Dr Habib Sadauki is the Country Project Manager, Engender Health/USAID Fistula Care Plus Project in Nigeria. In this interview, he speaks on Vesico-Vaginal Fistula (VVF), the challenges faced by women of child bearing age in Nigeria, saying that every year about 12,000 new cases are reported in Nigeria.
What is the prevalence of Vesico-Vaginal Fistula (VVF) in Nigeria?
We do not have the exact figure but estimates have shown that they may be about 150,000/200,000. Some people say there are about half a million VVF cases in Nigeria. But these are all estimates. We do not know the true prevalence. Definitely, there are a large number of women with fistula in Nigeria especially in the North.
Where are the VVF centres located in Nigeria?
The Fistula Care Plus is a project funded by USAID. It is implemented by Engender Health. We work in 11 states in the country. Kebbi, Sokoto, Zamfara, Kastina, Kano, Jigawa, Bauchi, in the North. We also work in Oyo State, in two centres; Adeoyo Specialist Hospital and the University College Teaching Hospital, Ibadan.
We also work in the Specialist Hospital, Ilorin, Kwara State, Abakaliki in Ebonyi State and in Ogoja in Cross River State, that is 11 states. Three of these centres have been designated as National Hospital Fistula Centres; these are Kastina, Bauchi and Abakalika. They are funded by the Federal Ministry of Health to provide exclusive fistula services.
Do these patients come out to seek help or do you go to fish them out?
The fistula patients historically tend to migrate to where they can get repair or where they can live together to console each other. You know it is a very devastating condition and a lot of women are virtually rejected by their husbands or families so they come together in places they can get help.
But these days, we make announcement, do a lot of mobilisation in different states through the media and especially through the radio calling out for these clients to come out and get repaired.
We try to emphasise that having fistula is not the end of the road. It can be repaired and patients can get better and go back to their normal lives. From time to time in all these centres, we do mass repairs. Before we do that, we do announcements in the state and neighboring state so they can be repaired free of charge.
So patients come to these centres and are repaired, fed and accommodated free of charge. In most cases, we collaborate with the state where we work to make sure they provide free accommodation and feeding for them while we do everything that is required to do the repair.
These include bringing surgeons from other places to come and do the repair for them. We don't have enough surgeons in all the centres so from time to time, they move them from their centre to other centres to do these mass repairs.
As we do these repairs, we have a backlog. Research has shown that we get about 12,000 new cases of VVF every year. Sometimes, we are able to repair about 5,000 on the average per annum. So there is always a backlog. To address that backlog, we move from state to state to do a mop-up. We do as much as we can and then the state will continue from there. The centres take care of the ones that trickle in.
The surgeons are mainly Nigerians with one or two foreigners. It is difficult to say how many surgeons we have because there are some that are dedicated to fistula centres and there are others that combine other jobs in addition to fistula surgery. Like urologists and gynecologists.
How successful have these VVF surgeries been?
About 95%, but it can go below that depending on how complex the fistula case is. You can get a minor fistula case that when you cut open and stitch, it will close. But you can get a very bad one that is very large that you cannot even repair in one sitting. You have to do multiple surgeries, do one surgery now and after three months you repeat the surgery until it is closed. So it is not the same for everybody. But averagely you get 95% success rate.
What can be done to reduce the cases of VVF in Nigeria?
The major cause of VVF in this country is obstructed labour. So, technically, you can say if you stop a woman from getting obstructed labour, you will stop people from getting fistula. One or two cases can be due to other reasons, but the major cause of VVF is obstructed labour, so we have to address obstructed labour.
How do we do that? We have to make sure women receive ante-natal care, we have to make sure those women who are in labour are supervised by trained midwives and if they show sign of obstruction, it should be overcome immediately with a caesarean-section. If you do this, then you can now eliminate fistula.
Historically, fistula is not something new, from time in memorial, women have had fistula. In Europe and America, there were times there were very high incidents of fistula, but because they overcame obstructed labour, women were supervised by midwives, you no longer see cases of fistula. So, if we can address obstructed labour we can address fistula.
How can we address obstructed labour?
We need community engagement to understand what causes VVF, what causes fistula and how to prevent it. The community leaders must be able to rise to the occasion and say, why are women getting these problems, how do we address it. We have to get women to the hospital to deliver there and in the hospital everything should be made possible for us to identify people who are showing signs of obstruction and it should be overcome immediately through operative delivery.