…No one wants to associate with me – Agnes
…I have been abandoned, rejected – Ekaette
By Chioma Obinna
Long years of misconception that Obstetric Fistula is restricted to the northern part of the country significantly affected the intervention of a condition that renders victims helpless.
But findings showed that fistula, an abnormal opening in the birth canal that results in chronic leakage of urine or faeces, has no boundaries. Vesico Vaginal Fistula, VVF, or rectum Rectovaginal Fistula is mostly caused by obstructed labour.
A visit to Cross River State, where 25 women were operated, revealed that the condition is also a raging threat in the state as well as many other states in the southern part of Nigeria. Health workers attribute fistula to harmful traditional practices like female circumcision and childbirth at home under the supervision of unskilled birth attendants.
According to statistics from UNFPA, over two million women are living with fistula worldwide and 50,000 to 100,000 new cases develop annually. In Nigeria alone, 12,000 new cases occur annually while 200,000 live with the condition. Unfortunately, only 5,000 of the victims have access to treatment.
Reports showed that the problem of adolescent pregnancy contributes to the burden of fistula. According to a recent United Nations report, researchers found that girls who become pregnant before age 15 in low- and middle-income countries have double the risk of maternal death and obstetric fistula than older women.
Also, the 2013 Nigerian Demographic and Health Survey showed that marriage is a primary indication of women’s exposure to the risk of pregnancy; and seven in 10 women are married or living together with partners as though married.
Sadly, while a report by The Lancet showed that caesarean section is an alternative to preventing fistula, findings among fistula patients in Cross River State showed that more cases are occurring due mismanaged caesarean section by medical doctors. Data from hospitals across the country also showed that Nigeria is recording over 20 per cent of Iatrogenic fistula (cases caused by mismanaged caesarean section).
Sunday Vanguard found that stories of rejection and mental frustration, from victims of fistula, are commonplace.
If life is said to be unfair to some people, 25-year-old Alice Abagu may have topped the list. Couples ordinarily should enjoy bliss in the first few years of their marriage. Unfortunately, the same cannot be said of Alice as life took an ugly turn immediately she gave birth to her first child within a year of marriage.
She could not celebrate the birth of her child due to prolonged labour which made doctors carry out caesarean section that caused her to leak urine uncontrollably. She had developed Vesico Vaginal Fistula, VVF.
“I was in labour for hours; when I could not deliver the child by myself, I was operated upon but after the surgery I started leaking urine.”
As it is usually the case with women down with fistula, Alice lost her child.
Fistula, according to experts, often leads to chronic medical problems, depression, social isolation and deepening poverty. Alice experienced all of these. First, she was thrown out of her matrimonial home by her husband because she was leaking urine.
“Since 2014 I have been abandoned by my husband who married another woman. He told me he could not spend money on my treatment. I lost my baby, lost my husband and lost my dignity,” Alice lamented.
“I am back to my parents’ house. I have handed everything to God”.
Alice is resident in Bekwarra Local Government Area of Cross River State but despite being repaired during the just-concluded intervention facilitated by Engender Health, implementing partners of USAID Fistula Care Plus project, is still leaking. She is yet to recover from the low self-worth and esteem she had suffered in the past years due to the condition. “I do not know what to do. They have promised to repeat the surgery.”
No one wants to associate with me -Agnes
The story of another victim, Mrs. Agnes, 34, who also lost her self-esteem to fistula, left this reporter with tears.
“My so-called friends ran away. No one wants to associate with me”, she said.
The situation of the mother of four, who has undergone fistula surgery three times without success, was pathetic. Life almost lost its meaning as she struggled to deal with the dehumanizing condition.
Agnes developed fistula after having a caesarean section for her last child. Although she has undergone surgery three times at a VVF Centre in Ebonyi State, she is yet to stop leaking.
Agnes, also a native of Bekwarra Local Government Area of Cross River State, said her ordeal began on May 7, 2015 after the caesarean section carried out at Cross River State General Hospital.
“My experience has not been funny. I used to be a big time businesswoman. I usually travelled to Nassarawa State to buy goods. But today, I cannot go out without pamper and that has been happening for the past three years. The cost has been so enormous on my family,” she explained.
I have been abandoned, rejected -Ekaette
Unlike other fistula clients, the condition of Ekaette may have affected her psychologically.
Picked by a Good Samaritan and brought to Ogoja VVF Centre, she was only able to recall her name and where she came from when Sunday Vanguard met with her.
“I was staying with my sister at Akamkpa but later on she abandoned me, I couldn’t see her again. I couldn’t see anybody who would treat me or take care of me. I kept begging people on the streets for help because I was very sick and I needed money to feed.
“I didn’t know what happened but ‘water’ has been coming out of my vagina.
Since I came here, I have been in pains. Last night I couldn’t sleep. Urine keeps dropping every minute. See my clothes, see my bed, everywhere is soaked in water.”
Some workers at the facility told Sunday Vanguard that Ekaette was brought and dumped at the place by an unidentified pastor two months ago.
The staff told Sunday Vanguard that her fistula repair had been delayed because she was brought in with a very low CD4 Count (Cluster of Differentiation 4) – a test that measures how many CD4 cells a person should have in his blood. “This means that much damage has been done to her immune system and fatality could result if her CD 4 count level is not increased before the surgery”, one of the doctors explained.
I lost my first child to fistula, but today I have another child – Elizabeth
Unlike Alice, Agnes and Ekaette, Elizabeth Ibak seems luckier even though she lost her first child to fistula. After a caesarean section, she has been able to have another child following interventions by Engender Health and experts at the Ogoja VVF Centre.
According to her, she had developed VVF after she gave birth through caesarean section.
Elizabeth told Sunday Vanguard that trouble started when she could not push during labour and caesarean section had to be done. The baby died and she developed VVF.
She, however, said that, through interventions, she became pregnant again and delivered successfully. Today, Elizabeth is happy she has been repaired. “I feel great,” she stated.
Victims like Alice, Agnes, Ekaette, Deborah and 21 others who were given their lives back, last week, might find it difficult to fully reintegrate into the society, going by the pyramid of challenges and condemnation they had suffered in the past.
Latrogenic fistula on the rise – Experts A consultant fistula surgeon, Dr. Sa’Ad Idris, who led a team of surgeons to carry out the surgeries on the 25 patients in Cross River State, sponsored by USAID Engender Health, Fistula Care Plus project, explained that the cause of fistula, which used to be long obstructed labour, was fast changing as there were indications that more cases of fistula were caused by doctors during caesarean section.
“This problem occurs either due to lack of expertise or some other condition which we are trying to liaise with the Society of Obstetricians and Gynaecologists to address at the university level”, Idris said.
The consultant, a former Commissioner for Health in Zamfara State, said, “Now a doctor, even at the House Officer level, should be trained to know that if you are going to conduct a C-section, you have to reflect the bladder very well, otherwise, what we are seeing more now is fistula following C-section which is technically difficult to do”..
USAID Country Project Manager, Engender Health Nigeria/ Fistula Care Plus, Chief Iyeme Efem, who confirmed that Nigeria had a backlog of over 200,000 women living with fistula, regretted that government was yet to show commitment towards ending the travails the women go through.
Also speaking, Dr Sadiya Nasir of the National Obstetric Fistula Centre, Katsina said the trend of fistula was changing in Nigeria as more cases of Iatrogenic fistula were being recorded. “Some centres have recorded up to 13 per cent of iatrogenic. In our two-year review of the cases in the Katsina Centre, we have up to 20 per cent cases of latrogenic. But that could be because our centre is a referral centre.”