Fistula is not death sentence, say experts

•Task lawmakers on policies as patients narrate their ordeal

Health experts are unanimous that fistula is not a death sentence because it can be repaired and treated.

Fistula, an occurrence of abnormal hole between bladder and rectum and vagina experience continuous and uncontrollable leakage of urine usually caused by obstructed labour during childbirth.

The medical experts at a three-day orientation meeting on Fistula Basics for journalists, last week, in Ilorin, Kwara State, said that one to two million women are affected by fistula in Sub Sahara Africa and as much as 150,000-200,000 cases in Nigeria. They stressed that most the women who suffer from fistula are very poor and cannot afford to treat themselves.

The medical experts include: Country Project Manager, Fistula Care Plus, Dr. Habib Sadauki; Consultant Gynaecologist at Sobi Hospital, Kwara State, Dr. Hassan Landan Wara; a volunteer surgeon, Dr. Halima Bello; Chief Medical Director of Sobi Hospital, Dr. Musa Sanni; and Permanent Secretary, Kwara State Ministry of Health, Abdulrafiu Anyila.

To address the situation, the experts said the United State Agency International Development (USAID) in collaboration with Federal Government has provided 11 centres in 10 states in Nigeria for fistula treatment and prevention. The centres include: Kebbi, Sokoto, Zamfara, Kastsina, Kano, Bauch, Kwara, Oyo, Ebonyi and Cross Rivers States. They said another centre is under construction in Jahun, Jigawa State and will be completed as soon as possible.

Also, USAID in collaboration with Kwara State government has provided health centres to treat the medical condition free of charge.

Obstetric fistula (or vaginal fistula) is a medical condition in which a fistula (hole) develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth, when adequate medical care is not available.

The United Nations Population Fund (UNFPA) defines obstetric fistula as, “A childbirth injury that has been largely neglected, despite the devastating impact it has on the lives of affected girls and women. It is usually caused by prolonged, obstructed labour, without timely medical intervention—typically an emergency Caesarean section. During unassisted, prolonged, obstructed labour, the sustained pressure of the baby’s head on the mother’s pelvic bone damages soft tissues, creating a hole—or fistula—between the vagina and the bladder and/or rectum. The pressure deprives blood flow to the tissue, leading to necrosis. Eventually, the dead tissue comes away, leaving a fistula, which causes a constant leaking of urine and/or faeces through the vagina.”

Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF).

According to Wikipedia, Vesicovaginal Fistula, or VVF, is an abnormal fistulous tract extending between the bladder (or vesico) and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.

It is often caused by childbirth (in which case it is known as an obstetric fistula), when a prolonged labour presses the unborn child tightly against the pelvis, cutting off blood flow to the vesicovaginal wall. The affected tissue may necrotize (die), leaving a hole.

During the Orientation Meeting on fistula basics for Journalists, the pressmen visited Sobi Special Hospital Kwara State, where the patients are undergoing surgery. Other places visited include Kwara State Ministry of Health and National Health Insurance Scheme in the state for the journalists oversight as part of the orientation.

Some of the fistula patients, who spoke to press, commended USAID and government in their efforts to ensure that Nigeria is fistula free. They added that USAID and Kwara State government have been providing their feeding and drugs since they arrived the hospital.

Country Project Manager, Fistula Care Plus, Dr. Habib Sadauki, said government needs to do more by providing resources, necessary materials, equipment and facilities including manpower for treatment and prevention of fistula.

Sadauki said: “Government should also provide resources to reduce increase in maternal mortality and to improve maternity care in the country. Fistula is a gender issue and those who affected have been neglected for a very long time. Most of these women have been abandoned by their husbands and family members because once a women is affected no body will afford to associate with her because offensive ordour emitting from her.”

He continued: “We want policymakers to make laws and policies that would help to eradicate fistula. It is role every need to play to ensure proper awareness of fistula prevention so that people can come out and benefit from this project. We want women who suffer from fistula to know that their condition is preventable. We also want those who have been affected for many years living in isolation to come because their condition is preventable.

Once a woman become pregnant with good antenatal care she can put to bed either by assisted or by her self. But the issue is that we do not have access to good antennal care. Age is a predisposing factor to vesico vaginal fistula (VVF), even in our eyes the smaller the girl is the more like she is to have obstructed labour it is predisposing factor because she would be pregnant for nine months in order to be prepared to put to bed. We advocate that people should avoid under age marriage because most tomes, people who suffer from fistula are under age women. Marriage should be at the age of 18 years because it would reduce the backlog of fistula menace we have everyday on our children. It is so pathetic that the fund been wasted in fighting fistula can be used for another thing else”.

“Fistula is 100 percent preventable. So, let us try to prevent it and one of the ways to prevent it is to attend antenatal care by women.

Dr. Hassan Landan Wara, from Kebbi State, who performed the surgery in Sobi Hospital, narrated that the major cause of fistula is prolonged obstructed labour during childbirth. He also tasked government to make policies to reduce increase in fistula cases.

Wara said: When a head of a baby is compressing on the bladder and tissue that is compressing would lack blood and later it would die and leave a hole. Over 80 percent of fistula we have is related to obstructed labour another way one can get fistula is through female circumcision. There is fistula caused by service providers may be mistakes during surgery. Cancer of the bladder can also cause fistula because of leakage from the cancer.

In the theatre the major activity we do is to repair patients and at the hospital level during the antenatal checkup (ANC), we do advocacy telling people the dangers of obstructed labour and how to avoid it. Another activity we do here is to call people and treat fistula cases. Any woman is vulnerable to fistula if she has not attended antenatal care. Another problem is lack of facility and there are no doctors and nurses to treat fistula. Lack of access to healthcare makes women to be vulnerable to fistula.

“Fistula is a disease of poverty and ignorance if we all can join hands government make good policies and individual play their own role. If government can reduce poverty and ignorance fistula would stop in America there is no fistula like Nigeria. If we can improve our healthcare facility and make health services free and fair for people it would reduce fistula cases”.

“We do not have enough service providers in fistula treatment so, we need people to come and lean the procedure in order to safe souls. Fistula treatment is not area to get money because it is a sacrifice. I have passion in treatment of fistula because without out passion one cannot treat fistula”.

Another female doctor, Dr. Halima Bello, also a volunteer, who participated in the surgery said fistula field is not where to make money which resulted some doctors leaving the field to another field where they can make money.

She said: “In fistula treatment you meet a lot of difficulties both in surgery and treatment aspect that is why some doctors are not interested in treatment of fistula”.

A patient, Razat Folake, 27, from Kwara State, based in Kogi State, said her ailment started five years ago but she had no money to carry out the surgery on her own.

She said: “Some people told me if I go for surgery I will die and I had no money then so, I was scared since five years ago until recently, my sister called me to come to the this hospital. Since I came in I have seeing other patients undergoing the surgery successfully so, my mind is at peace though I have not done the surgery but I hope that God would see me through. I want to say thank you for the sponsors of this programme, because since I came in here they have been taking care of our drugs and feeding”.