Nollywood actress Stephanie Okereke one of the top leading ladies in the movie industry in Nigeria has joined the likes of Hollywood celebrities Angelina Jolie and Madonna in giving back to the society. She has embarked on the fight to eradicate Vesico vaginal fistula (VVF) in Nigeria. Jonathan Isaiah writes on her efforts to eradicate this scourge among women.

Vesico vaginal fistula (VVF) or recto vaginal fistula (RVF) are holes resulting from the breakdown in the tissue between the vaginal wall and the bladder or rectum caused by unrelieved obstructed labour. The consequences of such damage are urinary or faecal incontinence and related conditions such as dermatitis and erosion of the skin and other tissues in the vulva and vagina from the constant leaking of urine or faeces. In extreme cases the urethra, bladder and vaginal wall can be completely eroded. If nerves to the lower limbs are damaged, women can develop foot-drop, a loss of co-ordination with one or both of the lower limbs.

In addition to these physical problems, VVF and RVF cause acute social problems. Due to constant leaking of urine or faeces and the accompanying smell, most communities consider these women outcasts and cut them off from all social activities. Commuting in public transport and engaging in social activities such as weddings and naming ceremonies becomes difficult. If the fistulae are not repaired, their husbands may divorce the women. Some leave their families to roam in the cities where they are not known as the outlook for them remains bleak in the community.

Awareness

On the drive behind her path of activism, she looked askance for a few seconds and responded, "Point of correction, it is no disease, it is a condition. VVF is not a disease like most people think, it is a condition. You are asking what spurred me: we all live in Nigeria and are witnesses to certain happenings. When we see these things, we say, 'oh, why is this thing happening, why can't something be done? Why is the health system badly schemed, such that people can not get proper medical care?' I have experienced the horrors of an auto-accident and I know what it means for you not to have proper medical care, especially when you need it (though all that is in the past now)."

She continued, "When I heard about VVF was when I was in the university. A friend of mine told me about it. Around that period, I met a couple of people who also were working on awareness on VVF at the time I was intrigued and saddened at the same time, that young people and others who don't have access to medical care, can actually develop fistula. At a point I got miffed that nobody was (and still is) talking about it. I went beyond that stage to appreciating how fortunate I was to get education, as well as have the freedom and opportunity to choose between left and right. I endlessly try to imagine what turn my life would have taken if I had been born in some village without access to education and healthcare".

Did she have any foreknowledge of the area of prevalence of VVF before now? She says, "I understand that, contrary to my thinking, VVF is not peculiar to the north alone, but also in the south. That is why when the USAID team went to Abakiliki, where they have their regional centre, we actually found out that a lot of women in the south go through this. That is why I am saying it is a condition and not a disease. If one is rich, poor, pregnant or in labour and you don't have access to healthcare on time, you can develop fistula. One's social status notwithstanding, one could get infected. It is just that it is more rampant among the poor, because they don't have access to good health care and education, a privilege most of us enjoy. That is why you find a lot of helpless, under-privileged and poor suffereing from this condition."

Role as USAID ambassador and spokesperson for Nigeria

What role does she play as far as the USAID is concerned and how far-reaching does she hope to extend her influence? She replies, after a brief pause," I am only with them in Nigeria, and their representative in Nigeria is Efem, I am actually partnering with them. What we are doing is fact- finding. In 2006 I was invited by the organisation when they brought the fistula center in Sierra Leone and in Liberia. Following that, the UN mission invited me for their anti-rape campaign. While there, I visited the fistula centre there, with the need to find out what is actually happening, know the causes and things that can be done to salvage, cure or control the situation. We also did the same when we visited Abakiliki and now we are going to the northern states, visiting some facilities that they sponsor, to train their doctors and sponsor the hospitals. That is what they do. It is something I have been doing on my own for a long time but partnering with them is exciting, because I feel it can be eradicated. Sometime back, it used to be a worldwide problem, but right now, no one talks about fistula unless one is delivered of a baby at home or does not go to the hospital. "In any case," she continued, "the statistics available in Abakaliki shows that most women go to the hospital for ante-natal and all of that but deliver at home or patronise traditional mid-wives when it is time for them to give birth. For one, I can say that partnering with them has actually opened my eyes to their activities and it has helped expand my knowledge on the causes of VVF. These facts stare us in the face in Nigeria, indicating that our health care system has actually fallen. If the health needs of women and children are not looked into, the death rate in the country will keep escalating and then what will happen to us?," she asked.

