By Ajuma Edwina Ogiri, Abuja
The air of anxiety was unmistakable at the National Obstetric Fistula Centre (NOFIC), Babbar Ruga, Katsina state, when Blueprint Weekend visited the centre to witness an Obstetrics Fistula otherwise called Vesico-Vaginal Fistula (VVF) pool repair, mass repair of women with fistula by a pool of surgeons from hospitals across the country.
Every available waiting space had been taken by the mass of women either waiting to be discharged after their successful repair surgery or waiting to be screened and prepared for surgery.
On the list of those waiting to be discharged was this woman, who identified herself simply as Amina, beaming with smiles following a successful repair surgery.
Filled with gratitude, she told Blueprint Weekend: “I am so happy I can go home now after over a month in this hospital, healing from the surgery.”
Amina, who said she arrived the hospital three weeks earlier in tears, expressed joy that she was leaving the hospital with joy in her heart. According to her, “I came down with fistula during my last delivery, which was my fifth. I have endured it for several months. But, today I am grateful that I can smile again because I am now dry.”
She thanked USAID Fistula Care Plus Project managed by Engenderhealth for putting together the free screening and repair for women with fistula at the centre.
She, however, was not alone in the songs of joy. 37-year-old Hauwawu Lawal from Dandimi local government area of Katsina state, who was on the list for repair surgery told our correspondent that the thought of being free of the condition was too good.
“I have had eight deliveries with the eighth one resulting in fistula. We went to the hospital when I was in labour but the healthcare givers told me I was not dilated enough for delivery, so we had to go back home.
“The next day we returned to the hospital to our shock they were on strike, so I eventually spent six days in Labour. I started leaking and went back to the hospital to be repaired.”
Unknown to the mother of eight, she had complicated fistula, which needed more than one-time repair, hence her optimism that the next round of surgery would completely repair the damage.
She was full of praises for her family for standing by her, stating: “My family has been very supportive, my marriage is intact because my husband has shown me love and always prays for me when I am down.
“Everyone prays for me to get well. My husband heard about the free surgeries during the pool efforts so we decided to come. I very hopeful that this would be my last repair.”
Speaking on some cases being handled by the surgeons, particularly the type presented by Hauwawu, a celebrated fistula surgeon who also trains doctors on how to deal with similar situations, Professor Oladosu Ojengbede, said every fistula is different.
“Some are simple while others are complicated and may require two or sometimes more surgeries to completely close the hole. So, what happens is that when we review the client and her condition we usually inform them on what treatment options are available for them.
“if it is the type that will require multiple surgeries to fix we tell the client so, but I can assure you that with the expertise in the country today, there are very few situations that we cannot successfully deal with,” Ojengbede declared.
He, however, advised women who are repaired to strictly adhere to post surgery advice of the doctors to fully enjoy the outcome of their surgery.
According to him, “We normally advise them on some dos and don’ts to give the surgery enough time to heal properly before they return to normal sexual and procreation functions.”
Fistula and pooled efforts in NOFIC
According to Chief Consultant, Obstetrician Gynaecologist and the Medical Director, NOFIC, Babbar Ruga, Dr. Aliyu Mohammed El-Ladan, said fistula is caused by failure to intervene in Labour.
“Any woman in labour, when you come, there is what we call active Labour; that is when you have Labour pains in association with the neck of the womb, which is the cervix opening up to the baby to come out. When that process begins, it should not last more than eight hours.
“But, when a woman is in Labour for four to five days at home before she comes to the hospital, there will be prolongation of Labour and compression of the bladder against the burning pelvics by the head of the baby, and so the tissue will die in between.
“So, by whatever means she delivers, she will have fistula and could even loose the baby. The work we do, the success we record and the patients we manage, are the ones who advertise us to the public.”
He said, “The success story they tell is what brings women who have been hiding to come to us for repair. Patients who have also had failed surgeries elsewhere, also hear these stories and come to us.
“When we have pooled efforts like this, it is the Non-Governmental Organisation, like EngenderHealth, that help us through their community based workers to go into local governments, villages and towns, to bring patients. They also do advertisement through radio and television, which also tends to bring out more patients.
“The last pooled effort, we had about 70 patients and repaired about 50 of them in that week. So, we had to manage the remaining the week after. By the time we finished managing the remaining ones, they looked at the success recorded and requested for a second round of pooled effort before the year runs out, that is why we are having this one now.
“Because of the call to end fistula by the year 2020, we are making more efforts to do more of this pooled effort to clear the backlog, and also trying to prevent the development of new fistula cases, by establishing proper Antenatal Care, Labour and Delivery Supervision,” he explained.
Dr. El-Ladan further explained that the key to eliminating fistula is good Aante-natal Care, Supervised Labour and Delivery and a good Caesarian Section.
“That is when we can stop the tap. What we are doing now is just emptying the bowl; the tap is flowing, the bowl is full, we empty it and put it back under the tap. The tap can only be stopped if we can have good ante-natal care, supervised labour and delivery services and caesarian section when necessary,” the Medical Director said.
Life after repairs
Explaining further on the life of these women after repair, Dr. El-Ladan, said “These women when they have Vesico-Vaginal Fistula (VVF), they suffer social segregation; they are separated from their husbands and families.
So, by the time most of them come, they no longer have human feelings because of the way the society has treated them. So, one of the things we do for them is to repair them first.
“After that, we look at all of them, some of them still have social support; that is, they have VVF but their husbands and families are around them for support, so they do not require rehabilitation.
“But those of them that are socially ostracised and abandoned, require rehabilitation. We have a rehabilitation centre opposite this centre, where we teach them different skills like sewing, knitting among others.
“When we finish training them, we give them sewing machines, grinding engines and other tools they can use to start life afresh in their various communities. We also give them cash in addition to these tools.”
