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Fistula: How surgeons restored dignity to 2 girls

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…Reconstruct new vaginal, anal openings

By Chioma Obinna

When Jenny, 9, and Grace, 8, were born, there were mixed feelings in their families, not because their parents did not want children, but  because they were born with congenital abnormalities.

According to medical doctors at the Fistula Centre, Ogoja, Cross River State, both girls were born without anal openings (Imperforate anus). In addition, they had a condition known as Anorectal sphincter.

The parents were confused at that time because no member of their families had ever had such conditions.

Explaining further, the experts said their condition resulted to a congenital fistula disorder that leads to faeces and urine incontinence.

More pathetic is that efforts by the families to find solution to the condition proved abortive. While Jenny had done several unsuccessful surgeries in a popular hospital in Abuja, the parents of Grace never knew there was a solution to their daughter’s condition.

Imagine having faeces and urine almost every minute in your vagina! Such was the fate of these two children. Although Jenny’s parents were able to provide diapers for her, Grace’s mother could not afford such luxury.  Rather, she improvised the use of rags in place of diapers.

She usually puts rags around her waist which she changes frequently to hold the droppings since they cannot afford diapers. As a result of this, Grace could not go to school.

Life has not been easy for these families as they have taken them to different hospitals and several drugs prescribed without success.

Grace’s parents who have been running from pillar to post throughout this period, felt that there was nowhere they can take her to. They have gone to various hospitals around and sometimes the doctors will prescribe drugs and injections without success.

And because of the situation, Grace is withdrawn from friends since she is leaking faeces through the vagina.

However, Jenny may be said to be luckier than Grace as her family was already making plans to fly her to India before they were directed to Ogoja Fistula Centre, where the corrective surgery was performed free of charge courtesy of Engender Health, through its USAID Fistula Care Plus Project.

Narrating her ordeal to Good Health Weekly, Jenny, a Primary Five pupil, said she feels great being free from a plague she had carried all her life.

She confessed that life has not been easy as she has been taken to different hospitals without any solution.

According to doctors at the Ogoja VVF Centre, Jenny had undergone series of surgeries earlier at other hospitals including a government-owned hospital in Abuja, but the efforts eventually failed.

During a live surgery on Grace in Ogoja General Hospital’s theatre, Lead Surgeon and former Commissioner of Health, Zamfara State, Dr Sa’Ad Idris,  who performed surgeries for 25 other beneficiaries, said the team of surgeons was able to create the anal orifice and corrected their vagina for them.

“You can see the anus in particular is now formed and the vagina is separate. What is left is the closing mechanism – that is to construct the internal and external sphincters. We have to dissect this out and then reconstruct the sphincter and the anus so that she can be controlling her stool all the time.

“Jenny had series of surgeries at the National Hospital but she cannot hold her stool but courtesy of the good work of Fistula Care Plus and the state government here, we are now able to bring her back, open and reconstruct her vagina entirely. That is exactly what we are going to do on Grace now.

“She is nine years old. You can imagine what she and her parents have been going through. All the time, this place would be packed with faeces. The nurses in the clinic have been having really very difficult time cleaning her up and putting her diapers on because she cannot control stools.

Asked whether  infections could have killed the girl, the surgeon, stated: “It might not be an infection but the condition itself can kill at the extreme. I can tell you that when urine keeps coming out uncontrollably into the vagina, you will see the rashes around the area.

“The same thing with stools and the whole place will keep getting messy and dirty. Most of the time, the infections don’t usually kill but in rare cases, can go through the blood and infect the whole system and can kill.

“And sometimes they might not want to drink water because of the excess urine and this itself can cause them to develop  stones. When they are not emptying the bladder very well because of the stone, some of the urine goes back to the kidney and eventually the kidney can fail which can be fatal too.”

He urged the State government to support the Centre more, as surrounding states and even beyond would be better off for it. “You can imagine that some people are coming from Cameroon, Lagos, even the northern part of Nigeria.”

Corroborating his views, USAID Country Project Director for Engender Health/Fistula Care Plus Project, Chief Iyeme Efem encouraged the Federal Ministry of Health to expand access to fistula surgery by extending it to tertiary health institutions where the expertise is.

“We are now working on a strategy we call unlocking potentials. We have spoken to the Minister of Health to waive the fees for repairs in Teaching hospitals, so that these fistula clients have free access and Engender Health will provide support through consumables.”

Stating that fistula knows no boundaries, he  disclosed that this year alone, Engender Health under FistulaCare Plus project has achieved about 96 per cent (1,937 cases) fistula repairs and intends to surpass the annual 2,000 cases the organisation does every year in Nigeria.

On his part, the Coordinator of the Centre, Mr. Paul Njagu said since inception, the Centre has performed over 400 surgeries free of charge.

Njagu said they never expected cases of fistula in Cross River State until the Centre was opened.

“If they do not know where to seek solution, they get into hiding and since the treatment and drugs are free with feeding inclusive, women started locating us and have been turning up. We have a facility support group where we feed the patients and provide  clothing for them.”

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