Thursday August 22, 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.

0
//
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

Nigeria, Cameroon Vow to Tackle Terrorism

The Cameroon-Nigeria Transborder Security Committee has as prime objective strengthening border security for both countries. It was created in 2012 in Nigeria

0
terrorism
Cameroon and Nigeria agreed on Friday to take further measures to boost multifaceted cooperation in the fight against terrorism along their shared border. Wikimedia Commons

Nigeria has promised to assist Cameroon in combating the separatist crisis rocking the central African country’s English speaking region. The pledge, made during a security meeting, has been described by Cameroon authorities as reassuring, following accusations that separatist fighters in Cameroon were being trained in Nigeria, and that weapons they use are brought in through the neighboring country.

Brigadier General Emmanuel Adamu Ndagi, leader of the Nigerian delegation to the Cameroon-Nigeria transborder security meeting that ended in Yaounde Saturday, says his country has been seriously affected by the separatist crisis in the English-speaking regions of Cameroon.

The closure of parts of the border has led to a sharp decline in food imports, like sorghum, rice and onions, to Nigeria on one hand, while basic commodities exported from Nigeria, like fuel, are hard to get into Cameroon. Ndagi says because of the security, economic and humanitarian threats caused by the separatist war, Nigeria will support Cameroon in bringing peace to its troubled regions.

terrorism
Delegates respect the Cameroon and Nigerian anthem during the Yaounde security meeting in Camerron, July 6, 2019. ( Moki Kindzeka/VOA)

“The current political upheavals in that region will not be allowed to affect our cordial relations,” said Ndagi. “We will continue to support your efforts to bring lasting peace to the region. This will facilitate the return of Cameroonian refugees that have crossed the border into Nigerian territory. We must reduce vulnerabilities along our borders that are being exploited to perpetrate transnational organized crime notably terrorism, proliferation of small arms and light weapons as well as piracy.”

When Cameroon declared war on the armed separatists in November 2017, it said gunmen were attacking border localities in Cameroon’s southwest and escaping to Nigeria, where some of them were trained. Nigeria denied the assailants were crossing over from its territory into Cameroon.

In January 2018, 47 separatists, including Ayuk Tabe Julius, head of a group from Cameroon’s Angolphone regions pushing for a breakaway from the French-dominant country, were arrested in Abuja, Nigeria, extradited and jailed in Cameroon.

Paul Atanga Nji, territorial administration minister and Cameroon’s leader of the delegation to the security meeting, says in spite of the collaboration, the separatists continue to use porous borders to import weapons through Nigeria, making the security situation very uncertain.

terrorism
Weapons used by separatist fighters suspected to have been made in Nigeria and brought into Cameroon, June 6, 2019. ( Moki Kindzeka/VOA)

“The security situation along our common borders has all of a sudden become a cause for concern,” Nji said. “These threats take the following forms. Secessionist tendencies, illegal exploitation of natural resources, conflicts between boarder communities, highway robbery, drug and human trafficking, illicit trafficking of fire arms, agro pastoral conflicts etc.”

The UNHCR says that by December 2018 there were more than 32,000 Cameroonian refugees in Nigeria’s Cross River state. Nigeria’s longest international border is with Cameroon. All along the 1,975 kilometer border there are violent crises. Nigeria’s northeast states of Borno and Adamawa continue to have Boko Haram terrorist attacks.

As the Yaounde security meeting was going on, Kildadi Taguieke Boukar, governor of Cameroon’s Adamaoua region that shares a boundary with Nigeria’s Taraba state, announced renewed conflicts with Nigerians escaping farmer-herder clashes to Cameroon.

“There is a conflict along some tribes in Nigeria’s Taraba state. About 100 people from Nigeria flee [have escaped] to our territory around Kontcha division [administrative unit and], there is agro-pastoral [farmer-herder] conflicts,” Boukar said.

terrorism
Paul Atanga Nji, head of Cameroon delegation (left) and Brigadier General Emmanuel Adamu Ndagi, leader of the Nigerian delegation (right) in Yaounde, Cameroon, July 6, 2019. ( Moki Kindzeka/VOA)

Nigeria has not confirmed the renewed violence, but confrontations erupted last year in Cameroon’s Adamaoua region between farmers and Nigerian cattle ranchers who had escaped tribal wars in Taraba state.

ALSO READ: US Institute of Peace Trains Kenyan Women to Help Fight Terrorist Radicalization Campaigns

The Cameroon-Nigeria Transborder Security Committee has as prime objective strengthening border security for both countries. It was created in 2012 in Nigeria. Cameroon and Nigeria agreed on Friday to take further measures to boost multifaceted cooperation in the fight against terrorism along their shared border.

They did not disclose details of how their cooperation will be carried out, but they said they would share information regularly to stop terrorist activities including Boko Haram attacks and separatists fighting for the independence of an English-speaking sate in Cameroon. They said they would make it difficult for criminals to leave Nigeria for Cameroon and vice versa. (VOA)