Tuesday February 19, 2019

Fistula Epidemic In Nigeria, Cultural Practices To Blame

Some women are born with fistula, which is rare. Other causes include injuries sustained during pelvic surgery and hysterectomies, inflammation and infections in the genital area, and sexual violence.

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Dr. Lengmang is considered one of the most skilled fistula repair surgeons in the world
Due to the stigma, most women say their husbands divorced them as they cannot go back home to face humiliation in their communities. Pixabay

Every morning, Asma’u Muhammadu removes the wet sheets from her bed and sets them out to dry. She opens the door to let in the fresh breezes that will air out the smell of urine in the mud-walled room. Along with the sheets, she brings out wet rags she uses to line her inner garments.

“I am dealing with yoyon fitsari. I don’t know when the urine pours out from my body until I see it leaking down the sides of my legs,” says the 27-year-old woman.

Yoyon fitsari is the term used in the Hausa language to describe vesicovaginal fistula (VVF), a medical condition in which a hole between the birth canal and bladder leaves women unable to control their urine. Women with a hole between the birth canal and the rectum, rectovaginal fistula (RVF) experience uncontrollable leakage of stool. Some women have both VVF and RVF.

Some women are born with fistula, which is rare. Other causes include injuries sustained during pelvic surgery and hysterectomies, inflammation and infections in the genital area, and sexual violence.

a medical condition in which a hole between the birth canal and bladder leaves women unable to control their urine
Yoyon fitsari is the term used in the Hausa language to describe vesicovaginal fistula (VVF). Pixabay

Mary Isu (black hijab) has had 5 fistula repair surgeries. Mary Amani (yellow hijab) has had 4. But they are still leaking.
But the leading cause of fistula is prolonged and obstructed labor. In Nigeria, between 400,000 and 800,00 women are currently living with fistula.

The World Health Organization describes fistula as “the single most dramatic aftermath of prolonged or neglected childbirth,” and estimates more than two million women live with fistula worldwide.

Young marriage only partly to blame

Nigeria has the world’s highest occurrence of obstetric fistula and the Nigerian government says early marriage is largely to blame. Often, the bodies of young wives are not physically prepared for childbirth.

Muhammadu was married at 12 years old and had her first pregnancy at 15. She labored at home for two days before going to the hospital, but it was too late.

“On the fourth day, I gave birth and my baby wasn’t alive,” Muhammadu said. Her mother also has VVF fistula. They take care of each other.

But health workers say other cultural factors contributing to the high occurrence of fistula need to be addressed and focusing on early marriage oversimplifies the problem.

The World Health Organization describes fistula as “the single most dramatic aftermath of prolonged or neglected childbirth
Nigeria has the world’s highest occurrence of obstetric fistula and the Nigerian government says early marriage is largely to blame. Pixabay

“I think we should de-emphasize the issue of early marriage as far as a direct cause of VVF is concerned,” says Dr. Bello Lawal, a fistula surgeon and the chief medical director at the Maryam Abacha Women and Children Hospital, the only one in the northwestern state of Sokoto that performs fistula repair surgeries.

“There are some traditional practices whereby a surgical procedure is carried out on a woman who is supposed to have a condition known as goriya, which is supposed to be a growth in the private part, that is supposed to be removed by the traditional barber, and in the process, they usually cause damage to the bladder or they cause damage to the rectum, and that can lead to recto-vaginal fistula or vesicovaginal fistula,” Lawal explains.

Iliyasu Ningi, a wanzami (traditional barber) holds up the instruments that he uses to perform yankan gishiri. It’s a cultural practice similiar to female genital mutilation where a cut is made on the vaginal wall.
Iliyasu Ningi, a wanzami (traditional barber) holds up the instruments that he uses to perform yankan gishiri. It’s a cultural practice similiar to female genital mutilation where a cut is made on the vaginal wall.
Traditionally in Hausa culture, barbers are called to remove goiters, remove enlarged tonsils, perform male circumcision and execute yankan gishiri, similar to female genital mutilation.

