solution. After the surgery in this centre, I became okay.” Grace said.

Explaining her decision to embrace family planning, she said: “Before I came here, I did not know about family planning but today, I have the knowledge and I did it because I don’t want to get pregnant again. I am 36 years old.  With this family planning I am sure I will not have fistula. This is because it will enable me to space my children.

The stories of Lucia and Grace are only two out of the backlog of about 150,000 cases of fistula in the country. Health experts agree that fistula has become a major public health concern in the country According to Clinical Associate, FistulaCare Plus, Dr Suleiman Zakariya in addition to the backlog, 12,000 new cases recorded annually. According to Zakariya, only 5000 of these new cases can be repaired every year collectively by the 12 fistula centres supported by Engenderhealth.

Blaming the high burden on the country’s poor health system he said: “Obstetric Fistula is a manifestation of a sub-optimal healthcare system.    “Most vulnerable group is the young, poor, rural women who are economically disadvantaged. There is need for government to provide needed policies to reduce chances of women coming down with fistula.

Calling for increase in political will to programmes on prevention of fistula, he said:  “There is need to improve the health seeking behaviour of Nigerian women and access to family planning. ”Worldwide, two million women live with untreated obstetric fistula. A woman in sub-Saharan Africa has 1 in 16 chances of dying in pregnancy or child birth compared to 1 in 4,000 risks in developed countries” he added.

However, hope is on the horizon as findings by Alalade and group on “Integrating Family Planning into Fistula Services” have shown that proper child spacing will help to reduce the morbidity and mortality associated with the condition.

It has also be proven that when women have too many children over a short period of time they are exposed to life threatening complications. Fistula is one of them.  But when women adopt family planning they will have as many children as they want at minimal risk.”

Cases at  Abakaliki Centre

For a Consultant Fistula Surgeon, National Centre for Obstetric Fistula, Abakaliki, Dr. Yakubu Emmanuel, obstetric fistula is one of the various challenges women face in the process of child birth. Emmanuel attributed the growing incidence of fistula to poverty and ignorance. The condition is prevalent among women who have many children over a short period of time. Since most pregnancies are not planned there is need to introduce compulsory family planning to prevent obstetric fistula.

He blamed most of the cases treated at the Centre on undesired or unplanned pregnancies. Before now, the Centre operated 20 fistula patients in a week. “Only this year we have done over 40 surgeries. But we cannot make any conclusive statement.”

A Matron at the Centre, Mrs. Nwaofe Veronica  narrated how the Centre is using family planning to tackle fistula, said: “Family planning is a preventive measure. It helps repaired fistula patients to keep away from intercourse and pregnancy for at least one year.”

 


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