"I feel it is high time we started taking care of our pregnant women as well as the children they are delivering into the world."

Government support

How much support has the government shown for the cause? "Well," she began, "they are partnering with the USAID Fistula Care. I was impressed with the level of support offered by the first lady of Ebonyi State, when I went to Abakiliki. You can see that someone is using her platform to create positive change in her community. Within 9 months I had the Fistula Centre which is going on, turned into the regional centre, which means everybody in the south and south-east can actually go there for free medical attention, as far as the health condition is concerned. She did that under 9 months. The acquired Fistula Care Project saw this and moved in to equip and train the doctors, as well as supplied them with needed medical appliances and equipment. That is basically what they do and the reason they need the government. Imagine a situation in which every first lady in every state erects a Fistula Centre for treatment and education, such that if the women begin to stream in for ante-natal care, delivery (because they will be educated on the dangers of doing it at home). If there are provisions for all these and if the government lends their support, the situation will be greatly helped," she emphasised.

"They are supporting the first lady in Ebonyi State because she has succeeded in influencing its passage into law, that the death of every woman must be recorded and anyone who fails to do so (whether husband or family) will be held responsible. It is also official that every woman must have access to medical care; it is enacted and implemented. That is actually impressive. Recently," she reveals, "it was discovered that in a village, there existed a 'quack doctor', one pastor, who has been delivering women of babies, though he is neither a medical doctor, nor does he have a license to practise. Despite this, people have been going to him to be delivered of their babies. They were able to shut the man down and other people who are doing same. They also told the traditional birth attendants that, 'if these women come to you, refer them to the hospital where they can get proper medical care'."

Vision for the north as the worst hit region

She says, "In Zamfara, the pool effort programme the first lady is organising is becoming a huge help. We are getting a number of medical doctors to help diagnose women in Zamfara. Treatment will be run within 4 days. The doctors will be available to treat anybody suffering from fistula. We will create awareness by going on air to announce that anyone suffering from fistula should come: sometimes, these women don't come because they are ashamed of themselves. In Ebonyi, I found a woman who has been suffering from fistula before the war. She has, practically, been leaking urine all her life. In the village, she was feeling that the gods had cursed her. Another woman has had it since 1976. Women have been leaking urine, padding themselves, thinking there is no cure. The woman said she has been going to various hospitals. We told her, she can actually get cured of the ailment and her bitter experience since 1976. It was almost unbelievable, but this goes to show that the situation is sad and could happen to anybody. Young girls who get pregnant, but are afraid of telling their parents, instead go somewhere to have the baby can end up getting fistula or if one delivers through a caesarian section (executed by one who is not a professional) and is wrongly sewn up, that could be the window for fistula infection. There are so many causes. This means that our health care delivery system needs to be on point: there has to be a lot of education for young girls and women, who are the potential victims, to get proper medical care. The government needs to provide proper medical care and make them accessible to these young women. This organisation can only do the best they can. The government can do the rest by passing laws and implementing them and everybody will follow. A laudable example can be cited in the partnership of the USAID with the governments of Kano and Sokoto states."

Challenge of marrying activism and acting

When asked if her acting career will not be outshone by her new status as an activist for the cause of VVF sufferers, she smiled warmly and answered," I am not sidelining my calling, everything goes together. I am working on a campaign on my own part, which is to educate people and work on ways to eradicate fistula infection. This is what the partnership is basically about," she says.

Pausing to think for a moment, she says, "It does not in anyway affect my career, rather, I am grateful to God for giving me the opportunity to meet people and talk about the infection. The advantage here is that people will listen to me, because in life, if you've been through an experience, you need to show love and care to people in a similar situation: that is why we are in this world to help each other. When it comes to health care anything can happen to anybody that is why we need proper health care."

End-point achievement

What goal does she set on achieving when all is said and done? A little ponder and the answer flows: "At the end of the day, I will be glad if fistula infection is reduced to its barest minimum. It will not do to keep treating; we are working on preventive measures to stop this from happening, because we can treat 600 people everyday! It keeps occurring at every turn. We are working on preventive measures and that is why we set about educating the women and telling them the proper things to do. If you are getting married to a young girl, you should allow her to get to the proper child-bearing age, when she is mature enough to have children. When you have a child carrying a child, it makes no sense. It all boils down to poverty. Sometimes, parents give out children early in marriage because of the bride-price they badly need. Culture is not helping matters and terrible practices like circumcision also lead to fistula."