Lifting fistula burden off sufferers

Mr. Zachaeus and wife after her treatment

• Stigmatisation, Prohibitive Cost Inhibiting Treatment
For lengthy periods, the notion that cases of obstetric fistula was endemic in the North and sparse in the South held sway. But it has now come to light that the situation on ground in the South may not be as good as thought, or imagined.

What is even more worrisome is the fact that a large number of women, who are currently ravaged by the condition, are going about in diapers, or with urine catheter hidden underneath their garments.

Several factors, including stigmatisation, lack of funds, as well as lack of awareness about the existence of free treatment centres in the country, account for this pathetic scenario.

Obstetric fistula, an abnormal opening in the birth canal, leading to uncontrolled leakage of urine or faeces- results in sufferers living in shame and depression.

A visit to some fistula treatment centres around the region showed that many of the patients were from South West region. That was the situation at Ibadan, where over 200 fistula clients are treated every year.

This was confirmed by the President, International Society for Obstetric Fistula Surgeons, and Head of Fistula Programme at the University College Hospital, Ibadan (UCH), Prof. Oladosu Ojengbede, during a visit to the centre.

He told The Guardian recently: “We see a lot of cases in Adeoyo Specialist Hospital Ibadan, and UCH together. Currently, the numbers are increasing. Last month, we had a pool effort and we had 36 cases. Some are still coming. We just started another one this week and we have 34 cases. Over 200 fistula clients are treated every year in Ibadan and most of them are from this region,” he said.

The Ibadan picture was the same as that of Kwara State Specialist Hospital, Sobi, Kwara State, which is another repair centre.

In Osun State, where some free fistula repairs were done recently, about 30 women living with the condition were on admission at the venue of the repair works, Wesley Guild Hospital Unit, Obafemi Awolowo University Teaching Hospital Complex, Ile-Isha, Osun State.

Here, the victims, all from the zone just emerged from hiding due to the free repair programme, which was announced on the radio.

According to the hospital’s management, the turnout of sufferers was large, but the hospitals could only admit the limited number it did due to lack of bed space.

Before the surgeries, the Chief Medical Director (CMD) of the hospital, Prof. Victor Adetiloye, told The Guardian that only two surgeries had been done at the hospital between January and June this year.

“All it took to bring this number of women out of hiding, was a two-week announcement on radio about the free fistula treatment. About 30 women are admitted already and more are still coming. Two of our wards are filled up already and we’ve never seen anything like this before,” Adetiloye exclaimed.

“The fact that this is done free of charge, has brought out this crowd, I doubt if we can finish this within one week. I salute the courage of some of the husbands. In some places they would have kicked these women out for a problem they didn’t cause by themselves. But you can see the husbands standing by their wives. We believe that this hospital will eventually become the focal place for fistula repair in this part of the country,” he said.

The “pool effort” repair, was organised by EngenderHealth, a non-profit organisation active in women’s health, sexual and reproductive health throughout Africa, and also implementing partners of USAID, in collaboration with the Federal Ministry of Health, and Osun State government, in a bid to reduce the backlog of obstetric fistula cases in the country.

One of the beneficiaries, 28-year-old, said she saw the free treatment advertisement on her friend’s Facebook page.

Nkechi, who had lived with fistula for 10 years told The Guardian how she had sought treatment in different hospitals, but the high cost of such services kept her away from being repaired.

“I live in Ekiti State, but I developed obstetric fistula when I was having my first Child 10 years ago, at a private hospital in Enugu. The baby died in my womb. After that my husband ran away. Now I am staying with my grand mother.

“I went to some general hospitals in Ado Ekiti, and I was asked to bring N200, 000 but I don’t have that kind of money. May God bless EngenderHealth, the sponsors of this surgery. Now my life is back,” she said.

Twenty-four-year-old Joy Michael, another beneficiary said she heard about the surgery on radio. Michael, who had been booked for surgery initially, at General Hospital Ile-Ife, said she had been waiting for over six months for her turn at the hospital after paying N120, 000.

