At the mercy of unskilled workers: death toll rises as more women develop fistula – Part 1

Following her last pregnancy in August 2017, Saheed Bola, 25 years old, from Kogi State, narrowly escaped death after unnecessarily delayed labour by unskilled nurses at some clinics in Kogi state.

She, however, lost her baby and developed Recto Vaginal fistula (RVF), a condition that made her leak faeces and urine through her vagina.

Six months later, she had a successful repair, by a team of expert surgeons at Sobi Specialist Hospital, a state VVF centre, in Nigeria, through the USAID fistula care plus project.

Now completely dry and excited about her recovery, she told The Guardian that she couldn’t believe how easy it was to get such professional care and help at no cost.

“The nurses here have been very friendly, they assisted me in everything. They’re always available to check my health status, they counselled and assisted me…”

This was not the kind of care she received a few months ago, at the private hospitals where she went for her delivery, she recalled.

“Immediately I started labour, I went to Carose Hospital, a church-owned small clinic close to my house.
The health worker was dressed in white like a nurse but she was very rude and harsh to me. She told me to start pushing if I want to give birth to the baby alive. She gave me drip and kept me on the couch, yelling at me to push. I kept pushing until the following day. Finally, the head of the baby came out but the shoulder refused to come out.

“Finally tired, I firmly insisted that I was leaving. The woman collected N7000 from me despite not delivering the baby and allowed me to go without any referral letter. With the baby’s head dangling in-between my laps, I left the place for another private hospital- Eko-Ese hospital, at Kabba road, Kogi state”.

At the hospital, Saheed was told that the doctor was not around so she left for a third hospital.

“The name of the hospital is Olorun-Ife hospital, along the same Kabba Road, Kogi State. The doctor was not around but the community health extension worker (CHEW) attended to me and she told me to start pushing.

“I spent a day there pushing and pushing until the next day. I was so tired that I laid on the floor. When she found out that I couldn’t push again, she collected N7,000 from me, and told me to go”, Bola narrated.

Exhausted and alone, Bola said she reached out to her sister who lives in Ilorin Kwara state for help.

“My sister asked me to start coming to Ilorin immediately. I entered a public bus to Ilorin still with the baby’s head dangling in between my laps. The baby was covered with my cloth so no one saw the baby. We drove for five hours from Kogi to Ilorin. The baby was already dead by this time. All this happened at the third day” Bola said.

But she was in for more surprises. “At Ilorin, my sister and I went to Taiwo Government Hospital- the Old Teaching Hospital at Ilorin. After taking my temperature and blood pressure, the nurse told me to go for a pelvic scan because I didn’t come with my scan result. After the scan, they said they couldn’t treat me there. I was referred to Oke-Oyi teaching hospital, Ilorin. We got to the teaching hospital in the evening only to find out that the doctors were on strike.

According to Bola, they had to switch back to a private hospital. “We left again to another private hospital nearby. At first, the doctor said we should bring N150,000 and my sister agreed. After a while, the doctor changed his mind and refused to attend to me,” she said.

By now, she said she and her sister were confused and helpless. “we returned back to the Oke-Oyi Teaching hospital and started begging them to help us. At 12 am the next morning, one of the doctors finally agreed to operate me. When I opened my legs during the examination, the doctor saw the baby’s head and shouted. He asked me how I was carrying this about for 3 days. He said I was lucky to be alive with the condition” she said.
After the examination, it was discovered that Bola had developed an infection in her womb.

“The dead baby was surgically removed but doctors noticed I had developed an infection.

We were billed a lot of money to buy drugs to clear the infection, I was operated on and admitted for two months. Due to the infection, the wound did not heal normally. They had to carry out a secondary closure of the wound. After the C-Section, I found out I was leaking urine and faeces, a condition known as rectro-vagina fistula (RVF),” she added.

Although Bola is lucky to be repaired and alive, investigation reveals that many women and babies have died during childbirth as a result of mismanaged labour by unskilled health workers and quacks.

Some churches and hospitals are training quack nurses
An investigation by this reporter discovered how some religious organisations and clinics give nursing training to some people, employ them as nurses and allow them to take part in child birthing, in their clinic.

These health workers are quack nurses according to the Nursing and Midwifery Council of Nigeria (NMCN), because they did not get their training from an accredited school of nursing.

One such nurse who simply identified herself as Kemi said she received her training at a private hospital located at Igbologun, Lagos. She said she paid N15,000 for the training and was later employed by the hospital as a nurse with N20000 as her monthly salary.

One of such training, also conducted late last year, in a church, in Port Harcourt, Nigeria, sparked a protest among nurses who have called for proper sanction of churches involved in such training.

A clip of the church video showing the trained nurses testifying in church has been uploaded online and can be seen in the video below:

In the video, the quack nurses, all clad in white uniforms boasted that in less than three weeks, using the curriculum of the Society for safe motherhood (a non governmental organisation taking part in the training), they had learnt how to assess the gestational age of the foetus, give injections and set up infusions, administer immunization, amongst other health services.

