DEMYSTIFYING VVF (OBSTETRIC FISTULA)
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.
• 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