By Chioma Obinna
“IF I had known, if I was told, if my in laws had not insisted on tradition, my marriage would still be intact.” These were the words of 20-year-old Fatimah Abubakar, of Tureta Local Government in Sokoto State. Fatimah’s marriage maybe under trial but she has another worry in her youthful mind for now.
Dressed in a Hijab, in the female ward of the Mariam Abacha Women and Children’s Hospital, Sokoto, Fatimah is not at home attending to her newborn, rather, she is in hospital awaiting the second, third and hopefully final surgery to close the hole in her bladder. Since putting to bed, Fatimah has been unable to control the flow of urine from her bladder. She is a victim of Vesico Vaginal Fistula, VVF.
A Clinical Associate with Fistula Care Plus, a USAID funded project on fistula managed by Engenderhealth, Dr. Suleiman Zakariya, says the condition is avoidable, preventable and treatable. However, the challenge is accessing healthcare for women living in the rural areas.
He says traditional practices which delay and stop women from going to hospital early for antenatal and delivery are other factors causing the condition. Fatimah’s story fits squarely into the latter causes. Married at 18, and pregnant at 19, she was sent to her parents eight months into pregnancy to prepare for delivery.
“But I could not attend ante natal from my parents’ home,” she narrated to a team of journalists on a reporting assignment on fistula to Sokoto state recently.
Journey to VVF
Two months after relocating, labour began and so did her slow march to VVF. As it is usually the case for women in her community and still in many others around the northern parts of the country, delivery at home is still very popular. As a result, Fatimah was left at home to labour for three days. “I spent three days in labour at home and when a traditional doctor was invited, he said we should go to specialist hospital Sokoto.”
As it turned out, Fatimah was already late but was lucky to be delivered of a baby girl at Sokoto Specialist Hospital through Caesarean Section. Unfortunately, she had developed fistula – an abnormal hole between the bladder or rectum or vagina or both characterised by continuous and uncontrollable leakage of urine or faeces following childbirth.
Fatimah continued: “After my repair at the Mariam Abacha Women and Children’s Hospital, I stayed there for nine months and was discharged but was asked to come back for two more surgeries. I am here for the second surgery. Today, my husband has run away.
“When I was discharged, my husband divorced me. He was initially with me but he has gone. I have been here for the second repair for two months. Fatimah has vowed not to return to her husband but hopes to get married again.
Sharing the same ward with Fatimah was Ubaidah Abdulahi from Boronyo LGA of Sokoto. Also down with fistula as a result of delay in accessing quality healthcare, she belongs to a rare few who have their husbands beside them as they battle to regain their self esteem at the operation table.
“My joy today is that my husband is still with me. I was not ostracised by my family. He brought me here. My baby girl is alive and well,” she said joyfully,” Ubaidah narrated.
A teenager, she had leaked urine in the last five months, no thanks to obstetric fistula. She developed the condition as a result of prolonged labour that lasted for two days.
Like Fatimah, she was sent to her parents’ home at seven months pregnancy. Caught in the web of tradition, Ubaidah could not go to the hospital because her parents wanted her to deliver in the house. Ubaidah was faced with the challenge and by the time the family consented, she had been in labour two days.
Her husband later took her on motorcycle to a specialist hospital in the state. She underwent a Ceasarian Section, but despite efforts by the medical doctors at the hospital, she came down with fistula. “I have been repaired and my child is alive. I was referred from the specialist hospital to this place. At the hospital, the doctors tried to help me by fixing catheter, unfortunately, I still developed VVF. I am now recuperating.
Zara Usman’s story
The case of Zara Usman from Gumburanwa, Kwari LGA of Sokoto, is not different. She was one of the fistula clients also abandoned by their husbands after the developed VVF. Zara went into labour while in her home and was rushed to the hospital for delivery. For hours, Zara could not deliver and medical doctors prepared her for emergency CS.
“My husband was with me in the hospital then, and he consented that I should be operated on.” Just like the popular saying, Man proposes, God disposes, as the medical practitioners were still deliberating on her surgery, Zara delivered her baby through the natural way.
“It was miracle. Allah was on my side because we have almost loosed hope that I was going to deliver on my own. But God did it.” Unfortunately, after her safe delivery, she started leaking urine and faeces, a condition known as Obstetric Fistula. Zara was discharged few days after delivery and was asked to come back in two weeks to enable the doctors know the extent of her leakage for effective repair.
But little did Zara know that her case may go from worse to worst. At the end of the two weeks, Zara was faced with one of the established factors that contribute to high rate of maternal mortality in the country, bad road. Navigating through the pot holes on a motorcycle her leakage became worst.
“After my stay in the hospital, I was discharged and asked to come back in two weeks time. Today I am here waiting to be repaired. m“But my greatest challenge is that I am now leaking uncontrollably because there was no vehicle to bring me to the hospital. My husband has since abandoned me. He has refused to ask for my welfare.”
Health experts agree that fistula has become a major public health concern in the country, particularly in Sokoto state.
Impact of tradition
Confirming the influence of traditional practices on rising number of fistula cases in the state, the Chief Medical Director, Dr. Bello Lawal affirmed that there are rising cases of fistula in the state due to activities of Traditional Barbers popularly known in Hausa Community as Wanzan.
Lawal said the traditional practice known in Hausa as “Gyaran Gurya, by traditional barbers in the state has continued to fuel the cases.
“The Traditional Barbers’ activities are particularly causing a lot of iatrogenic fistula in the process of trying to remove a supposed growth in the vagina of the woman and in an attempt to remove the supposed growth, the traditional barber will injure the vagina and the woman will end up with fistula.
“Again, the same traditional barbers are also invited to help women with obstructed labour at home, in the process of trying to expand the size of the uterus, inadvently they will injure the bladder or the rectum and the patient will end up with VVF or Rectum Fistula.”
He disclosed that the Centre has treated over 261 fistula clients in the last year with a success rate of about 85 percent. Due to the rampant cases of abandonment of these women, the hospital also offers post operative rehabilitation for clients and integration services to fistula clients through the support of the state government and partners.
He lamented that the major challenge faced by the state is how to get many of the affected women to the hospital for treatment.
He blamed the rising cases in the state on ignorance, stressing the need for more awareness around the disorder. “We are seeing more cases compared with few years ago, because there is now enlightenment but the increase does not commensurate with the pool in the communities”
Clinical Associate, Fistula Care Plus, Dr. Suleiman Zakariya said in addition to the backlog, 12,000 new cases are recorded annually. Unfortunately, only 5000 of these new cases can be repaired every year collectively by the 17 fistula centres supported by Engender health.
“Obstetric Fistula is a manifestation of a sub-optimal healthcare system. Most vulnerable group is the young, poor, rural women who are economically disadvantaged. There is need for government to provide needed policies to reduce chances of women coming down with fistula,” he noted.
Calling for increase in political will to programmes on prevention of fistula, he said: “There is need to improve the health seeking behaviour of Nigerian women and access to family planning.” Worldwide, two million women live with untreated obstetric fistula. A woman in sub-Saharan Africa has 1 in 16 chance of dying in pregnancy or child birth compared to 1 in 4,000 risks in developed countries” he added.