Free surgeries empower survivors of vesicovaginal fistula
Northern Nigeria has the highest number of women living with VVF, yet a hospice in rural Kontagora offers hope for treatment and rehabilitation.
By Tijani Abdulkabeer
The energetic matron of Amina Bello Women Health Centre – known as “aunty Zaynab” by the patients, is a survivor of vesicovaginal fistula. She received treatment at the centre and has since started working with other women like herself.
In May 2021, Raise Foundation, a non-governmental organisation, launched Amina Bello Women Health Centre to bring succour to women living with Vesicovaginal Fistula (VVF) in Niger state. The organisation provides free surgeries and skills acquisition programs to empower survivors after treatment and rehabilitate them back into society.
Northern Nigeria has the highest number of women living with VVF. The centre in the rural community of Kontagora, a suburb of Niger State, is one of the major hospices and treatment centres for VVF patients which offers a ray of hope.
One of the survivors who received treatment at the centre is Lydia, who had undergone multiple surgery at the centre following birth complications, which led her to develop severe vaginal fistula. Recounting her experience in what was an emotional moment, she explains that the intervention is very timely and it’s the reason she has a second chance at giving birth, now that she has been repaired.
“I am okay now and happy because there is hope for me to conceive. I want to carry my own baby.”
What is Vesicovaginal Fistula?
Vesicovaginal fistula or VVF is an abnormal communication between the vagina and the bladder, often due to obstetrical and gynaecological injury resulting in continuous urine leakage.
VVF is a type of Obstetric Fistula where a hole between the vagina and rectum or bladder caused by prolonged labour, leaves women incontinent of urine or faeces or both.
It is estimated that more than 2 million women around the world live with vaginal fistula – according to the World Health Organisation and almost a million of them live in Nigeria.
There are millions of women that live with this condition globally, but those in less developed countries like Nigeria are mostly affected. The disparity in incidence is due to poor availability of midwifery and skilled birth attendants which limits access to quality medical care for many of these women. Oftentimes, aside from the emotional trauma, the stigma is also one of the toughest aspects of fistula. The leaking of urine results in hygiene issues and a handful of them lose their marriages and loved ones.
Research published in the National Library of Medicine, suggests that vesicovaginal fistula is one of the most traumatic maternal challenges in Nigeria.
The United Nations Population Fund (UNFPA), also describes Obstetric Fistula as the most devastating of all pregnancy-related disabilities, noting that women undergo extreme physical and psychological trauma which persists for as long as they live with this condition.
Reconstructive surgery and empowering survivors
Like any pregnant woman, all Lydia ever wanted was to carry her baby upon delivery, but what was supposed to be a thing of joy for her, became a source of sorrow. Her first attempt at conceiving was in 2018 and this left her in an obstructed labour that later caused her uterus to be ruptured. The Caesarean section (CS) which was supposed to save her also went wrong and left her uterus stitched to her bladder. The baby didn’t survive.
“The results are life shattering.” Lydia was unable to control the flow of her urine. Nerve damage to her legs also made it difficult to walk. But she was lucky to have the support of her husband, after the loss of her child, but she was still shunned by some of her community members and left to live a life of shame and isolation.
This changed her life’s trajectory. She could no longer control her urine and started leaking like a baby, she says. Visitations from family and friends ought to be a means of comfort, for Lydia it was a thing of shame as her visitors always held their nose because of the urine stench.
“When people come to greet me and they hold their nose, I know that it is because of the urine, and I feel sad. I cry bitterly.”
In September, Lydia had another operation and for the first time since 2018, there is hope that her dream of being a mother would be fulfilled.
Lydia is just one of the numerous women in Kontagora whose lives have been disrupted by Vesicovaginal Fistula (VVF) because of childbirth complications.
Like Lydia, Zaynab Shafiu also contracted VVF during her first pregnancy and spent four years battling the disease. She explained that the experience shattered her especially because she only received little help, and her husband abandoned her when she needed him the most.
“If he entered my room, he would spray perfume on his palm, inhale it, and come near me. He would constantly complain that I smelled and tell me to go and bathe.
At one point, he asked me to return to my parents’ house. Women with VVF face serious humiliation and discrimination in our community. Some people even use derogatory words against us,” she recalled her struggles with Obstetric Fistula.
A happy ending with room for improvement
One day, she was introduced to one of the surgeons at the Centre by her friend and that was how she got her repair at the VVF Centre.
“I’m very happy because I no longer have VVF. I can wear my clothes, walk freely, and go wherever I want. I am grateful to Allah and to Hajiya Amina, who helped restore my dignity. Before, people hated to see me, but now the story has changed”.
So far, Raise Foundation has repaired 708 women since 2015 in Niger State, but this is only covering 0.0885% of the nation’s obstetric fistula burden due to the prevalence.
Fistula patients at the Dr. Amina Bello Women Health Centre are getting reintegrated back into the society. For many of them, these free repairs are a timely intervention and after treatment, they go back to their communities, full of confidence, whilst serving as ambassadors fighting against the menace of Obstetric Fistula.
“They become our Ambassadors. They began to share their own experiences with other women to encourage them to prioritise proper maternal care,” says Ruth Jiya, Communications Officer at Raise Foundation.
According to Ruth, after six weeks of receiving treatments, patients are empowered with vocational skills such as bag making, tailoring, bead making so that they can be financially independent. “We also give them startup packs to be able to start on their own.”
Speaking with Dr. Sulaimon Taofeeq, he agrees that the primary reason why VVF spreads especially in the North is due to the limited access to adequate and emergency obstetric care as well as the cultural practices of the people. He believes the government needs to improve the conditions of secondary healthcare to eradicate this burden.
“The major cause of VVF is prolonged obstructed labour,” says Dr. Sulaimon, further revealing that depending on the extent of the damage, a woman could be operated on for about three times before healing competition.
Why is vaginal fistula prevalent in northern Nigeria
An estimated 800,000 Nigerian women are either living with VVF or are survivors after undergoing surgery and over 90% of them are from the northern part of the country. Niger State – one of the 19 provinces of northern Nigeria is amongst the worst affected.
One of the major challenges is limited access to healthcare, due to a shortage of health providers and caregivers in rural communities, and possibly the most critical issue is the fact that northern Nigeria is very conservative and traditional, and medical procedures like antenatal care and examination of pregnant women by male physicians would not be allowed.
These traditional views as well as lack of education further aggravates the already precarious situation, but it gets even worse.
According to the United Nations Children’s Fund (UNICEF), between 50,000 and 100,000 new cases are added every year, showing the extent of the damage. This global body also revealed that the prevalence of Fistula is 3.2 per 1000 births, suggesting that the backlog of unrepaired cases may take about 83 years to clear at the present rate of repair.
And what about the government
The Commissioner for Health Niger State, Dr Bello Tukur noted that cultural practices are a major enabler of VVF incidence in the state. He says that this is complicated with the beyond limits operations of the traditional birth attendants whom women see as their first call during pregnancy.
“We are currently working on a program to incentivise antenatal care. We noticed from our data that some women attended antenatal care throughout their pregnancy but did not deliver at the facility” due to a preference for traditional home delivery with its cultural trappings.
The health commissioner said Niger state has established a new health policy that ensures that each of the primary healthcare facilities in the state has at least two midwives, available 24 hours to meet the maternal health needs of the women of Niger state.
This article was written as part of the OWM’s Health Solutions Programme, alongside the short documentary Dry Again, produced by Melony Ishola & Tijani Abdulkabeer. See project details here.