LAGRANGE, Ohio — Fistulas in Nigeria are a significant issue. In his 2013 book “Tears for My Sisters: The Tragedy of Obstetric Fistula,” physician and medical anthropologist Dr. L. Lewis Wall narrates the story of Henhenit, an Egyptian noble notable as the woman with the first recorded case of fistula.
One of many wives to Pharoah Montuhotep II, who unified Egypt under his rule, Henhenit received love for her beautiful looks and noble station as a priestess to Hathor, the Egyptian goddess of fertility. Montuhotep claimed to be a son of this goddess to unite Egypt for political purposes. Soon, she fell pregnant with a son. However, her labor process became obstructed and her child could not pass through her birth canal. While the child did pass through four days later, it had already died. Henhenit herself suffered a hole between her bladder and vagina so urine leaked out of her vagina instead of her urethra. In other words, she had a vesicovaginal fistula. This is still a significant problem today.
Facts on Fistulas
An obstetric fistula is an abnormal opening between the vagina and the bladder or the rectum. Caused by unusually long and/or obstructed labor, the condition may lead to continuous urinary or fecal incontinence. Obstetrician-gynecologist Dr. Oluwasomidoyin Bello and her colleagues found that more than 1 million Nigerian women experienced obstetric fistulas, with a prevalence rate of 3.2 per 1,000 births. The prevalence rate refers to the proportion of persons who have a condition at a particular time period. In their literature review, the researchers found that approximately 13,000 new cases occur annually. Obstetric fistula is treatable. However, scholars found that lack of access to quality emergency care explained the continuation of the public health problem.
This reflects a 2016 qualitative study that the University of California San Francisco project, director Beth S. Philipps and her colleagues Dr. Dorothy Ononokpono and Dr. Nsikanabasi Udofia performed. The study found that both professional health care providers and patients identified limited access to medical facilities as a major factor leading to obstetric fistula. However, the reasons for holding this belief differed among both groups.
Health consequences of obstructed labor include the creation of a fistula and the destruction of much of a pregnant woman’s vagina. This latter consequence essentially includes infertility. However, for obstetric fistulas, the consequences also include physical, psychological and social issues, according to physician Dr. Mbanefo Ojukwu in an interview for The Borgen Project. The physical impairments that fistulas cause include continuous urinary leakage, urinary odor and infections in many bodily systems, including the genito-urinary system, reproductive system and integumentary system (skin system).
The psychological effects of this disease include ostracism (no friends and no husband) which may lead to depression, isolation and possible suicide. This latter psychological consequence accords with a narrative Wall recounts in “Tears for My Sisters.” A group of Somali women with fistulas committed mass suicide off a dock in Mogadishu, the capital of Somalia. Finally, the social effects of fistulas include possible firing, absenteeism from one’s illness and social stigma. In addition, fistulas make future pregnancies difficult.
Treatments of Fistulas
However, fistulas have cures at both the individual and public levels. Individually, trained gynecologists might be able to cure them via surgery. This surgery may involve cutting off scar tissue, closing the holes that occurred through obstructed labor or opening with stitches, flaps or both.
At the population level, prevention is key. This occurs by avoiding early pregnancy, circumventing prolonged labor through a C-section, having more trained medical doctors and educating the population on fistula prevention and treatment.
Curing fistulas reverse the consequences of the disease and improve the woman’s quality of life. In a 2007 research paper, MN Wegner and colleagues found that involving community members’ efforts in fistula reduction helped defray treatment costs for poor women, buy surgical materials and renovate fistula wards in Nigeria. In addition, the researchers stated that collaboration between the public and private sectors was significant in Kano State in northern Nigeria in a project managed by EngenderHealth, which advances sexual and reproductive health and rights through gender equity.
Worldwide Fistula Fund
Two nonprofits that are curing fistulas in Nigerian women include the Worldwide Fistula Fund and Fistula Foundation. Both organizations take a public health and preventive approach to solving the crisis as Nigeria carries the highest rate of obstetric fistula in the world.
Founded in 1995 by Dr. Lewis Wall under a different name, Worldwide Fistula Fund works to prevent and treat childbirth injuries holistically, including fistulas. The organization partners with leaders in low-resource countries to broaden their impact on women’s health. Some of their historical accomplishments in Nigeria included funding providers at Evangel VVF Centre and providing surgical training to treat fistulas. The Evangel VVF Centre of Jos state in central Nigeria evaluates and treats women with vesicovaginal and rectovaginal fistulas at no cost, using both medical and surgical means.
Founded in 2000 as a support to the Addis Ababa Fistula Hospital in Ethiopia, Fistula Foundation expanded nine years later to combat obstetric fistulas globally. The nonprofit organization, which Kate Grant leads, funds more obstetric fistula surgeries than any other organization. In Nigeria, Fistula Foundation invests in four areas to improve Nigeria’s medical services and provide fistula surgeries for women. These four areas include the cost of fistula surgeries, surgeon training, community outreach and reintegration support. Investments come through donations, with the majority going towards fistula surgery costs.
Similar to Worldwide Fistula Fund, Fistula Foundation amplifies the efforts of local surgical teams who have successfully treated obstetric fistula. One of its partners includes the Evangel VVF Centre, with whom the Foundation has partnered since 2011. The organization helps women with fistulas in Nigeria get the surgery they need. The Fistula Foundation has funded nearly $3 million to the organization. Obstetric fistulas remain a problem. However, research and action show that people can resolve obstetric fistulas one step at a time.
– Ozichukwu Ojukwu