“I had to wait a long time at a general hospital after being booked for surgery. I developed fistula in April 2016, when I was having my first child, at a church. The baby died. From there I went to General Hospital Ile-Ife and was told the repair works would cost N120, 000. I was scheduled for surgery some months later.

“On the day I was supposed to be operated, I saw my period so it was cancelled and rescheduled for another three months. The three months would lapse August 30. But when I heard about this free surgery and I decided to come.

“The condition affected my relationship with my husband because we don’t have sex again. Now there is hope that I will soon have a normal sexual relationship with my husband, and so I am very grateful to all that made the free surgery possible.”

After wearing adult diapers for 10 years, visiting so many prayer houses in search of solution, Oduayo Oni, another beneficiary, is elated to be set free from bondage with the free surgery.

The 27-year-old from Osun State, said she developed VVF while giving birth to her first baby 10 years ago, through operation, at 7th Day Mission Hospital, Ile- Ife.

After developing the condition, Oni said she managed the situation quietly for seven years before finding the courage to seek treatment. “All the while we were going to church, praying for mercy, until we heard about this repair through an advertisement.

Her husband Zacheus Oni, said: “I stood by my wife all this while because of the love I have for her. I encourage all men to always stand by their wives in this kind of circumstances. I pray that God will bless the sponsors. After this repair, we will go to church and do thanksgiving.”

Mrs. Abbas Oluwaremi-Lekun, another beneficiary is yet to come to terms with the fact that her years of leaking faeces and wearing pampers were finally over.

Overwhelmed with joy, she managed to summarise: “I feel okay, better than before. Am so grateful to the sponsors.”

Thirty-year-old Oluwaremi, who has been living with the condition for five years said she never heard about free fistula repairs before.

“We have been to different hospitals, where we were given medications, injections until we finally heard about this programme through the radio,” she told The Guardian.

She said she developed the ailment after labouring for four hours at a private hospital.

“It was during my fourth delivery five years ago. The baby is still alive. We were using a private hospital- Olaiya Hospital, Ibadan. The hospital said I would delivery through surgery, but we refused to go that way because we didn’t have money for surgery, and I was afraid of surgery. That is why I laboured for four days. We finally move to Idiogugu Primary Health Centre, where I had the baby through vaginal delivery, but I had a tear. It was immediately after this that the problem started.

“I used to sell provisions, but because of this condition, I stopped selling because nobody wanted to buy things from me. People used to complain when I pass that I smell awful. My husband’s family even asked him to send me away but he refused.”

Oluwaremi’s husband, Abbas Bayonle Ahmed, a Muslim cleric said he used to think the problem was spiritual so he sold his land to buy a cow to appease the gods.

“I sold my land to buy a cow to appease the gods, but the problem continued. Now I have realised that this is not witchcraft. I am grateful for this free surgery,” he said.

Mrs. Sarah Famagiwa, was the beneficiary repaired by Minister of Health, Prof Isaac Adewole, as well as, seasoned fistula surgeon, Prof. Ojemgbede, among others.

Prior to the surgery, Famagiwa said she normally moved about with urine catheter everywhere she went, a development that brought shame and disgrace to her.

The Oyo State indigene had started leaking urine three years ago, after 14 hours of labour at a private hospital- Olaiya Maternity Home, Ondo.

“When I wanted to deliver, there was a strike action at the General Hospital, Ondo, where I live. That was how I ended up trying to deliver at the private maternity. After undergoing 14-hour labour, I finally delivered my baby, but I started leaking urine. After that, I went to Oyo State to meet my parents and they took me to a general hospital for repair, which was not completely successful, prompting us to go to the teaching hospital at Ile-Ife. I was given September 6th for the surgery, but we decided to come here when we heard about this free surgery.”

Since suffering the condition in July 2014, her husband, Taiwo Orobola Famagiwa, said he never had sexual relationship with his wife. “We have not had sex since then. Now that she is repaired, there is hope that things will be okay soon,” he said.

