THE HORRORS OF VESICO-VAGINAL FISTULA (VVF) IN SOKOTO

By: Jameelah Yusuf


 It is the sprawling Maryam Abacha Women and Children’s Hospital that most women in Sokoto State living with vesico-vaginal fistula or VVF visit for remedies. The government-owned facility is located at Diori Hammani Road, Sokoto, the state capital. The hospital consists of two buildings, one the administrative block, the other the wards. A walk into the hospital on a hot Friday afternoon opened my eyes to a whole different world. It is a hospital with specialists on various gynaecological fields. The most famous for which it is known is the vesico-vaginal fistula disease. Wikipedia defines vesico-vaginal fistula as an abnormal fistulous tract extending between the bladder and vagina, resulting in continuous voluntary release of urine into the vaginal vault. The sight of young and older women with a bowl in hand, and a tiny pipe channeling liquid from beneath their wrapper into the bowls is one you cannot be oblivious to. The hospital has on admission, an average of 40 women of different age range that are mostly from various rural settlements in the state capital and its environs. Most of these women are awaiting surgery or have just been operated on. Hauwa, a 20-year-old lady revealed that she had just had her fourth operation in four years. She got married at 13, and had a baby she lost at 16. She got VVF as a result of childbirth. Since then, she kept returning to the Maryam Abacha Hospital, as the operated place opens up after a while. Hauwa said her father brought her to the hospital as her husband works in faraway Ibadan and only returns home after a year. So, she is in the hospital all by herself. She would return to her father’s house once the catheter is removed. When asked if she plans to have a baby anytime soon, she said she hadn’t thought about that yet. Her major concern is to get her health back. Another patient, Kulluwa, 33, who had just been operated, after trying to deliver her seventh child at home. “It was difficult to get the child’s head out and when it finally came out, she was a lifeless baby,” said Kulluwa’s mother who was with her in the hospital. They noticed she was passing urine involuntarily and brought her to the hospital. A nurse at the hospital, Zainab Ahmad explained that they do not have a very accurate record of the age of the patients as most of them do not know their exact age. Mrs Zainab explained that contrary to popular belief, early marriage is not the only cause of the vescovaginal fistula disease as they have patients who are of age. She said, “Apart from early marriage, some people have this disease as a result of prolonged labour and some other ones have pelvis that are too small to carry the weight of their babies. Another identified cause among women is numerous childbirths. Some of these women have given birth to over 12 children.” “The rate at which patients are brought here has reduced significantly as there is more awareness at the grassroots level. “Once admitted admitted, patients have the catheter fixed on them. It is taken off after four weeks, and then they have the surgery if there is the need for it. Some patients have this surgery more than four times while some others have it just once and they get cured. “Ideally, once the patients get their surgery done, we discharge them as soon as they are fit and schedule a checkup appointment for them after every two months for six months. After six months, if they are no longer dripping urine, we place them on a family planning package that ensures they do not give birth, after a year, we take it off and they can have their babies successfully. We however advise them strongly to come to the hospital when they are almost due. If they try to give birth at home by themselves, they would get the VVF disease once again.” “Most of the patients on admission are either victims of early marriages or prolonged labour. They live in small villages that are far away from the hospital. The hospital is a place of last resort for them as most of them attempt to deliver at home and only resort to the hospital when complications occur. Most times, it is already too late as they have to cover a distance of an hour or more to get there.” One very impressive thing you would notice about the VVF patients of the Mariam Abacha hospital is the spirit of sisterhood they share. These patients are mostly from villages far apart, united by the same predicament. In the evenings, they are mostly found in the hospitals courtyard with the bowl that collects the urine from their catheter lying close to them while they weave hand fans from straws or do other things. The atmosphere isn’t as gloomy as one would imagine as these women seem to have accepted their fate and are doing a good job at staying happy and living in the moment. One would think that with the amount of aid Nigeria receives from numerous international organisations especially for health, funding would not be a problem. I met a number of patients who haven’t been operated and have only had one dosage of their required drugs in over four weeks of their admission. When asked why they haven’t been given more drugs, I was made to understand that there are no more drugs. The hospital is impressively maintained but the welfare of the patients could make use of more attention. The bureaucracy in the administration of most sectors in Nigeria, including the health sector, is the major reason why funds given as aids do not get to the intended recipients as it was given by the organisation. Hospitals like the Maryam Abacha clinic have special needs that should be attended to as a matter of priority by the state Government.