Goriya is said to be a tumor-like blockage of vaginal tissue, but Dr. Lawal said, “There is no tumor. Most of these cases, which we call goriya, are usually psychological cases.” Goriya is a form of the pseudoscience that has led to millions of women developing VVF.

The practice is also performed in cases of infertility.

Lack of skilled doctors

Many women have had several failed fistula repair surgeries. Due to the stigma, most of them say their husbands divorced them. Dozens of former fistula patients live at the back of the Maryam Abacha Women and Children Hospital. They say they cannot go back home to face humiliation in their communities.

Only about a dozen doctors in Nigeria are skilled enough to perform the intricate fistula repair surgery, like Dr. Sunday Lengmang, a surgeon at the ECWA Evangel VVF Center in Jos.

this means the doctors working in this area must be highly motivated.
Fistula affects the poorest of the poor in the poorest countries of the world. Pixabay

Lengmang is considered one of the most skilled fistula repair surgeons in the world and the Evangel VVF Center is the only hospital in Nigeria that performs urinary diversion surgeries to handle complex fistula cases.

“Fistula affects the poorest of the poor in the poorest countries of the world,” he said, adding that this means the doctors working in this area must be highly motivated.

“But apart from that, we also have the issue of the difficulty in finding doctors who have the skills,” he said.

Data of Nigeria Fistula

With about 12,000 new cases reported around the country each year, the 14 Nigerian hospitals that perform repair surgeries are only able to handle about 5,000 operations, leaving an enormous backlog. USAID’s Fistula Care Plus says about 200,000 women in Nigeria are waiting for fistula surgeries.

Read More: Beware of Secretly Unhealthy Food Items

Hospitals mostly rely on funding from outside of Nigeria. Donations fund the Evangel VVF Center, where surgeries are free of charge for patients. At other facilities, patients bear some of the cost of the surgery, which is about $300.

In her remote village, Muhammadu says her husband has stayed with her, despite her condition, and she is content. He has told her not to go the hospital for treatment since the fistula has not affected her ability to have babies. She has two daughters.

She wants the fistula to go away, but says it is “destined by God to happen that way.” (VOA)

Next Story

Nigerian Elections : Debates All About Economy, Insecurity and Corruption

Buhari’s supporters call him “the incorruptible man.” But critics accuse Nigerian military officials of corruption and say Buhari's administration has looked the other way.

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Nigeria
Demonstrators appeal for peaceful elections in Nigeria during an event in Abuja, Feb. 6, 2019. Presidential and legislative elections are set for Saturday, Feb. 16. (G. Alheri/VOA)

Nigerians go to the polls Saturday to choose a president and legislature for Africa’s most populous country, returning two weeks later to pick state governors and local representatives.

Voters in the West African nation must decide whether to grant a second term to President Muhammadu Buhari.

The 76-year-old former military leader won office in 2015 on promises to improve Nigeria’s oil-dependent economy, fight rampant corruption and quell insecurity — especially in the northeast plagued by Islamist extremists.

Buhari’s main challenger — in a field of at least 60 contenders — is Atiku Abubakar, a 72-year-old businessman and former vice president campaigning on a similar platform.

But another issue looms over the vote: election-related violence. Last Sunday alone, five people were fatally shot near the southeastern city of Warri in what local police attributed to political divides, the AFP news agency reported. The shootings had followed clashes between young supporters of Buhari’s ruling All Progressives Congress (APC) and the main opposition People’s Democratic Party fronted by Abubakar.

“Violence is the major problem of every election,” said Patricia Onoja, a 60-year-old retired nurse in Abuja, the capital. She told VOA she counsels young people to resist any thuggery – a mission undertaken by other Nigerian parent groups, too.

