DE­MYS­TI­FY­ING VVF (OB­STET­RIC FIS­TULA)

THISDAY Style - - CONTENT - By Faith Fookes

it was a cold geneva win­ter morn­ing as i walked briskly to my gy­nae­col­o­gist’s of­fice. to­day i would get his di­ag­no­sis af­ter sev­eral weeks of tests and ex­am­i­na­tions and agree a treat­ment regime. my plan and prayer? god please just bless us with a set of twins.

i was 38, mar­ried for 2 years, and had been try­ing for a baby un­suc­cess­fully af­ter a late mis­car­riage the pre­vi­ous year. the ap­point­ment was short. “mrs. fookes”, my doc­tor said,“i am sorry we are wast­ing our time and your money. you can­not have chil­dren due to un­ex­plained in­fer­til­ity.”i re­mem­ber his ex­pres­sion like it was yes­ter­day. that of the sage who had all the con­trol. He had spo­ken and was gath­er­ing his pa­pers, a cue for me to gather my­self in turn to­gether with the shards of my shat­tered hope and leave.

i stared at him with a smile on my face, hold­ing his gaze and said:“Doc­tor, you may be a great gy­nae­col­o­gist but you are not god. i do not ac­cept your di­ag­no­sis. i will seek other opin­ions”. He looked at me, in­cred­u­lous. i stood up, shook his hand, turned and walked away, my head held high. to­day, at 50, i am the proud and happy mother of naomi“mimi”Oghenete­jiri, which in Urhobo means‘god is wor­thy of praise’and isn’t He just!

i got preg­nant nat­u­rally af­ter 2 failed iVf cy­cles. i made a point of send­ing the doc­tor a pic­ture of me at 5 months preg­nant-my round tummy in full view. Did i hear you say“gbam”? i had naomi at 41. she was born pre­ma­ture at 32 weeks as i suf­fered pre-eclamp­sia. We are both here to­day be­cause i had ac­cess to the best pos­si­ble care in geneva.

We came out on the right side of our chal­lenge. naomi is thriv­ing and it’s such a priv­i­lege to be her mummy. the joy that she brings me is what i wish all who are still on this jour­ney. i want you to know that i feel you, that i see you and that i pray for you.

i have shared my story be­cause i be­lieve we have to break the si­lence of our health chal­lenges as women and come to­gether as a peo­ple and as a na­tion to find ways to solve them. in shar­ing, we can learn from one an­other, de­feat shame and stigma, stand as one and lend a sis­terly hand of com­fort.

i also share my story as back­ground be­cause my ex­pe­ri­ence in­spired me to con­vert that chal­lenge into an op­por­tu­nity, sup­port­ing women with ob­stet­ric fis­tula and ba­bies who are born too soon. i like to say fis­tula chose me but that is a story for an­other day as is my work on neona­tal health. i did not suf­fer a fis­tula but have stud­ied the con­di­tion in depth, spent enough time with pa­tients and ob­served a fair amount of sur­gi­cal re­pairs to speak of it with some au­thor­ity. An ob­stet­ric fis­tula oc­curs due to ob­structed labour when the tis­sues that nor­mally sep­a­rate a woman’s vagina from her blad­der or rec­tum are de­stroyed by pro­longed pres­sure from the foetal head trapped in the birth canal. this re­sults in the devel­op­ment of a hole (fis­tula) due to the lack of blood flow to these ar­eas leav­ing a woman in­con­ti­nent, con­tin­u­ously leak­ing urine or fae­ces, or both. it is the most se­ri­ous and dev­as­tat­ing of child­birth in­juries. A fis­tula pa­tient al­most in­vari­ably has a still­born child, smells, is of­ten re­jected by her hus­band, some­times by her fam­ily and sits in her bod­ily wastes, day in day out. i jointly ran 2 si­mul­ta­ne­ous fis­tula re­pair surgery camps

for 92 pa­tients in septem­ber. One in part­ner­ship with the Univer­sity Col­lege Hos­pi­tal, ibadan, led by Pro­fes­sor Ola­dosu Ojengbede and Dr. Doyin Bello; the other in Bida part­ner­ing with Dr. Amina Abubakar Bello, Ob.gyn, Chair­per­son of Raise foun­da­tion & wife of the gov­er­nor of niger state, led by Dr.s’Kabiru Abubakar and sadiya nasir. i thank all my friends who con­trib­uted to pay­ing for the surg­eries and to giv­ing these women hope.

