10 years of fistula didn”t stop me from having my 2 kids, says survivor

Oju Abiodun has lived 10 years with a fistula that caused urine to leak uncontrollably from her vagina—and she’s given birth to two children with it. The 28-year-old hairdresser’s journey into living with fistula began during her first childbirth. In a prolonged labour, her baby died, and the pressure of labour ruptured a hole in […]

Oju Abiodun has lived 10 years with a fistula that caused urine to leak uncontrollably from her vagina—and she’s given birth to two children with it.

The 28-year-old hairdresser’s journey into living with fistula began during her first childbirth.

In a prolonged labour, her baby died, and the pressure of labour ruptured a hole in her vagina. She leaked urine without control.

“It was always there with me,” she recalls.

“The shame, the smell and the embarrassment, which made me withdraw from people at some point.”

A pregnancy and working in a saloon made her condition difficult to cope with.

“With my pregnancy and working in the saloon, it was becoming too challenging because I had to stand all through not to get wet. Once I notice am wet, I excuse myself and clean up,” she says.

Fistula is the result of prolonged and obstructed labour. In cases where the foetus’ head is trapped in the pelvis, friction causes death of surrounding vaginal tissues.

They eventually break down and give way, causing an abnormal hole to the rectum or bladder, or both. The result faeces or urine leaking into the vagina—in some cases, both.

Some gynaecologists cause fistula too, in this case damage to the vaginal wall, in attempts to perform Caesarean sections. This type of fistula is iathrogenic.

The abnormal and uncontrolled leakage of urine and faeces comes with the stink of defecation or urine. Many women are forced to live in isolation and subject to stigma.

They lose dignity, self worth and social roles as women and wives. Many are accused of witchcraft, forced out of homes and marriage.

Abiodun is among a rare number of women who face different prospects living with fistula. Her mother, husband and community didn’t abandon her, she recalls.

“My husband has been supportive and kind in taking me to the hospital all these years and it has not affected our sexual interaction with him.”

And the couple has two children—born in spite of a fistula—to prove it.

“He has not used the occasion to misbehave or mistreat me,” Abiodun goes on.

“I am very grateful to my mother also who have been assisting me with the kids most of the time. I wouldn’t have managed this ailment for over 10 years if not for them.”

Not all women with fistula are fortunate as Abiodun. It is unclear the exact number of women who live with the condition. Estimates are that there may be up to 2 million globally.

Nigeria alone has some 200,000 women living with the condition, and 12,000 women come down with the condition every year—many in conditions worse than Abiodun’s.

Like Lucas, 27, and still living with the trauma of fistula. She was already attending antenatal clinic at a hospital, but when she went into labour, she went to a church to give birth.

“I could not get the proper care I needed. I was later forced to go to the hospital in an ambulance when the condition got worse,” she recalls.

She lost her baby, she got fistula and is now part of clients pooled to be repaired by surgeons convened by the Fistula Care Plus in Ilesha.

“All of my friends abandoned me and my husband too. He neglected me and did not bother to take care of me,” says Lucas.

Her husband threatened her not to return home after her repair.

Social workers have been counseling the couple—and her husband has changed his mind.

“We were able to convince him to accept her back,” says Lilian Ibah, assistant director at the Medical Social Workers of Nigeria.

“Society at large must desist from treating these women with so much contempt and rejection,” she adds.

She says total acceptance, support and medical attention will help to improve sense of self-worth and maintain the dignity of women living with fistula.

Fistulas can be completely repaired, but stigma is a barrier keeping women from accessing care. Groups working in fistula are stepping up sensitisation and advocacy, says Ibah

“Like in the case of Abiodun, they were tired and had no money to continue visiting hospitals without positive results because they lack the correct information about the fistula prevention and cure that is going on.

“Her mother walked up to me because she is familiar with my social worker uniform and explained everything. I related her case to the doctor and her daughter has been fixed free of charge. She has been dancing since her daughter came out of theatre –a woman who has not taken her bath for 5 days,” Lilian narrated.

Fistula is like any other gynecological complaints—say, fibroid, infertility—that confront many women. The only difference is many with fistula needing surgery are “very poor”, says Dr Ernest Orji, head of obstetrics and gynecology department at Obafemi Awolowo University Teaching Hospital, Ile Ife.

“Many of them don’t have money to feed talk more of coming to the hospital. The few [who] used to come before the pooled repair run away when they are billed for surgery because they can’t afford it.”

Since late last year, surgeons have repaired some 57 women pooled for surgery at the Wesley Guild Hospital, one of six centers that make up the OAUTH complexes.

Around 4,000 women undergo repair each year, nearly half of them in pooled or adhoc repairs at teaching hospitals and pet projects run by state first ladies.

The drive is toward a generation free of fistula but sustaining repairs is hampered by a lack of good infrastructure, theatre materials, lighting, consumables, manpower and drugs.

“Like now that we are doing this pool repair, there are lots of surgeons ready to join the fight against fistula if the resources are made available,” says Orji.

“The only way we can say that we are truly working on fistula is if we prevent the occurrence and reduce the incidence to barely nothing,” says Iyeme Efem, project manager for Engender Health’s Fistula Care Plus.

The project is the second phase of a five-year US-funded programme for fistula prevention, care and treatment.

The project ends this September, bringing into question how to sustain the momentum for repairs and rehabilitation.

“Sustainability can only work where the systems are put in place to ensure continuance,” Efem.

Fistula is curable and preventable. Women are capable of leading normal lives after repair.

“One of the ways that we have ensured that this is sustainable is by ensuring that we don’t set up a fistula centre on our own. It has to be part of a government system. That means that the environment should be enabled for us to come in and support,” says Efem.

“We are asking states to create a fistula desk office and fund it with a budget line. Some states have actually done this.”

Kwara set up a fistula desk and N16 million budget line. Cross River voted N72 million.

Moves as those make big difference in the lives of women as Abiodun. Post-repair, she has found new lease on life.

“I am going to live every day like it is my last,” says Abiodun.