Vesico-Vaginal Fistula, VVF, and Recto-Vaginal Fistula, RVF, are among the devastating maternal diseases and tragic childbirth injuries affecting women. They can lead to depression, social isolation and deepening poverty of the victims. In an interview with Rev Sis Maria ObotAmah, the Matron, Family Life Centre/VVF hospital, Mbribit Itam, Uyo, Akwa Ibom State, she explained the peculiar causes of VVF/RVF in Akwa Ibom and reeled out some measures put in place by the centre to curb it. Excerpts!
What is the prevalent rate of VVF in Akwa Ibom?
First of all, VVF is an abnormal opening between the bladder and the vagina that results in continuous and unremitting urinary incontinence. We also have RVF which is an abnormal connection between the rectum or anus and the vagina where bowel contents can leak through the fistula, allowing urine or stool to pass through the vagina.
In my heart, I was thinking that VVF will decrease but from what we are seeing here, it is rather increasing. Like in the last camp, 31 patients registered, and out of that, 25 were new cases and it is a sad thing to know. I still believe that together, we can do more in creating awareness telling women not to predispose themselves to activities that can lead to VVF.
What are those activities that can lead to VVF?
There are so many factors that can cause this disease such as early childbearing, prolonged labour, low uptake of conventional antenatal care, as well as lack of access to emergency obstetric services. That is why we always advise pregnant women to access antenatal care and ensure that they deliver their babies in the hospitals where professional doctors and nurses would attend to them in case of emergency.
Unfortunately, many of them are still patronising quack Traditional Birth Attendants, prayer houses or healing homes for deliveries and would be brought to the hospital when their case becomes critical, by then, there is little or nothing doctors can do.
Some do not even attend antenatal care at all. We’ve had some young persons come in here when their pregnancy is nine months gone, you ask where did you attend your antenatal care? You will be shocked to realise that they didn’t do it.
For instance, there was a young lady that was brought into our ward on a wheelchair and she had both VVF and RVF; she couldn’t control urine and faeces. We admitted her and from history she went to a church to deliver her baby and was in labour for more than 48 hours. The unskilled personnel there tried to wangle their way around her body and she sustained severe injuries.
Even for her, sitting on the bed was difficult. She was in pain, she couldn’t walk, she was urinating and defecating and was malnourished. We kept her here and cared for her because at the end we had to do a Caesarean Section to bring out the dead baby. We started to work on her, we invited a physiotherapist to care for her.
She stayed here for about six months, we taught her how to stand and then to walk with a walking aid. Finally, it was a thing of joy for her to enter the theatre. But they were able to repair the VVF first, so we are hoping that she will be back to repair the RVF in the next camp. We were happy that when she left here, she was able to walk by herself and came to this office. She climbed the staircase all by herself and we took photographs before she went home.
So it is our hope that when she comes for the next camp, she will be totally well so as to go back to live a normal life as a young girl.
Can older women suffer from VVF?
Yes, Obstetric fistula is not age specific, though it mainly affects the underaged ones who experience the rigours of labour. But we have had a case of a very mature lady who came because after some few years of not having babies, became pregnant and then went to deliver somewhere, she lost the baby in the process and even developed VVF.
We discovered that she had a prolonged obstructed labour (POL); this is usually when the pressure of the baby’s head restricts blood flow and damages tissues between the vagina and the bladder or rectum. So a corrective surgery has been carried out.
Can the survivors of VVF or RVF live their normal lives again?
Of course they can live their normal lives after a successful repair surgery, but, there are cases where the patient has to live with it for the rest of her life depending on the severity of the injury.
For example, we had a 17 year-old-girl whose case was pathetic. Normally, we examine the patient first to see the extent of the damage, so, she went and they looked at it and the injuries were much, so they did the repair, but she didn’t stop leaking.
After about six months, she did another repair, and was still leaking, because of the injuries she had, the bladder became very small and was severely damaged and it may happen that she has to live like that till the rest of her life because of the extent of the injury. So there are cases like that when they will try and at the end of the day the injury is so difficult to repair.
What is your advice to teenagers or those involved in childhood pregnancy?
I will advise young people to live their lives well. Don’t get into things that will get you pregnant when you’re still very young. There is what we call maturity. So please, go to school, focus on your studies, get your qualifications and then get married properly, get into your husband’s house and get pregnant properly and try and access good antenatal care. If you go to a good hospital when you’re pregnant, they will take care of you and they will be there for you. They will be able to foresee if there will be any danger and will intervene in time so that baby and mother will be saved.
What are the statistics of successful repairs carried out in this facility?
In the last five years, we’ve had a total of 506 repairs and we believe that the number would change at the end of the next camp coming up in November.
Are there incidents of stigmatisation of VVF patients?
Yes, they are being blamed as the cause of their problem, labelled all sorts of names. Most of them are rural women, wretched, and looked down upon in their communities. We’ve had cases where some fell into deep depression, that is why we camp them here before the surgery so that they will see others and know that they are not the only ones suffering from the problem, you see them bond like sisters here because they will have the opportunity to share their experiences with one another.
After treating them, we make sure we rehabilitate them and empower them with skills and funds so that they can live a meaningful life thereafter. We have our hairdressing salon, tailoring department, agriculture, etc. We can empower them with kits, sewing machines, pay for one year house or shop rent as the case may be to those we have trained to enable them stand on their feet easily.
We have organised outreach programmes educating women on how to take care of their health and we have also been to schools teaching young girls on ways they can help themselves and put an end to VVF, how to keep themselves so that they don’t get pregnant very young and the need to assess good antenatal care when they eventually get married and become pregnant.
How is this facility funded?
It is mostly funded by individuals and groups like NGOs. We are very grateful to everyone within and outside the State and Nigeria who has been supporting us. Not long ago, a labour ward theatre was donated to us by Misean Cara from Ireland. During camps, patients come in but most of them don’t even come with things that will help them. So when they come, they will be demanding from us and we give them. Those food items we give them come from people out there. Before camp, we go round to solicit for help and people respond, church groups too.
God has been so faithful to us. But we need more help and support so that people coming here who are not able to settle their bills, we can subsidise it. The finance to continue work as we want it has been a major challenge. We will love to do a lot more but if we don’t have the resources, that is where the problem will come.