Quick facts:

• 15% of our pa­tients were teenagers. The youngest 14. some pa­tients had lived with fis­tula for 10 to 25 years.

• Nige­ria fis­tula guessti­mate-400,000-800,000. Heads global fis­tula league ta­ble of es­ti­mated 2 mil­lion women.

• Cor­rect generic ap­pel­la­tion-Ob­stet­ric Fis­tula. VVF (Vesico Vagi­nal fis­tula) is one type- hole lead­ing to blad­der with uri­nal in­con­ti­nence. RVf (Recto Vagi­nal fis­tula), an­other, -hole lead­ing to rec­tum caus­ing fe­cal in­con­ti­nence.

• To pre­vent a fis­tula, the sun must not set twice on a woman in labour. Over 75% of women with fis­tula have en­dured labour last­ing more than 3 days.

• Fis­tula more preva­lent in the north but oc­curs coun­try­wide wher­ever women give birth with­out ac­cess to med­i­cal help. some pa­tients in ibadan gave birth at na­tive doc­tors.

• Glob­ally, 25% of fis­tula pa­tients are child brides. In North Western Nige­ria, 76% (UNICEF).

• Fis­tula is 100% pre­ventable and mostly treat­able. for ev­ery woman who re­ceives treat­ment, at least 50 go with­out.

• 3 Na­tional Fis­tula Cen­tres in Bauchi, Ebonyi and Katsina states.

• Global av­er­age cost of Fis­tula surgery and care - UsD$400.

to erad­i­cate fis­tula our gov­ern­ment must com­mit to:

• A fo­cussed, im­ple­mentable and co­or­di­nated na­tional fis­tula erad­i­ca­tion plan with mea­sur­able re­sults.

• A fis­tula cen­sus. What we can mea­sure we can man­age.

• A fis­tula aware­ness-rais­ing pro­gramme to ed­u­cate our pop­u­lace and to en­cour­age women with fis­tula to seek help. • Train­ing fis­tula sur­geons to tackle the high bur­den. • Run a na­tional fis­tula pre­ven­tion pro­gramme to en­sure the con­di­tion does not oc­cur in the first place.

• En­sur­ing all states im­ple­ment 18 years as min­i­mum age for mar­riage and en­force it.

• Pro­vid­ing ac­cess to free emer­gency ob­stet­ric care and cae­sare­ans to women prone to ob­structed labour.

• Pro­vid­ing more sup­port for the 3 Na­tional Fis­tula Cen­ters and de­vel­op­ing ca­pac­ity in each state.

• A re­ha­bil­i­ta­tion and so­cial rein­te­gra­tion pro­gramme for these women.

i live in con­stant hope that the plight of these voice­less women will be made a na­tional pri­or­ity. i will ad­vo­cate for this cease­lessly. some have told me i am wast­ing my time. i dis­agree.

As my edi­tor said in dis­cussing this col­umn,“faith, if in swim­ming against the tide you can hold two peo­ple and bring them to shore…you must.” i agree. stand up. step up. speak up. Act. More next month. FF. Faith is a lawyer & busi­ness devel­op­ment strate­gist fo­cused on build­ing high­per­form­ing part­ner­ships across sec­tors. she founded Bridge­wise, a ngo fol­low­ing her own ex­pe­ri­ence with preg­nancy re­lated prob­lems. she ad­vo­cates and im­ple­ments pro­grammes for Fis­tula erad­i­ca­tion, neona­tal health and women’s rights. www.bridge­wise.org.

Dr. Doyin Bello train­ing meD­i­cal stu­Dents & Faith Dur­ing Fis­tula surgery, uch iBaDan

Faith with a Fis­tula pa­tient

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