By Chioma Obinna

The lamentations of women living with Vesico-Vaginal Fistula, VVF, leave much to be desired.  The stories of rejection and mental frustration abound of these helpless women are commonplace. And between 120, 000 and 150, 000 Nigerian women and girls out of the two million worldwide live with the despicable disease caused by obstructed labour.

• Prof. Isaac Adewole performing the surgery

Unfortunately, the most vulnerable group is the young, poor, illiterate and rural women, who are economically disadvantaged.“The unacceptable situation has risen to a level where government is expected to declare a state of emergency on the economic depriving disease.  Every year, over 12,000 new cases are diagnosed whereas only 5,000 are repaired by the not more than the 20 Fistula surgeons in the country.

“Meanwhile, there seems to be a ray of hope for victims as the Minister of Health, Prof Isaac Folorunso Adewole, led a team of fistula surgeons to repair 26 patients at the Wesley Guild Hospital Unit, Obafemi Awolowo University Teaching Hospital Complex, Ilesa, Osun State.“For thirty five- year – old Mrs. Bola Ige resident in Erinmo Ijesa, life almost lost its meaning for the three years that she had struggled to deal with the dehumanizing condition she had found herself after being diagnosed of obstetric fistula, commonly known as VVF.

Despite being repaired during the just-concluded intervention facilitated by the Federal Ministry of Health, in partnership with Engender Health, implementing partners of USAID Fistula Care Plus project, and Osun State government, she is yet to recover from the low self-worth and esteem she had suffered in past years due to the condition. ““I still do not know where to begin,” she said. Victims like Bola might find it difficult to fully reintegrate into the society, going by the pyramid of challenges and condemnation she had suffered in the past.

The story of another victim, Hajia Safiyat Kolawole, a mother of two, from a Lagos hospital, was pathetic. Safiyat claimed she was abandoned by her family including her husband.

“I was abandoned by family, relatives and even my husband is nowhere to be found in the last two years. I used to be a trader but I have since been economically devalued as I can’t stand in public places for too long because of the odour emanating from my body,” she lamented.

Bola and Safiyat are among 26 women who were given their lives back.  And 24 of them had either been divorced or separated. Obstetric fistula is a hole between the vagina and rectum or bladder that is caused by prolonged obstructed labour, leaving a woman incontinent of urine or faeces or both. More than 75 per cent of women with obstetric fistula have endured labour that lasted three days or more.

90 per cent of the cases, according to researchers, are caused by prolonged obstructed labour during the first or second child bearing process which is often associated with marked pressure necrosis, edema, tissue sloughing and cicatrization. Studies have shown that cultural beliefs of marriage and conception at a very young age, often before full pelvic growth has been achieved, is the most prevalent causative factor, coupled with no supervised antenatal care by quack medical professionals during child birth and prolonged labour

In the western part of Nigeria, cases of obstetric fistula are usually from the havoc caused by Traditional Birth Attendants, TBAs, and from mismanagement of Caesarean Section, CS, in hospital.

Sadly, these women become a financial burden to their communities as they are not employable due to the stigmatization and serial loss of dignity over time. It also affects profoundly their emotional and psychological wellbeing.

According to the Country Project Manager of USAID Fistula Care Plus, Chief Iyeme Efem, during the flag off of the surgery, the deafening silence and long years of medical denial that VVF is only restricted to the northern axis of the country has, in no small measure, affected intervention.

Efem explained that the massive turnout of people for the project in the South-West has revealed that many sufferers were hiding as none of the 26 patients was a northerner. He admonished VVF victims to seek medical help by reporting to the nearest teaching hospital in their locality.

The initiator of the three-day marathon surgery, a professor of gynaecology and obstetrics, is the Minister of Health, Prof. Isaac Folorunso Adewole.

Even before he became minister, he had been a leading voice on issues affecting women.  Free fistula surgery is just one of his many interventions. Others include free cervical and breast screening for women, and the North East Emergency Nutritional and Medical Response. He has promised to implement more VVF surgeries under the 2018 budget.  Already, measures are being taken to clear the backlog of fistula cases through the establishment of more fistula centres across the country.

According to Adewole, the Federal Government, alongside concerned stakeholders, is determined to eradicate obstetric fistula in Nigeria within the next 10 years.

He had, last year, led a team, including the National President of the International Society of Fistula Surgeons, Professor Oladosu Ojengbende, to the Federal Medical Centre Jabi, Abuja, where surgeries were carried out on more than 50 VVF patients.

Ojengbende and the Minister`s Special Adviser, Dr. I.O Morhason Bello, also a consultant genitourinary & urogynecology, also joined Adewole and other surgeons for the VVF surgery at the Wesley Guild Hospital, Ilesa.

Speaking at the event, the minister said: “This is our small way of showing leadership and concern to the plight of the suffering masses, and our display of affection must be a thorough practical approach of putting smiles on their faces, removing shame and reproach, restoring dignity to womanhood and more importantly lifting the undue financial burden the disease has placed on them”

Ordinarily, the cost of VVF repair is not less than N500, 000. This is what the leadership of the Federal Ministry of Health under Adewole, with support from USAID, is embarking on free.

“We still have a large backlog of women living with fistula in the country, and there is need to close the tap and clear the backlog, which is why we intend to open up more centres across the country. We will make Wesley Guild a Federal Medical Centre and a centre of excellence for fistula intervention, to show equity in the distribution of healthcare in the country. We will make fistula repair one of our cardinal issues this year. We also need a crop of seasoned people ready to operate on these cases,” the minister added.

According to him, one of the simple ways to prevent obstetric fistula is to be delivered safely by a skilled medical personnel.

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