VVF: Reflection of chronic health imbalance, human rights abuse

Zainab Ahmed is a twelve-year-old girl from the Northern part of Nigeria. “I wanted to become a doctor,” she says. “I don’t know if that can happen now that I am married and I am also ill,” she added. Zainab was a brilliant pupil as a child and always had the desire to become a doctor but was given away in marriage when she was eleven.

Now she is twelve years old and she walks around with her urine bag; she has been confirmed to have Vesico Vaginal Fistula (VVF). VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.

VVF is not peculiar to young girls forced into early marriage alone. Late last year, Queen Akindeleni, of Anu Oluwa Complex, Jolu Road, Sango-Ota, Ogun was in the news and she narrated her ordeal with the police, of how an iron rod was forcefully inserted into her vagina to make her confess because according to them, she was responsible for the death of her husband.

Due to the severity of the injuries incurred, Queen was confirmed to have Vesico-Vaginal Fistula (VVF) as she had continuous involuntary discharge of urine, because of the abnormal openings in the internal parts of her genital caused by the metal the police officer inserted into her vagina.

Between two and three million women and girls in developing countries are living with obstetric fistula, a condition that has been virtually eliminated in industrialised nations.

“It is often caused by childbirth (in which case it is known as an obstetric fistula), when a prolonged labor presses the unborn child tightly against the pelvis, cutting off blood flow to the vesico vaginal wall. The affected tissue may necrotise (die), leaving a hole. Vaginal fistulas can also result from violent rape or forceful sex which is common with young girls when they are made to marry while very young,” Femi Olaleye, managing director/CEO, Optimal Healthcare company, reveals.

United Nations Population Fund (UNFPA) revealed that more than 50,000 new cases of fistula develop each year.

For Babatunde Osotimehin, executive director, UNFPA, “The victims of obstetric fistula are women and girls, usually poor, often illiterate, who have limited access to health services, including maternal and reproductive health care.”

“More than 200,000 women in Nigeria are currently suffering from Vesico-Vaginal Fistula (VVF) condition,” Iyeme Efem, programme manager, USAID Fistula Care Project in Nigeria, has said, adding that “the disturbing magnitude of VVF prevalence in the country had forced the Federal Government to order care of 66,000 patients in 2013.”

Osotimehin has also noted that it is the poorest, most vulnerable women and girls that are mostly affected adding that the prevalence of VVF is a proof of human rights abuse. “It reflects chronic health inequities and healthcare system constraints, as well as wider challenges, such as gender and socio-economic inequality, child marriage and early child bearing, all of which can undermine the lives of women and girls and interfere with their enjoyment of their basic human rights,” Osotimehin said.

There have been challenges with financing the eradication of the ailment and as such, USAID was only able to carry out repair surgeries on not more than 8,000 patients in its centres across the country in 2012.

“Federal Government’s budgetary provision for the care of VVF patients in 2011 and 2012 were N300 million and N250 million, respectively; but the money was not released and no one could account for it,” Efem revealed.

There is a National Strategic Framework for the Elimination of Obstetric Fistula in Nigeria, which time frame is between 2011 to 2015 but the question is how feasible is this? Responding to this, Femi says “A lot needs to be done. It is okay to set targets but execution is always a challenge and the major one being finance.

“For instance, the cost to surgically take care of VVF is about N50,000 (depending on where it is done) but guess what? It doesn’t end there. You need about the same amount for post-surgery rehabilitation; for someone who cannot afford three square meals, how can they get such money? I also believe a lot of enlightenment needs to be done in the grassroots so they know that for instance, marrying off a child at a very young age has detrimental effects,” he warned.

However, other states in Nigeria have also embraced the eradication of the ailment. Take for instance, in Ebonyi State, the National Obstetric Fistula Centre in Abakaliki, had since its inception in 2008 treated and discharged over 1,600 indigent clients across 20 states of the federation.

According to Josephine Elechi, the first lady of Ebonyi State, “The National Obstetric Fistula Centre in a bid to deliver more services to a greater number of sufferers of this scourge and in line with the Presidential mandate that one-third of the VVF patients should be repaired in 2013, the centre has commenced the provision of free surgical repairs to the states of the Southern and Middle Belt zones; beginning with the treatment of 21 patients from Delta State only recently,” she said.

Experts have said that VVF can also be caused by female genital mutilation and this is done by cutting the inner part of the vagina so as to increase the size of the vaginal orifice to relieve prolonged labour. The result of such an act can lead to injuries which can cause urinary imbalance and sometimes inability to pass faeces easily.

VVF operation in a clinic.