When Halima Sa’adu a 34-year-old mother of two went into labour for her second child 15 years ago, she bore the pain but looked forward to the silver lining behind the dark cloud, her child.
She had no premonition that it was the beginning of what would become a long battle with a health condition that has caused her a lot, including her marriage.
According to her, she was sent to a traditional birth attendant when she fell into labour on that fateful day and what was supposed to last maybe a few hours became prolonged and she encountered a lot of difficulty before she eventually had the baby.
“It was after ten days that I noticed I couldn’t hold urine and that was when I was taken to Jahun Hospital in Jigawa state by my parents, where I was diagnosed with Vesico Vaginal Fistula (VVF).”
Sa’adu is one of many women suffering VVF, a condition that creates an abnormal opening between the bladder and the vagina and results in continuous and unremitting urinary incontinence.
VVF is still a major cause for concern in many developing countries including Nigeria.
Statistics by the UNFPA show that 800,000 out of a total two million cases of VVF in the world, are in Nigeria and that every year, 12,000 new cases are recorded in the country.
Northern Nigeria accounts for the highest prevalence of VVF in Nigeria, with 75 per cent of recorded cases happening in the region.
Early marriage and childbearing and the poor uptake of conventional antenatal care have been identified as some of the causes of VVF.
Women afflicted with the condition are subjected to untold suffering including stigma, harassment, neglect and intimidation in their homes and communities.
Many of them become recluses and live like outcasts as a result of the stigma they face, with some resorting to living at treatment centres where they are members of a support community.
Sa’adu said rather than support her to find a solution to her condition, her husband divorced her.
“I later received a divorce letter from my husband while I was still in the hospital receiving treatment. I have lived with this condition for 15 years and my life has never been the same. Apart from uncontrolled urination and stigma, I am still suffering from absence of menstruation,” Sa’adu recounted amid tears.
She further stated that she had undergone two surgeries so far but was yet to be repaired.
Records show that there are hundreds of thousands of women suffering from VVF, which causes significant morbidity in female urology cases and death. Moreover, continual wetness, odour, and discomfort cause serious social problems to these patients and their families.
Many innocent women have lost their lives, and some have lost hope of having a normal life due to this ailment while a lot of them are subjected to serious ridicule and stigmatisation and also face other serious health challenges.
Available data also shows that at least three million women in poor countries have unrepaired VVFs, and that 30,000–130,000 new cases are recorded each year in Africa alone. Moreover, in Nigeria there are uncountable women suffering in silence due to VVF and other related health challenges that clinical interest hasn’t recognised yet.
Another VVF patient, Rabi Ali, from Tofa Local Government Area of Kano, said she has been living in agony as a result of stigma from her husband and his relatives as well as other community members.
“Ever since I returned home after the surgery, life has never been the same. I am really facing a serious challenge as I cannot mingle with my peers as I used to. As far as I am concerned, I am living in isolation as people don’t want to associate with me anymore,” she lamented.
Similarly, 18-year-old Fatima Kamal said she spent four days in labour and she goes through a series of complications as a result of fistula.
“I had a prolonged labour; I spent four days in excessive pain. I was taken from one hospital to another. Initially, I was taken to Burum Burum Maternity and Child Health Center and later transferred to Rano General Hospital in Kano. From Rano I was transferred to Nassarawa Hospital and it was in Nassarawa that we got to know that I couldn’t deliver the baby through a normal way. And they told us to go to another hospital for Cesarean Section (CS) as they don’t have bed space to accommodate me. We went to a private hospital in Gandun Albasa. When they saw my condition they advised us to go to Aminu Kano Teaching Hospital (AKTH).
“I finally delivered my baby via CS and the baby died. I went through so many complications thereafter, and I was later diagnosed with VVF. I am still praying and hoping to undergo another surgery soon, so that I can go back to my husband’s house like my other co-patients,” Kamal stated.
Similarly, another VVF patient Yasira Musa from Minjibir Local Government Area of Kano state said she had a prolonged labour for five days as a result of inadequate health facilities in her locality and after she had spent days in pains, she was taken to .Minjibir General Hospital where she had the baby removed after which she realized she was experiencing difficulty holding urine.
