Fistula project ends after surgery on 10,000 women

A seven-year US-funded programme, FistulaCare, has wound down after providing free surgeries to repair fistula in an estimated 10,000 women in Nigeria.While many have been reunited with their families, the US Agency for International Development, called for continued fight against fistula—a condition in which an abnormal hole develops between the rectum and vagina or the […]

A seven-year US-funded programme, FistulaCare, has wound down after providing free surgeries to repair fistula in an estimated 10,000 women in Nigeria.
While many have been reunited with their families, the US Agency for International Development, called for continued fight against fistula—a condition in which an abnormal hole develops between the rectum and vagina or the bladder and vagina.
“This is not enough. When you look at the numbers, we with our one project can’t do it alone,” said USAID mission director Dana Mansuri.
The prevalence of fistula among Nigerian women is uncertain—ranging from 148,000 to 800,000, according to latest statistics—with Nigeria having the largest burden among the 2 million women with the condition globally.
Since FistulaCare started, three regional centres have opened up to treat women with the condition in Ebonyi, Katsina and Bauchi—with two more planned in Oyo and Kwara—and up to $7 million (about N1.13 billion) this year in health spending has gone into fistula care.

Increasing knowledge “We now have several states that understand and appreciate the devastating effects that fistula is having on their
communities and they have also included fistula in their strategic plans with budgetary allocations for fistula service delivery,” said Mansuri.
Health minister, Onyebuchi Chukwu, said collaboration with USAID through its seven years of intervention helped Nigeria develop its five-year strategic framework to eliminate fistula in Nigeria, draw up standards of practice for doctors and nurses and set up a national working group for obstetric fistula, chaired by Josephine Elechi, first lady of Ebonyi state, where the first fistula centre is sited.
In comments delivered by the ministry’s family health director Wapada Balami, the health minister said since the latest National Demographic Health Survey showed a declining trend over the years in fistula prevalence, the government needed partnership from political
traditional and religious groups to “further reduce the determinants of maternal, newborn and child mortality in Nigeria.”
“We need to surpass current efforts to ensure that our great country remains on track toward actualising MDG5,” he added.

Stigma and stench

Up to 90% of fistulas of many kinds can be treated by surgeries. Treatments have been limited to hospitals until women’s groups started to make fistula management a social issue on account of the stigma involved.
Depending on the location of the hole—of fistula—in the vagina, urine or faeces may flow into the vagina and cause offensive odour.
Women with fistula are “usually stigmatised and isolated as a result of the offensive smell or urine that exude due to damaged urinary tract,” said women affairs and social development minister, Zainab Maina.
Consequently, they are “often prevented from socialising with other members of the family or society and as such many of them become beggars and even destitute.”
Nene Nwosu, one of the women treated at a FistulaCare-supported centre, suffered abandonment by family after she developed a fistula.
During induced labour in 2010 for the birth of her son, the doctor “cut me from my vagina to my anus,” she recalls.
Months of embarrassment before friends and colleagues followed.
“My mother was devastated, and my husband—probably because he didn’t really understand it, he didn’t really care,” she says, near
tears.

“I didn’t feel normal. I hated to see young girls around me, because I didn’t feel like a woman.”
Mrs Abraham carried the condition for 10 years after an initial repair surgery failed.  She was told the repaired hole would close, and was “too scared to go through another operation after having two children by caesarean section,” she recalls.
“It never closed. It was an unpalatable experience. I used nappies like a baby. I was not able to go to any function. I was patching life. It was difficult.” Her husband helped her wash up sometimes, she adds.
This year, Nigerian government pledged to provide repair for at least one-third of women with the condition, in addition to rehabilitating and reintroducing them to communities from which they may have been shunned on account of their condition.