Human Rights Watch says that more than 800 people died in 2011 election-related violence. But voting in 2015 brought the comparatively peaceful handover of power from Goodluck Jonathan to Buhari.

Now, the country will be tested on whether it “can successfully conduct two consecutive, credible elections,” says Oge Onubogu, a Nigerian-born Africa program officer with the United States Institute of Peace who closely follows the elections.

Nigeria’s Independent National Electoral Commission (INEC) says it’s prepared for Saturday’s vote, despite troubles such as a suspected arson fire at its annex in the Middle Belt city of Jos.

Clement Nwankwo, a lawyer and convener of the Nigeria Civil Society Situation Room, said that umbrella group has built “a good relationship” with the INEC. Nwankwo said the Situation Room has trained monitors and will relay any concerns – from missing elections materials to allegations of abuse – so INEC can address problems quickly. “We’re able to intervene,” he said.

Here’s a closer look at the campaign issues:

Security

Buhari, in a late-December interview with VOA at the presidential villa in Abuja, said Nigerian security troops had reduced the amount of territory controlled by the Islamist extremist group Boko Haram in the country’s northeast.

Nigeria's President Muhammadu Buhari, at right, greets supporters during a campaign rally in Rivers State on Feb. 12, 2019. He seeks a second term in the election Saturday.
Nigeria’s President Muhammadu Buhari, at right, greets supporters during a campaign rally in Rivers State on Feb. 12, 2019. He seeks a second term in the election Saturday. VOA

 

“Now you can check in the northeast that Boko Haram is not holding any local government, per se,” he said.

FILE – A still image taken from video shows a group of girls, released by Boko Haram jihadists after kidnapping them in 2014 in the north Nigerian town of Chibok, sitting in a hall as they are welcomed by officials in Abuja, Nigeria, May 7, 2017.
FILE – A still image taken from video shows a group of girls, released by Boko Haram jihadists after kidnapping them in 2014 in the north Nigerian town of Chibok, sitting in a hall as they are welcomed by officials in Abuja, Nigeria, May 7, 2017.
But a decade after their emergence, the Boko Haram militants have kidnapped hundreds of people – most notably girls from a school in Chibok, many of whom still are missing. They’ve also killed tens of thousands and displaced millions. And now an offshoot group, the Islamic State West Africa Province, has added to the destabilization.

Another threat comes from increased conflicts between herdsmen and farmers over land use in the so-called Middle Belt. The International Crisis Group reports more than 1,300 related deaths since January 2018.

Abubakar blames the Buhari administration for what he calls Nigeria’s “worst insecurity. … It was confined to the northeast” when Buhari took office but now has spread.

John Campbell, a former U.S. ambassador to Nigeria and a senior fellow with the Council on Foreign Relations, edits the CRF Nigeria Security Tracker. It maps reported violence around the country.

He said he sees “no new ideas from either candidate about how to deal with Boko Haram, no real discussion about the much more broad-based security issues which now cover the entire country.”

Economy

Though oil-rich Nigeria has one of Africa’s leading economies, it’s still recovering from the 2014 plunge in crude prices. Poverty is rife in the country of nearly 200 million, with an estimated 87 million (44 percent) who are desperately poor, according to the World Poverty Clock.

Men stand near displayed merchandise for sale around the informal sector at the Wuse market in Abuja, Nigeria, Jan. 30, 2018.
Men stand near displayed merchandise for sale around the informal sector at the Wuse market in Abuja, Nigeria, Jan. 30, 2018.
In interviewing Nigerians late last spring, the Gallup World Poll found the highest level of food insecurity in 13 years. Three out of five respondents — 71 percent — said they lacked enough money for food at times during the previous 12 months.

“In terms of having money for food and shelter, things are as bad as they’ve ever been for Nigerians,” said Jay Loschky, the poll’s regional director for English-speaking Africa.

Buhari has said that, if granted a second term, he would focus on boosting job creation and completing infrastructure projects.