Addressing members of the church, one of the trained quack nurses who said she was an accountancy graduate of the University of Porth-Harcourt without any prior medical training, boasted that through the primary healthcare component of the skills acquisition programme, all the trainees could now perform clinic tasks.

Following this, a registered nurse and member of Nursing and Midwifery Council of Nigeria who spoke under anonymity said that the Council was aware of the quack nurses churned out by the church, and was going to do everything possible to investigate and get to the root of the matter, as well as ensure necessary actions are taken.

“The church founder is aware of the laws, that it is the Nursing and Midwifery Council of Nigeria that has the powers by law to accredit Schools of Nursing and Midwifery to train Nurses and Midwives in Nigeria and also to licence them to practice.

We (Council) are putting modalities to handle the matter, please, nurses should be rest assured of the Council’s assurance in protecting our Noble Profession, the nurse said.

In a chat with The Guardian, the Chairman, Forum for Local Government Nurses and Midwives Association (FOLGONM) Lagos chapter, Mrs. Mary Lateef-Yusuf, said: “If you are not registered and licensed with the Nursing and Midwifery Council of Nigeria, which is the appropriate body here, then you’re not a nurse, irrespective of any training you had.

The International Council Of Nurses (of which Nigeria is an affiliate) describes a nurse as a person who has completed a detailed program of basic, generalised nursing education in an accredited school or college of Nursing and is authorised by the appropriate regulatory authority to practice nursing in his or her country.

Parading yourself as a nurse without the necessary prerequisite amount to impersonation and willful desire to harm/maim/kill Nigerian citizens; which inevitably amount to wilful intention to commit murder: which is punishable under the criminal penal code of the country”.

Cases of iatrogenic fistulas linked to unskilled Health Workers
During a verification discourse with the Matron in Charge of VVF Ward, Mrs Otepola Adedoyin, Sobi Specialist Hospital, Kwara; she disclosed that the reasons for the continuous rise in iatrogenic fistula cases are basically due to increasing of unskilled health workers and quacks in the medical profession”.

She noted that it, however, calls for the urgent intervention of the concerned authorities so that it can be curbed from the grass root.

She stressed: “There has to be good monitoring from the government –at the Federal, State and LG levels. Health authorities must go from one hospital to another to check and fish out quacks. Also, the Nigeria Medical Association (NMA), Nursing and Midwife Council of Nigeria (NMCN) and Nigerian Medical and Dental Council of Nigeria (NMDC) must improve the monitoring outings to twice a month. They must ensure that only qualified doctors and nurses that attend to patients and especially expectant mothers.

“Furthermore on administrative processes, nurses’ uniform should be tagged with the name and rank of each respective nurse to display what job each does in the hospital.

“TBAs have to be warned to practice quick referral for any case that is beyond their capabilities.No patient must be allowed to be in labour for more than 24 hours. Unfortunately, these quacks will not refer the patients even though they know they can’’t handle the case, simply because of the money to collect from them.

“So many of the private hospitals have no pathograph. Some of them will keep the patient on a drip and leave the patient without even monitoring the contraction. Also, there is often nobody to monitor the drip or contraction. At the end of the day, the patient will be pushing at the undilated cervix and the result is, lives are lost.

Nigeria has below 2000 Gynaecologists
The Society of Gynaecology and Obstetrician of Nigeria (SOGON), recently revealed that Nigeria has less than two thousand gynaecologists serving its 180 million population. The body also says that several of the gynaecologists are unskilled in fistula surgery. This has resulted in more quacks and unskilled health workers attending to women in labour.

Outgoing President of SOGON, Prof. Brian Adinma, at its 51st Annual Scientific Conference held at Usmanu Danfodiyo University Teaching Hospital (UDUTH) in Sokoto State, said the rising incidents of iatrogenic fistulas, that is, fistulas caused by surgical errors, most often during caesarean sessions; is due to the few number of gynaecologists and fistula surgeons in the country. Prof Adinma noted that many of the doctors who cause iatrogenic fistulas and injuries to women during CS are mostly not qualified gynaecologists.

He said: “This is the problem we have in Nigeria. Here in Nigeria, everybody wants to do everything even when not qualified. One of the medical ethics we recognise is that a medical professional must always refer cases that are beyond him. But here, health professionals are cashing in on people’s ignorance and poverty to carry out surgeries that are beyond their capability.”

In Lagos State, the Assistant Director, Health Facility Monitoring and Accreditation Agency (HEFAMAA), Lagos Ministry of Health, Dr. Iboma Godswill, encouraged women who have been injured in labour to report such case to the association for proper investigation and sanction: “If a woman receives obstetrical care in a facility and got injured or died in the process and we are informed, we will go and investigate and find out if the person that performed the procedure has the licence to practise as a gynecologist or as a nurse.

“The person aggrieved can also write to the commissioner, the permanent secretary, or to executive secretary HEFAMAA, stating your grievances and your case will be taken up. After investigating, if it is necessary to report the issue to the Medical and Dental Council of Nigeria (MDCN), or to the relevant bodies, we will refer the case for appropriate sanction. If we find out that the medical doctor is not registered with the MDCN, he will be prosecuted and the facility sealed up.”