Jaafar Jaafar
16 November 2008
Kano — The fight against the maternal health problem, Vesico-Vaginal Fistula (VVF), plaguing the womenfolk, is being carried out in many ways. Be it through governmental or non-governmental approach all are taking different ways, apart from providing surgical repairs.
Unless a nosy reporter is looking for trouble, getting official data on the effect of the VVF would be very difficult.
At many government owned centres where the patients are admitted, newsmen are not officially allowed to report or take photographs.
Notwithstanding the poor access to official information, Pyramid Trust gathered that patients are in dire straits despite government's efforts to provide free antenatal care for many years.
At most of the centres our reporter visited, patients cry out, saying enough medical and rehabilitative attention are not being given to them.
But only recently, Kano State Government disclosed that it will build N1billion VVF centre in the state, saying the decision was borne out of the administration's desire to control the ailment. With this, the government argued, VVF would be kept at bay.
People say that if government would honour its pledge and commit such a huge amount of money on VVF, the sufferings of the patients will reduce. But medical experts observe that keeping control of VVF goes beyond the confines of the hospital.
On her part, the Kano State Commissioner for Health, Hajia Aishatu Kiru, told Pyramid Trust that as part of government's effort to control VVF, it provides rehabilitation centres where the patients are kept for three months before their discharge. She added that government also schedules the patients' spouses and give them seminars on reproductive health related issues.
Findings, however, showed that despite the proliferation of admission centres and the fact that though VVF is not contagious, communicable or infectious, but the cases are increasing every year.
One measure experts think government should adopt to take the edge off the ailment is robust enlightenment campaigns and empowerment so as to douse the effects of excruciating poverty in the rural areas.
Poverty is also considered a causal agent.
Perhaps, worried by the effect of VVF and how it is gradually ravaging village women, non-governmental organisations open centres where patients are treated, educated and trained free of charge. On realizing that so many problems were suspected to fuel the embers of the ailment, inflate its annual statistics and make it appear an intractable phenomenon, the NGOs take diverse approaches apart from the normal way of medication and carrying out surgery.
Pyramid Trust learnt that local women at these centres are admitted regularly.
At many other centres where non-governmental organisations administer, they even give the patients general and spiritual education.
Complementing the efforts of the state government, some NGOs are somewhat emphatic on enlightenment and empowerment. As part of their campaigns to reach several audiences in rural areas, they adopt radio programmes through which they tell the women the measures they should take during ante and postnatal periods.
Typically, a programme, 'Tsarabar Mata' (A package for women), is aired weekly on Freedom Radio. The interactive programme, sponsored by an NGO, FORWARD Nigeria, explores different areas of reproductive health. The programme is as educative as it is popular.
However, during a modest graduation ceremony of VVF clients trained and treated by an NGO in Dambatta Local Government, Kano, the graduands dazzled the audience when they were ordered to recite a number of chapters of the Holy Qur'an and some extracts from Islamic jurisprudence.
Wearing light green hijab and various wrappers to match, with clear and impeccable diction classically adopted by urban mullahs, the graduating VVF patients chorused in unison.
According to the Director of the Foundation for Women Health, they hired the religious teachers for them, saying most of those who left the centres had imparted either reproductive health (RH) related knowledge on other villagers or taught them Islamic education. "With this, we believe the cases will reduce. People should borrow a leaf from us so as to salvage them from suffering," she said, challenging well-meaning people to help in this direction.
After the graduating patients regaled the audience with such spiritual highlights and later an educative drama, the stunned members of the high table were conducted round the wares produced by the patients during their stay at the centre.
Going by the different crafts they did learn, people surmised that many of them can now open cottage industries. Crafts ranging from tailoring, weaving, spaghetti making, pomade making, beads making, among others, were taught at the Dambatta centre.
On his part, Dr Amiru Imam, a consultant surgeon with Kano State Ministry of Health, said many issues compound the case of VVF.
He said apart from low literacy, poverty and poor access to medication, the dearth of medical personnel in the state is detrimental to maternal health as related to VVF.
According to him, there are two types of obstetric fistula which are Vesico-Vaginal Fistula (VVF) and Recto-Vaginal Fistula (RVF). He said VVF occurs when blood supply to the tissues of the vagina and the bladder are restricted during prolonged obstructed labour, the tissues die between these organs forming holes through which urine can pass uncontrollably.
On the other hand, he added, Recto-Vaginal Fistula (RVF), occurs in a similar way to VVF. He said holes form between the tissues of the vagina and the rectum and leads to uncontrollable leakage of faeces.
Dr Amiru who carries out surgical operations on VVF patients said prolonged obstructed labour is the major cause of the ailment.
He said other complications associated with this obstetric fistula are psychological and neurological conditions where the women come up limping.
He said notwithstanding all the joint efforts, the incidence are on the increase.
The surgeon recalled that in 1989, the campaign against VVF started vigourously, but still, the cases of VVF range from 500 to 600 in Kano annually.
Speaking further, he noted that, at least, 15 new cases are operated upon every week, but the number is still increasing.
"One should question why things are not moving. Why are we still stagnant?" In answering the question, he said so many factors are involved, stating that the government is doing its own through offering free antenatal medicare. According to him, this has reduced the sufferings of women in labour.
He lamented that the price of Caesarian Section (CS) is still rising in private hospitals where services are paid for.
According to the consultant, those who go to private hospitals don't, in the main, stand the risk of having fistula, especially the obstetric fistula.
Dr Imam further said that more deliveries are being conducted daily, revealing that at the Murtala Muhammed General Hospital, 1,000 deliveries are carried out every month. "This is just for those who have come to the hospital. The number of home deliveries cannot be ascertained and is more than the hospital deliveries," he noted.
The consultant said the issue of creating awareness on the maximum utilization of health facilities and need for improvement of social amenities such as roads and community ambulance.
"The ambulance can help in no small way because any time a woman gets into labour, she can be conveyed to the hospital," said the doctor.
He also advocated the inter-ministerial approach to the issue of Reproductive Health generally.
He argues that through this approach, Ministries of Education, Women Affairs, Health and Local Government could come together and fashion out a way they can work collectively. Dr Imam then added that the improvement of CS facilities, regular seminars and workshops for doctors, nurses and midwives who are working in any obstetric or maternity unit would help immensely.
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