According to her, when she was diagnosed with VVF, she was brought to the VVF centre by her husband and has not experienced any form of social discrimination from her family members or her husband as she went through the rudiment of repairs.
What the government is doing
It was gathered that Kano state government has been assisting VVF patients through the state Ministry for Women Affairs and Social Development by providing assistance to treated VVF patients as part of efforts to reintegrate them into the society.
Records show that through the ministry, VVF patients are empowered through skills acquisition training, moral support, encouragement; love and care to enable them live a normal life.
Commenting on the plight of the patients, Chairman, Kano council of Ulamas, Sheikh Ibrahim Khaleel, advised people to embrace rehabilitated VVF patients to enable them live normal lives.
“There is every need for people to accept the rehabilitated patients to give them a sense of hope to live like any other individual. This is a sickness from our creator and we thank Allah (SWT) that such sickness is being healed; therefore, we have to reintegrate them into the society without discrimination.
“I enjoin us all to accept them, love them, sympathise with them and give them all the necessary support to feel normal and loved. VVF is a disease that can be cured and is non-communicable. Therefore, we should not run away from our relations, friends or loved ones because of the problem,” said Khalil.
Another scholar, Ustaz Aliyu Harun, described VVF as a destiny and advised husbands and patient families to always accept them after treatment to enable them enjoy a normal life.
He said the treatment along with medical doctors’ guides after treatment indicated that they can become normal, stressing that religion considers them safe as it is not a disease that is communicable or that could endanger lives.
However, amidst clinical repairs attempts, new findings have revealed that apart from the already highlighted issues, VVF patients suffer menstrual absence and this has become a source of concern to a lot of patients because the fear is that they may not be able to conceive again after repairs.
According to the findings these VVF victims get the ailment at their tender age, ranging from 15 to 20 years, so the absence of menstruation is not as a result of onset of menopause which happens to women in their 40s and 50s.
It was also gathered that while the absence of menstruation often resolves once the cause is treated in some cases; some victims suffer the condition for the rest of their lives.
A surgeon at Murtala Mohammed Specialists Hospital, Kano, Dr. Amiru Imam Yola, said there was no strong correlation between VVF and cessation of menstruation as that of cessation of menstruation after vaginal delivery, adding that in the case of VVF patients, it usually happens when they give birth before they are operated on
He explained that when a woman is about to give birth, there will be problems that will stop menses like bleeding or when she is injured in the womb as a result of Manual Vacuum Aspiration (MBA).
“They can prevent the formation of the menses. So they cause bleeding to women who got VVF. So operation on VVF in most cases doesn’t have to do with the womb. It is only related to her bladder and vagina, he said”
In Kano, VVF sufferers are being rehabilitated after treatment to ease their reintegration into the society without discrimination.
The VVF centre at Kwalli, Kano state, has been a hub where victims of fistula have been rehabilitated and trained on different skills.
The reintegration programme supported by health officials, donor agencies, families and community leaders has helped the victims to return to their communities and enjoy normal lives after the treatment.
However, some of the victims are still asking for more, especially in the area of skills training to enable them cater to their financial needs.
In Kano State, the Fistula Foundation Nigeria, said it has adopted social and physical reintegration approaches to return VVF patients to their communities.
Musa Isa, who heads the organisation, said that the intervention helps the women to overcome social, physical and socio-economic challenges which were identified by the women themselves.
He said that the women had complained that those challenges deter most of them from going back to their communities.
According to him, the physical approach involved the surgery where the women are operated upon, while the social integration involved fighting stigma among the patients and building their capacity in many ways to ease their stress.
“We first identified 367 patients who were inoperable from North Western States for the reintegration. With support from the United Nations Population Fund (UNFPA) and Fistula Foundation California, we were able to provide social and economic support to the patients, and we are going to do a surgery for about 1000 patients before the year ends,” he revealed,
Isa explained that the foundation secured free accommodation for the patients and set up literacy classes and empowerment initiatives for them. He added that they paid advocacy visits to communities of the patients and organised interactive sessions in order to clear misconceptions about the illness.
He further revealed that some of those reintegrated to their communities had returned to the cities due to challenges and resorted to street begging.
Isa, howeve, expressed optimism that with the continuous support of NGOs, the reintegration of VVF patients would be much easier in the state.