There are a number of terrible maternal disorders and horrific childbirth injuries that plague women, including vesico-vaginal fistula and recto-vaginal fistula. They can put victims in a downward spiral of mental illness, alienation, and poverty. Rev. Sis. Maria ObotAmah, Matron, Family Life Centre/VVF hospital, Mbribit Itam, Uyo, Akwa Ibom State, spoke with us about the unique factors that contribute to VVF/RVF in Akwa Ibom, as well as the central government’s efforts to combat the problem. Excerpts!
How common is VVF in Akwa Ibom, exactly?
Urinary incontinence is a primary symptom of vaginal vesicoureteral fistula (VVF), which is an irregular hole between the bladder and the vagina. In addition, we have rectovaginal fistula (RVF), an improper connection between the rectum or anus and the vagina through which feces or urine might leak.
I had hoped to see a decline in VVF rates, but instead it appears to be on the rise. Sadly, the same number of patients as the previous camp—31—registered this time around, with 25 being new cases. Still, I have faith that we can do more to raise awareness and encourage women to avoid behaviors that put them at risk for VVF if we work together.
What are some examples of behaviors that put you at risk for VVF?
Early childbirth, longer labor, limited uptake of normal antenatal care, and lack of access to emergency obstetric services are all risk factors for this illness. Because of the potential for complications during childbirth, we always recommend that expectant mothers give birth in hospitals with the assistance of trained medical staff.
Many women still go to questionable Traditional Birth Attendants, prayer houses, or healing homes for their pregnancies and births, only to be rushed to the hospital when complications arise and the doctors can do little to nothing to help.
Some women do not even bother with prenatal visits. Some young women have come in here nine months into their pregnancies, at which point we inquire as to the location of their antenatal treatment. You will be astounded to find out that they are innocent.
A young woman was wheeled into our ward with VVF and RVF; she had no control over her bowel and bladder movements. We took her in, and we learned that she had been in labor for over 48 hours and had gone to a church to give birth. She was badly hurt as the incompetent staff there attempted to maneuver around her.
She found it challenging to even sit on the bed. She was malnourished, in constant agony, peeing and defecating, and unable to walk. We took care of her and kept her here since we ultimately needed to do a C-section to remove the stillborn infant. We got to work on her, and eventually brought in a physiotherapist to help.
We had her for about six months and helped her learn to stand and walk with a cane. Getting to go to the theater was a huge relief for her. However, the VVF was fixed first, and we anticipate her return to the following camp to fix the RVF. When she departed, we were relieved to see that she had made it to the office on her own two feet. We shot pictures of her ascending the stairs alone, and then she went home.
We anticipate that by the time she returns for the subsequent camp, she will be healthy enough to resume her previous, more typical existence as a young girl.
VVF: a problem only for young women?
Although the young women who go through labor for the first time are more likely to develop an obstetric fistula, this condition does not discriminate based on age. However, we did have a case of a very mature woman who presented because, after going childless for a while, she became pregnant and proceeded to deliver elsewhere, where she tragically miscarried and afterwards acquired VVF.
We determined that she was experiencing prolonged obstructed labor (POL), which occurs most frequently when the weight of the baby’s head causes a disruption in the blood supply to the tissues connecting the vagina to the bladder or rectum, prolonging her labor. As a result, surgical correction was performed.
Can those who recover from VVF or RVF lead typical lives again?
After a successful operation, individuals can get back to their regular lives, but in certain situations, the patient may have to learn to live with the damage for the rest of her life.
A girl of 17 years old whose situation was particularly dire served as an example. She went in for an examination, and they determined that the injuries were extensive; hence, they performed the necessary repair, but she continued to bleed afterward.
After about six months, she conducted another repair and was still leaking; the injuries she sustained shrank and severely damaged the bladder, and it is possible that she may have to continue to live with this condition for the rest of her life. So there are situations where they will try, but the damage is just too severe.
I was wondering if you have any words of wisdom for teenagers or young mothers.
I will tell the youth to make the most of their lives. Avoid risky behaviors that could result in pregnancy at a young age. Maturity is a concept that exists. So, ladies, please go to school, pay attention in class, graduate, get married, settle down in the marital home, and try to conceive while having access to quality antenatal care. If you’re pregnant and in need of medical attention, the staff at a reputable hospital will be there for you. They will be able to anticipate any potential threat and act quickly enough to save both mother and child.
How often do repairs at this facility turn out to be successful?
We’ve had 506 repairs during the past five years, but we expect that number to go down after the November camp.
Is there any evidence that VVF patients face discrimination?
Yes, they are being held responsible for the issue and called derogatory terms. The vast majority of them are poor, rural women who are stigmatized by society. Some of our patients have experienced severe depression; as a result, we house them here in preparation for surgery, where they can talk to others who are going through the same thing and form close bonds through shared experiences.
After receiving medical care, we put an emphasis on rehabilitation and providing patients with the resources they need to resume productive lives. We own our own barbershop, clothing factory, farm, etc. Those who have been trained can benefit from us by receiving kits, sewing machines, and a year’s worth of rent for a residence or shop, as appropriate.
We’ve held outreach programs to educate women on how to take care of their health, and we’ve visited schools to educate young girls on how to help themselves and end VVF, how to maintain their health to avoid becoming pregnant at a young age, and the importance of evaluating good antenatal care if and when they do get married and become pregnant.
How do they pay for this center?
NGOs and other non-governmental organizations provide the bulk of the funding. We appreciate the help from everyone in and out of Nigeria and the State. Misean Cara of Ireland just gave us a theater for our labor and delivery unit. Patients are admitted to the facility during camps, but few of them bring anything that might be useful to them. When they do arrive, they will undoubtedly make demands of us, and we will comply. All of the food we offer them is donated by kind people like you. People and church groups alike react to our requests for assistance in the months leading up to camp.
God has been incredibly reliable. However, we require additional aid and support to subsidize the bills of those who are unable to pay them. Obtaining sufficient funding to maintain operations at the desired level has been difficult. We’d like to accomplish more, but it could be an issue if we don’t have enough money.