Category: Editor's picksPublished on Tuesday, 10 February 2015 05:00Written by Judd-Leonard Okafor & Eyo Charles

In one year, Hajjo Audu went from a newlywed bride to an abandoned woman dripping urine from her vagina.
The 17-year-old’s bladder ruptured as she tried for hours to give birth to her first baby.
Asked how she ended up at a clinic for obstetric fistula in Ningi, Bauchi, she simply says, “Piss.”
And it was a lot. Doctors would later tell her what happened. Her labour was prolonged, her pelvis was narrow. Through hours of labour, her baby’s head compressed soft tissues against her pelvis and cut off blood flow to her bladder. The result was a hole (or fistula) in her bladder.
Constantly leaking urine caused her to smell terribly. Her husband divorced her, and her father bundled her off to the clinic in Ningi.

Audu is among the lucky few. With a bit more pressure, she could easily have developed a hole in both her bladder and rectum, allowing faeces to leak also into her vagina.
In a dedicated ward at the clinic, some 50 women lay stretched out on hospital beds.
Over three weeks, each is stretchered into a theatre, where healthworkers trained in fistula repair will try to close up the hole.
More than 150,000 women could have the condition, according to national surveys, and up to 12,000 new cases come up every year. Many are unreported and never seek treatment.
A surgical injury could also cause the same hole, but in very rare cases, according to doctors.
Fistulas come with the adjective “obstetric” because they are found in women alone and related to child birth. They either leak faeces from the rectum into the vagina (for recto-vaginal fistula) or leak urine into the vagina (called vesico-vaginal fistula). In some cases both occur at once.
“See these patients and you will be demoralized,” says Dr Adamu Mohammed, medical director of the clinic.
“They have lost their husbands, relatives and everybody, because if one patient comes into this place, it will be all smelly. Almost everybody will be running away from them. And they are helpless.”
He is among healthworkers who pool their training a couple of times every year to repair women like Hajjo under a programme run by the group Engender Health Plus, funded by the US Agency for International Development.

The Ningi clinic (formally known as the National Obstetric Fistula Centre) is among 12 so supported, where women can be treated.
Inside the theatre, Dr Sa’ad Idris works on another 17-year-old girl. He carefully points out the fistula that now runs faeces into his patient’s vagina.
“She was married at 16 and now she’s 17; she’s been living with this problem for one year,” he translates his patient’s words as she lays open on the surgery table. Anaesthesia is local; she can’t move but she speaks.
“She’s married, but not living in her husband’s house. She’s living in her parents’ house,” Dr Idris goes on. “This is the common scenario.”
Six out of 10 women with fistula end up divorced by their husbands, says Dr Adamu Isah, deputy manager for Engender Health in Nigeria. In three out of four cases, a woman loses her baby. But she also loses her dignity, work, battles stigma, discrimination and depression. She might also contemplate suicide.
“Some have stayed for over 40 years with this condition, and some have undergone operation more than 10 times without success,” says Ahmed Nasaru, chief nursing officer at the clinic.
“So you must pity these patients because they are downtrodden. Most of them have exhausted everything they have to secure their health.”
And many like Hajjo travel from far to get to Ningi, prompting newer centres to open up. The latest at Jahun in Jigawa still awaits final agreement between Fistula Care Plus and Jigawa state government to provide surgeries there.
“You cannot imagine somebody staying in villages where there is no road to come to hospital. Some don’t even attend antenatal clinic. They stay in labour for three, five days,” says a health worker at the clinic.
“You see them taking a lot of concoctions, rubbing so many things on their abdomen because they want to deliver naturally. There are so many misconceptions about this thing.”
The misconceptions—even an attribution to witchcraft, in some cases—bring on more cases, which stays unknown until a woman is helped to seek treatment.
“The challenges we are having is that as we are repairing, newer cases are coming up. We need a holistic approach,” says Dr Idris.
“Apart from the technical challenges—lighting, support for patients, instruments, government commitment to train, retrain and provide drugs for these people.”
Evidence suggest all that will require political will. Visitors to the VVF centre at Ogoja General Hospital in Cross River State speak of little work and drugs running out, decay hitting the ward built with USAID support and little training of more surgeons to repair fistula.
Repair surgery for fistula is not exactly lucrative: many of the women are rural dwellers, young and poor, so there’s no large naira sign to attract new trainees into a field that’s consider largely charity.
Yet a workplan published by the federal health ministry more than four years ago proposes that, on the strength of studies, it is possible to eliminate obstetric fistula by 2015.
Protocols for treatment and care have been set up and documents launched to push the policy since two years ago.
But what’s more crucial, according to former health minister Onyebuchi Chukwu, is to push up quality of care, without which, he said, even ignoring newer cases, it could take 100 years to deal with fistula.
Audu’s surgery lasted hours that morning last December. In three days, she was up and smiling, talking freely to fellow patients. But no relation has visited her in hospital.

(Culled from Daily Trust Nigeria 10th Feb. 2015 news )

How sad. I read from from the first word to the last with plenty of interest. I have a cousin who suffered from this. She later died after several complicated surgeries. At one point her faeces had to be channeled through a hole on her stomach. It was a frightening and pitiful sight..

grandlexuz:
How sad. I read from from the first word to the last with plenty of interest. I have a cousin who suffered from this. She later died after several complicated surgeries. At one point her faeces had to be channeled through a hole on her stomach. It was a frightening and pitiful sight..

So sorry for your loss. Was she underaged? and what tribe is she?