Abubakar — who worked in customs and the oil sector,and founded the private American University of Nigeria — says he has the business acumen to help guide the economy and encourage job creation.

In an interview with VOA last month in Washington, Abubakar derided the Buhari administration for Nigeria’s jobless rate, which officially rose to 23 percent in 2018’s third quarter, up from 19 percent the previous year. That translates to more than 20 million unemployed. “Twenty million is no joke,” he said. “It is a time bomb.”

Job creation is critical, especially given Nigeria’s huge and underemployed youth population.

John Sunday, 23-year-old student and first-time voter, poses for a picture in the Makoko shanty town built on stilts in a lagoon in Lagos, Feb. 4 , 2019.
John Sunday, 23-year-old student and first-time voter, poses for a picture in the Makoko shanty town built on stilts in a lagoon in Lagos, Feb. 4 , 2019.
Obadiah Tohomdet, a 63-year-old communications consultant in Abuja, said his son graduated from university five years ago and still has not found work except for odd jobs.

“The private sector is not expanding. … I think that’s the greatest problem we have in Nigeria,” Tohomdet told VOA. “And the youth, of course, are frustrated.” And vulnerable, he added. “They can be subject to manipulation and they could be used for antisocial activity. … It’s not that they are not ready to work. The atmosphere is very tough.”

Corruption

Buhari’s supporters call him “the incorruptible man.” But critics accuse Nigerian military officials of corruption and say Buhari’s administration has looked the other way.

Last month, the president also drew condemnation — domestically and from abroad — when he suspended Nigeria’s chief justice from the position where he would have a key say in resolving any election disputes.

FILE – People protest at the secretariat of the Nigerian Bar Association following the suspension of Nigeria’s Chief Justice Walter Onnoghen, in Abuja Nigeria, Jan. 28, 2019.
FILE – People protest at the secretariat of the Nigerian Bar Association following the suspension of Nigeria’s Chief Justice Walter Onnoghen, in Abuja Nigeria, Jan. 28, 2019.
The trial for Walter Onnoghen — who allegedly made false claims about his assets — is pending.

Abubakar has encountered clouds of suspicion over time. As the BBC pointed out in a candidate profile last week, he was accused in 2006 of diverting public money toward “his business interests” while serving as vice president. A 2010 report from the U.S. Senate Permanent Subcommittee on Investigations also alleged that Abubakar was involved in bringing “suspect funds into the United States” through the bank account of his American wife.

He was linked to another case: the bribery conviction of a U.S. congressman, William Jefferson, a Democrat from Louisiana. Identified by the U.S. government as a corrupt foreign official, Abubakar was barred entry to the country.

Supporters of the People's Democratic Party (PDP) attend a campaign rally in Lagos, Feb. 12, 2019.

Supporters of the People’s Democratic Party (PDP) attend a campaign rally in Lagos, Feb. 12, 2019.

But he never faced any charges.

“Nobody has brought any evidence of corruption against me,” Abubakar said during his interview at VOA’s Washington headquarters.

His two-day January visit to the United States — his first in more than 12 years — dispelled the Nigerian rumor that he would be arrested upon arrival. Instead, the candidate met with some members of Congress, the State Department and the U.S. Chamber of Commerce.

Abubakar was able to obtain a U.S. visa through the intervention of American lobbyists, Bloomberg news reported last week.

He also has said he would consider an amnesty program to encourage looters of public funds to voluntarily return the money.

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Improved confidence in voting

Nigerians view the approaching elections with modest but improved confidence in the process, according to a Gallup poll released Based on polling conducted in mid-2018, it found that roughly a third of respondents — 34 percent, up from 13 percent in 2014 — have faith in “the honesty of elections.”

By comparison, 49 percent of respondents in sub-Saharan African countries polled last year expressed confidence in their respective elections, said Gallup’s Loschky. He also said 37 percent of Americans voiced confidence in U.S. elections. (VOA)