By Chioma Obinna
Established by a former first lady of Ebonyi State, Mrs. Josphine Elechi, before it was taken over by the Federal Government in 2011, the National Obstetric Fistula Centre, Abakaliki was mandated to offer free treatment to indigent women afflicted with fistula, a condition caused by obstructed labour. Sunday Vanguard visited the hospital and spoke with the Chief Medical Director, Prof Sunday Adeoye. According to Adeoye, the centre, which started with a small building, has ballooned to a three-star hospital, both in services and facility. He said the hospital has not only achieved the vision of the founder but has also surpassed its mandate of instilling hope in the lives of helpless women. He said no less than 2,280 fistula, 625 vagina prolapse, five sling surgeries, and 80 uretheric surgeries had been carried out for women across 26 states of the federation.
Primarily, this place is an obstetric fistula centre. In other words, we operate on VVF patients. Somebody will ask, how come VVF is in the South? We use to think that VVF is the problem of the Northern part of the country because of small girls that are given out in marriage. The truth of the matter is that VVF is the product of prolonged obstructed labour. Simply put, it is a situation where a woman had been in labour for several hours because of disproportions between the baby she is carrying and her pelvic. In a layman’s term, the baby she is carrying is bigger than her pelvic. Normally, the answer should be a Caesarean section, CS. But when the CS is not timely for whatever reason and the labour now becomes prolonged obstructed labour, VVF is the result. Whether it is the small or teenage girl in the North or the mature woman in the South, the basic fundamental is the baby is bigger than the pelvic. If the baby is not delivered for whatever reason, be it religious reason, financial reason and cultural reason, among others, and the CS is not done early enough, the woman is bound to come down with VVF, irrespective of her position in the society.
Unfortunately, fistula is associated with high foetal wastage. In over 90 percent, the baby will be dead and the woman will be leaking urine or faeces and in some cases both. It is not just the small girls of the North. It is the same basic principles everywhere.
Burden of VVF
The burden of VVF is bigger in the North because of early marriage but it is equally significant in the South. And that’s why we have been able to provide completely free treatment to over 2,280 patients with VVF from over about 26 of the federation thus far.
Often times when you come to the hospital it is like a melting point for all the states. When you move from one bed to another, you will see a Kogi woman, next is Delta, Rivers. It brings people from different states. That tells you the spread of what we are doing here.
Apart from repairing fistula clients, what we are doing now is providing urethral surgeries for women who have injuries to their urethra. Unfortunately, people do surgeries which they do not have the necessary competence for and a lot of complications do arise. But I must equally say that even when the best of hands do surgeries, complications can also arise but they are fewer. The less competent the fellow is, the higher the complications. So we do have patients that come with uretheric injuries. We have about four in the ward currently. They may have occurred during the course of surgeries such as hysterectomy, etc.
We have done close to 80 of such surgeries to re-implant the urethra. If the people were to pay for such surgeries, they will be paying hundreds of thousands of naira. And many of the VVF patients cannot afford it.
But they are offered the treatment completely free and they are equally fed and taken care of courtesy of the Federal Government because they are the major supporters of what we do here for indigent patients.
We equally do sling operations. Some women, when they laugh, they pass urine depending on their age apart from fistula patients. Even after they have been repaired, they leak urine from the urethra.
This urine comes from the urethral not from the fistula. We do sling operation to correct that. Recently, arising from complications of the fistula due to significant loss of tissue, even when you repaired them the capacity of the vagina is grossly reduced. The condition is associated with vagina scar and reduced vagina capacity. Some patients will even tell you that they will rather have their vagina than to lose it.
We face a lot of challenges trying to correct this because, after the surgery, many of the women will come back to ask you what happened to their vagina. Some will tell you to undo whatever that was done on them. Majority prefer to have the road open and leak than not having the road. And not having the road means no more sexual relationship. You can imagine when a young woman has been repaired but will no longer have a quality sexual relationship. It is a serious matter. We understand fully the burden they have and we empathise with them. What we now do for them is to create vagina through extensive surgery.
We are able to use the colon or a graft from some other part of the body to fashion a vagina or create a vagina for them. We have done about five cases. One of them that we did was combined case of abdomen and vagina and it took us almost nine hours. I wonder if she was asked to pay if she would have been able to pay. For such surgery, she would have up to N5 million before anybody will listen to her even though it is not a common surgery that you can walk into any hospital and do. It is a highly complex surgery. We have expanded our services not only to fix fistula holes but also some of these surgeries.
In 2008, I had a mandate to determine the burden of fistula in Ebonyi before then I was a surgeon in a teaching hospital. We moved with a team to have an idea of the burden. I went to 12 local governments in the state I couldn’t go to the 13th LGA because there was a crisis.
In all the women who came out that were leaking urine, over 308 had fistula. But significantly, we noticed another problem which we did not know that they were there from that community screening. It is not every woman who is leaking urine that actually has VVF. Some have copious vagina discharge. Apart from asking if they were leaking urine, we went a step further to physically examine them. I must give credit to Mrs Elechi for her leadership role then. We had a burden of over 56 percent.
Our women are suffering. Another significant problem that we discovered was pelvic organ prolapse. It is like a hyena. It is a situation whereby the uterus (womb) dangles down the vagina, to the extent that part of the uterus or the whole uterus is outside the vagina completely. You can imagine a woman having her entire womb that is supposed to be anatomically situated now dangling down her vagina with the wrapper and legs rubbing on it. The number of patients we saw with the condition during the screening was worrisome. But we could not handle it then because our mandate was to attend to VVF patients.
AS of the time we stopped registering women, we had registered over 900 women. Eventually, when we decided to give the prolapse cases attention, we were embarrassed by the number of women that came to the hospital. It was like a market. The women of this country are suffering. The patient load was embarrassing. We knew we could not combine the two, so we decided with the support of UNFPA to start something.
By 2014, UNFPA had stopped giving us support but, thus far, we have been able to offer free treatment to these women, but with the financial situation in the country, we could not sustain the free care for the prolapse patients any more. We have been able to provide surgery for over 625 women with the condition since we started the surgery in 2012.
The significant thing about this surgery is that, even in most teaching hospitals across the country, if they do about 50 cases in a year. then they have tried. For us to do 625 in less than four years should tell you the volume of what we have done. We still have quite a number of patients that could not pay for the surgery and it grieves my heart. We don’t have any form of support for us to perform free surgery for these women because they are the indigent women of Nigeria.
We are looking for partners that can support us. FistulaCare raised my hope that we are going to have support with them. We even had a meeting with them in New York. We were ready to escalate because we don’t have the capacity.
Why prolapse patients pay a token
As of December last year everything including three times a day feeding was less than N60, 000 and they will stay here for 16 days depending on how serious their case is. It was more of service for the poor. If we are able to get some form of support from partners, individuals, companies and organisations, not necessarily from abroad in terms of drug, tools, we don’t need money from anybody or organisation what we need is the tools to work. You can buy the infusions, gloves, sutures, antibiotics etc that we will need to operate, then we can roll with it and we will give you result.
Appeal for support
I am appealing to indigenous organizations to say ‘I am giving you enough infusions’, and we will go back in making the prolapse free. We develop a training programme around the prolapse because if you don’t do it well, you may end up giving the woman hysteretic fistula or Vesico Vagina Fistula. In the process of providing care, you may give them other fistulas. It is not just enough