Fortnight Prepares More Nigerian Doctors to Fight Fistula

BIRNIN KEBBI Nigeria—Dr. Mustafa Lawal checks on his patient, 20-year-old Rahamu Manu, in the recovery ward of the Birnin Kebbi Vesico-Vaginal Fistula Centre in northern Nigeria.

Two years ago, Rahamu gave birth to a stillborn baby girl after three days in labour. When asked why she did not go to the hospital, she replies simply, “I was not permitted by my husband.” A week later, she started leaking urine.

“It’s because of their traditions,” explains Assistant Chief Nursing Officer Aishat Bawa. “They want the baby to be delivered at home.”

Rahamu’s fistula was repaired during the “Fistula Fortnight,” a two-week effort in which hundreds of women in northern Nigeria are being surgically treated at four sites to repair their childbirth injuries. Fistula occurs when a woman, like Rahamu, endures obstructed labour without medical intervention. Often the baby dies and the woman is left with chronic incontinence.

The Fortnight is also a training opportunity for Nigerian and international doctors to learn the surgical procedure from Nigerian medical experts. In this way, more and more doctors in Nigeria will be able to repair women affected by the condition.

The two-week pilot program is the result of a unique partnership between UNFPA (the United Nations Population Fund), Federal and State Governments of Nigeria, Virgin Unite, the Nigerian Red Cross, Voluntary Service Overseas, health professionals and Nigerian non-governmental organizations.

“We have a low level of manpower. Even the medical staff often thinks these patients have no hope and isolate them,” said Dr. Lawal, a fourth year resident in Obstetrics-Gynaecology in Kebbi. “Many doctors also don’t have the skills. This is an opportunity to acquire and perfect new training. They taught us how to go step-by-step from the assessment through the operation. We’re so happy to have the surgical team with us.”

As many as 800,000 women in Nigeria are living with fistula, with an estimated 20,000 new cases each year.

About 15 per cent of all pregnancies result in complications that require emergency intervention, typically a Caesarean section. In Nigeria, a woman has a one in 18 lifetime risk of dying from complications of childbirth – a stark contrast to Europe, where the figure is one in 2,400.

Dr. Lawal believes that many women do not seek treatment where it is available because the cost is prohibitive. The average cost of fistula treatment and rehabilitation is $300, well beyond the reach of most poor women living with fistula.

“The reason why I came to be a part of this exercise is the nature of the patients – these women are of low economic status, and they need serious help. Because of poverty, they can’t afford care at clinics and hospitals,” he said. “It’s a very good development for UNFPA to help train us as fistula surgeons.”

Dr. France Donnay, Chief of UNFPA’s Reproductive Health Branch, said the Fortnight highlights the need for women in Nigeria and around the world to have access to good basic maternal health care.

“The reproductive health of young women and adolescent girls is the foundation upon which UNFPA’s mandate is built,” Dr. Donnay said. “Through the attention being generated by the ‘Fistula Fortnight,’ these women are drawing attention to their plight. They are the strong ones. They are the fighters. They deserve no less.”

Rahamu heard about the Fortnight on the radio and her brother accompanied her to the hospital. She says she is very happy that the surgery was a success and that she appreciates the doctor’s efforts. “I want to have another baby,” she adds, a brilliant smile lighting up her face.

Seeing his patients’ happiness after a successful surgical repair makes all the hard work worthwhile to Dr. Lawal.

“If you see them when they arrive – they feel like outcasts. There is no hope,” he said. “After, when they have their fistula repairs, naturally they are very, very happy.”

—Angela Walker