200,000 women living with fistula in Nigeria, says experts

• 700,000 Cases Enter Into Backlogs

The life of Mrs. Patience Stephen, an indigene of Akwa Ibom State, took a downward plunge 18 years ago, when she developed vesico vagina fistula (VVF). Not only did her husband abandon her, other family members also deserted her because of her worsening health condition.

Fortunately, Mother Luck smiled on her, as she was successfully repaired and treated.“It started after I had my first child,” she narrated. “During this period, I was stigmatised because of the offensive odour my body was emitting, as a result of steady leakage of urine.

“But today, I thank God for the opportunity and the sponsorship that got me healed. I am better and stronger now. I would want to advise other women with the same condition to visit hospital for repair, since it is free.”

Another fistula client, 27-year-old Mrs. Lucas Oluwaseyi from Osun State said she went into prolonged labour. But rather than go to a hospital, she went to her church, where her problem became more complicated. So, she was taken to Mother and Child Hospital in Ondo State, where she was operated on. Sadly, the baby did not survive and she also developed fistula.

She explained that it was her brother, who encouraged her to go for fistula repair, which was successful. She said: “During my predicament, all my friends abandoned me, and even my husband-to-be, who impregnated me ran away. I was helpless until this opportunity came.

“From my experience, I would advise pregnant women to register at the hospital for proper antenatal care. They should avoid going to wrong places for medical attention, such as the church. Those who have fistula should come here because the repair and treatments are free.”These two testimonies were obtained during Media Roundtable Discussion on Fistula Intervention/Fistula Repair Programme at Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) Ilesa, Osun State, organised by Fistula Care Plus Project, implemented by Engender Health and funded by the United States Agency for International Development (USAID), held in Ilesa Osun State.

Country Project Manager, Fistula Care Plus, Chief Iyeme Efem, said his organisation is supporting 12 states and have 13 facilities in the states, which include OAUTHC Osun State, Adeoyo Maternal Hospital in Ibadan, Oyo State, Sobi Specialist Hospital Ilorin Kwara State, VVF Centre in Kebbi State, Maryam Abacha Women and Children Hospital Sokoto, Women and Children Hospital Gusau Zamfara, National Obstetric Fistula Centre Katsina, Laure Fistula Care Hospital Kano, VVF Centre Kaduna, VVF Centre Zaria, VVF Centre Bauchi, National Obstetric Fistula Centre Abakiliki Ebonyi, Ogoja General Hospital Cross Rivers State and the newly opened VVF Centre Damaturu, Yobe State.

Efem said: “USAID research in 2012 showed that 200,000 women live with fistula, while 12,000 new cases occur every year. USAID does 200,000 repairs yearly. This means we have 400, 000 to 500, 000 cases every year and it does not catch up with 12, 000 new cases. The research shows additional 700,000 cases entering into backlogs. Looking at it from that perspective, it shows we have not done enough and we have a long way to go.

“The only way we can say we have prevented fistula is if we prevent the occurrences and reduce the incidents to zero, but we do not have the structure in place. Which is why one of the strategies we are introducing is having teaching hospitals undertake fistula repairs. This will help to reduce occurrences to zero. But you know teaching hospitals charge fees. So, we were able to negotiate with the minister of health, who liaised with the teaching hospitals, by sending memo to them to stop fees. Some of the hospitals have begun to comply, but some are not.

“The strategy is that, every teaching hospital should do at least 15 repairs in a month. If we have 44 teaching hospitals undertaking 15 repairs, this means we have 660 repairs from each of them in a month. Multiply this by 10 months, and you have 6,600 repairs. So, in a year, we will have about 700,990 repairs by teaching hospitals alone.

“If we add this to what Fistula Care Plus is doing, which is 200, 000 repairs yearly, we have 9,990 repairs plus 3,000 by other programmes, making 12,000 repairs in all. With this, we will completely zero the incidents of fistula cases in Nigeria.”

Head of Obstetric and Gynaecology, OAUTHC, Prof. Ernest Orji, said treatment and repair of fistula had been in existence in the hospital, though it was under missionary control. But the challenge then was that many of the women who developed the condition were indigent, and they found it difficult to afford treatment.

“This was the trend, until Engender Health came in. And ever since, there has been a lot of improvement in terms of health workers’ training and provision of consumables,” he said. “They have been very helpful. Now, we have dedicated surgeons among us, unlike before when all our consultants are surgeons. OAUTHC Ilesa has been dedicated for fistula repair among others branches of the hospital in the Southwest.”

He explained that in the whole of Southwest, awareness creation about fistula repair and treatments in the hospital have been ongoing. So, new clients are being admitted on a daily basis.

Orji said: “The awareness has been on radio and television jingles, social media and WhatsApp, among others. More women are coming for repair, especially now that it is free. We partner with market women, community leaders and traditional rulers to ensure that the information reach people at the grassroots. We also work with social workers in Osun State to ensure more awareness and improvement.”

In terms of manpower, he said the hospital is ready to serve clients even better, as they recruit gynaecologists regularly, as well as train their health workers.

“We also organise skill acquisition for women after the repair, as many of them are poor and unable to feed and care for themselves. I would want government to employ more doctors and nurses for the hospital,” he said.

He explained that private organisations, families and individuals have been donating to the hospital, which has helped in the development and maintenance of the facility, adding that there is a fistula centre under construction in the hospital.

He said: “By time we complete the centre, we will employ more doctors, nurses and other health workers to ensure adequate improvement in the hospital setting. We also advise philanthropists to donate more resources to enable us take care of our clients.

“We advise pregnant women to book early for antenatal, as well as deliver in hospitals with qualified personnel. They should come for delivery early and not when labour has become complicated. What we do is to save the women’s lives and we advise them to stay away from sex for at least three months after a successful repair and wait for two years before getting pregnant.”