By Ajuma Edwina Ogiri
As Nigeria commits to achieving the Sustainable Development Goal 3, which seeks to reduce maternal mortality ratio to less than 70 per 100,000 live births, obstetric fistula poses as one of the major threats in achieving this goal. This is because Nigeria, with a population of over 170 million, has only 20 fistula surgeons who can treat the over 120,000 cases of obstetric fistula which occurs annually in the country.
Revealing this at a media round table discussion on Fistula intervention, in Sokoto, a Clinical Associate with Fistula Care Plus, a USAID funded project on fistula managed by Engender health, Dr. Suleiman Zakariya, said the “few number of fistula surgeons in the country fall short of over 120,000 Nigerian women affected with the disorder every year.”
According to Dr. Zakariya, fistula which is the occurrence of abnormal hole between the bladder or rectum and the vagina characterised by continuous and uncontrollable leakage of urine or faeces usually following childbirth, is one of the five major causes of maternal death, adding that two to five per cent of women who experience prolonged obstructed labour will develop obstetric fistula.
A visit to Maryam Abacha Women And Children Hospital and VVF Center, Sokoto State, showed an increasing number of fistula clients in Nigeria, with most of them between the age range of 17 to 28 years, awaiting either the first, second or even third repair surgery.
One of such clients is 27-year-old Lawiza Sani, an orphan, who was divorced by her husband when she was eight months pregnant, and has been living with Vesico-Vaginal Fistula (VVF) for two years.
“When I was pregnant at twenty five years old, I went into labour for five days because I wanted to deliver my baby at home. I was later taken to the hospital on the fifth day, to be delivered of my baby. I lost my baby as a result of prolonged labour and started leaking urine thereafter. I am presently waiting for my third surgery,” she explained.
Another client, Fatima Abubakar, 20, said she married at the age of 18, got pregnant when she was 19 years old.
“I was sent to my parents when I was eight months pregnant to prepare for delivery. I could not attend ante natal from my parents home because of the distance to hospital. I was in labour for three days, hoping to deliver at home; as most women from my village deliver at home. When it was obvious I could not give birth on my own, I was taken to the specialist hospital, Sokoto.
“I was delivered of a baby girl through Caesarean Section, and was happy she survived, but unfortunately I developed VVF.
“After my repair, I stayed in this hospital for nine months and was discharged, but was asked to come back for two more surgeries. I am here for the second surgery,” she explained.
Dr. Zakariya, explained that the condition is avoidable, preventable and treatable, however, one of the challenges is access to healthcare for women living in the rural areas, adding that traditional practices which delay and stop women from going to hospital early for antenatal and delivery are other factors causing the condition.
“Many of these women are young and poor with little education and limited access to quality health care, including emergency obstetric care.
“Some live in rural areas where there is no access to good hospital and the road is bad. During labour, many of them trek long miles before they get to a health clinic. These delays may lead to loss of lives especially when there is prolonged obstructed labour. Prolonged obstructed labour may also result in birth complication such as obstetric fistula”, he said.
According to him “only 5,000 of the 12,000 new cases can be repaired every year collectively by the 17 fistula centres supported by Engender health. The rest are left to their fate due to the acute shortage of fistula surgeons.
“All doctors know about fistula, but not all surgeons can repair fistula because it is a specialised area of surgery.
“Nigeria may continue to witness shortage of fistula experts, because fistula repair is a specialised area of surgery that does not attract financial gains as most of the surgeries are done free of charge. As a result, many of the doctors are abandoning it to specialise in other lucrative areas.”
Explaining some of the intervention activities of EngenderHealth, he said;
“we are involved in upgrading of emergency obstetric care to prevent fistula, procuring of essential equipment, improving access to Family Planning, use of catheter and partograph to monitor labour, readiness to provide safe and quality caeserian.”
Speaking to journalist, the Chief Medical Director, Maryam Abacha Women and Children Hospital, VVF centre, Sokoto, Dr. Bello Lawal, said the rising cases of fistula in the State is due to activities of Traditional Barbers in the community who carry out traditional practice known in Hausa as“Gyaran Gurya.
“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, 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.
