Sunday December 15, 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.

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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

Nipah Virus has Serious Epidemic Potential: Health Experts

Health Experts Warn of Emerging Threat of Nipah Virus

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Virus
A deadly virus called Nipah carried by bats has already caused human outbreaks across South and South East Asia. (Representational Image). Lifetime Stock

A deadly virus called Nipah carried by bats has already caused human outbreaks across South and South East Asia and has “serious epidemic potential,” global health and infectious disease specialists said on Monday.

The virus, identified in 1999 in Malaysia and Singapore, has sparked outbreaks with mortality rates of between 40% and 90% and spread thousands of kilometers to Bangladesh and India – yet there are no drugs or vaccines against it, they said.

“Twenty years have passed since its discovery, but the world is still not adequately equipped to tackle the global health threat posed by Nipah virus,” said Richard Hatchett, chief executive of the CEPI Coalition for Epidemic Preparedness Innovations, which is co-leading a Nipah conference this week in Singapore.

CEPI, a partnership between disease experts, and public, private, philanthropic, and civil organizations, was set up in 2017 to try to speed up the development of vaccines against newly emerging and unknown infectious diseases.

Health epidemic
Doctors and relatives wearing protective gear carry the body of a victim, who lost his battle against the brain-damaging Nipah virus, during his funeral at a burial ground in Kozhikode, in the southern Indian state of Kerala. VOA

Among its first disease targets is Nipah, a virus carried primarily by certain types of fruit bats and pigs, which can also be transmitted directly from person to person as well as through contaminated food.

Within two years of being first discovered, Nipah had spread to Bangladesh, where it has caused several outbreaks since 2001.   A 2018 Nipah outbreak in Kerala, India, killed 17 people.

“Outbreaks of Nipah virus have so far been confined to South and Southeast Asia, but the virus has serious epidemic potential, because Pteropus fruit bats that carry the virus are found throughout the tropics and sub-tropics, which are home to more than two billion people,” Hatchett said.

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He said since Nipah can also pass from person to person, it could, in theory, also spread into densely populated areas too.   The two-day Nipah conference, the first to focus on this deadly virus, is being co-hosted by CEPI and the Duke-NUS Medical School in Singapore and starts on Monday.

“There are currently no specific drugs or vaccines for Nipah virus infection, even though the World Health Organization has identified (it) as a priority disease,” said Wang Linfa, a Duke NUS professor and co-chair the conference. He hoped the meeting would stimulate experts to find ways of finding Nipah. (VOA)