Expressing shock at the large turn out of patients at Wesley Guild Hospital Unit, Obafemi Awolowo University Teaching Hospital Complex, during the surgery, Country Project Manager, EngenderHealth, Iyeme Efem, said: “These clients are mainly from the South West, and that is the surprising thing because South West has the best health indices, yet you find fistula here. So, when some people say there’s no fistula in their state, when we put out an announcement and people turn up, they are shocked. We have been repairing a lot of people from Lagos State, so no place is immune from fistula in the country. Until the officials stop hiding their head in the sand and accept that there’s fistula in their communities, we will not be able to clear the backlog cases”

He said the pool effort was introduced in 2007 and involves bringing surgeons from different facilities into one facility, catering for them, and engaging them to carry out repairs throughout the week.

“Usually, we do about 35 repairs or more, depending on the complexity of the cases and the number of theatres. Here they have three theatres, and at a point all three were in use with seven surgeons conducting the repairs.

Efem, who explained that as part of the exercise, the hospital provided beds, theatre and manpower, added that since the staff were on hand, “what we can do is help train them and ensure they begin to do routine repairs, occasionally we can come in to do pool effort repairs. The outlook is that this hospital will remain a centre, which will be supported by UCH, Ibadan so that UCH will oversee the repairs. Where there are difficult cases, they would be moved to UCH Ibadan. We intend to have three new centres by September next year, am sure there will be additional three or four more centres,” he said.

On why women with this life-threatening condition hide, he said, “It is those who have money that go to hospitals. Those who don’t have money live with it, especially if it’s not so debilitating, but when you provide an opportunity for them to have free treatment, then they will come out.

“In the South, victims hide this condition; they hide at home because when it is known, it is like a family disgrace, which is why we are insisting on free treatment. We have provided the consumables.

“Another challenge we face is lack of referrals to the free centres. We have had clients we’ve repaired who told us how private hospitals charged them as much as N2m for repairs that eventually failed.”

Still in awe at the large turn out of patients Chief Medical Director (CMD), Obafemi Awolowo University Teaching Hospital Complex, Prof. Victor Adetiloye, said: “What we’re witnessing today is a novelty in the history of this hospital. We have been having patients with fistula cases, but the dimension this one has taken is completely beyond our expectation in terms of the number of patients; personnel available to do the operation, the facilities and consumables. So it has been very fantastic. The number of patients we have right now is beyond expectation, we have people from virtually every part of South West.”

The CMD, who noted that the countenance of many of the patients changed after the repairs added, “Many of them have been depressed, you just imagine someone continuously dripping urine, nonstop. You can see the joy on their faces now that the repairs works have been done. Just imagine a full-grown woman not just using pampers, but being smelly. It’s a depressing situation.

“Fistula is a great burden that cannot be borne by the individual alone because this problem leads to depression, causes other infections and can affect the kidney. Which is why we are speaking to governments to come to the aid of the people. We need government to support this kind of interventions We’re grateful to EngenderHealth and USAID Fistula Care Plus for this effort because it costs a lot of money to do this kind of programme and the money is not there. Although we have about two trained surgeons already, we hope that more of our staff would be trained. We are in dire need of trained nurses, who will be dedicated to the management of fistula.

“There’s need to focus on prevention as well, so as to attack the case from the roots. The commonest cause is prolonged labour, which is why it’s important for women to always register in a hospital once pregnant,” he stated.

Deputy Director, Nursing Services Unit of the hospital, Olamijuwon Eunice, regretted that all sufferers of the ailment know that they have a problem, “but nobody wants to go for surgery. So that is where extensive nursing care comes in. We are left with preparing them, explaining to them to need to have the surgery. And if we have clients that have been operated successfully, we show this to them…”

In his remarks at the event, Minister of Health, Prof. Isaac Adewole, said the Federal Government, along with concerned stakeholders, would work towards eradicating obstetric fistula in the country within the next 10 years.

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