Curtailing maternal mortality through services of National Obstetric Fistula Centre

NWAEZE ANGELA, writes that 4,000 obstetric fistula patients have been treated free at the National Obstetric Fistula Centre, Abakaliki, Ebonyi State capital, while the centre has also operated about 3,000 uterine prolapse cases since 2008.

Vesicovaginal fistula, or VVF, is an abnormal fistulous tract extending between the bladder (vesica) and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.

It could be caused by a congenital birth condition such as VATER or VACTERL. Vistula is often caused by childbirth (in which case it is known as an obstetric fistula), when a prolonged labor presses the unborn child tightly against the pelvis, cutting off blood flow to the vesicovaginal wall. The affected tissue may die, leaving a hole.

It could also be as a result of particularly violent cases of rape, especially those involving multiple rapists. Whatever the case, the disease often has a profound effect on the victim’s emotional well-being.

Before the 19th century, women who suffered from VVF were judged harshly and rejected by society. Throughout the 19th century, treatment for VVF was limited because the practice of gynecology was perceived as taboo, according to “The medical ethics of the “father of gynecology, Dr J. Marion Sims .

Doctors were almost entirely male at this time and looking at a nude female, even for medical purposes, was seen as divergent from 19th-century values.

Black enslaved women in the American South were particularly prone to VVF because they were denied proper nutrients and medical care.

But in the 20th century, the story has changed. Women with such disease receive quality health care services, most especially, in Nigeria and Ebonyi state in particular.

The Nigerian government on seeing the pains and disgrace women were passing through because of the disease, decided to establish centers where these women would be treated and returned back to how they were before the ailment.

In May 2011, the National Obstetric Fistula Centre, Abakalki, was established. It was formerly known as the South East Fistula Centre, Abakaliki, established by the Mother and Child Care Initiative (MCCI), a pet project of the wife of the then Governor of Ebonyi State, Her Excellency, Mrs. Josephine Elechi.

The Centre was commissioned on the 5th of December 2008, by the then first Lady of the Federal Republic of Nigeria, Hajiya Dr. Turai Yar’Adua.

But it was taken over by the Federal Government in May 2011 as a National Reference Centre for Management of Obstetric Fistula with mandate for provision of free Treatment, Training of medical and paramedical Personnel, Rehabilitation, Research and Prevention.

Treatment at the Centre is free, such that when a woman is admitted all her expenses are covered (including medical care, drugs, laboratory tests, food, and toiletries). On arrival she receives a small bag which contains her personal items.

However, some of the women suffering from VVF are abandoned at the center by their husbands, according to the Medical Director, in charge of National Obstetric Fistula Centre (NOFIC), Abakaliki, Ebonyi state, Prof. Johnson Obunna, during an interaction with this correspondent.

He said an average of 15 fistula cases is repaired weekly in the centre. And since 2008 till date, about 4,000 obstetric fistula patients have been treated free, while the center has also operated about 3,000 uterine prolapse cases.

He said, “One of the major causes of obstetric fistula is poor or default obstetric services. Many women due to poverty or ignorance on how to access standard obstetric services, resort to quacks or deliver at home and therefore come up with obstetric fistula due to absent or poorly supervised labour.

“Currently, we are observing ugly and worrisome trends where poorly done Cesarean section is increasingly becoming the commonest cause of obstetric fistula in our southern region which is not the same in the North.

“In the North, it is obstructed labour because many of their children girls marry early; their pelvis are not yet developed and they have obstructed labour.

“But here, the people that have fistula in this southern part of the country are people that are 28 years, 80 years and their pelvis have grown.

“ They have four, five children but they didn’t go to a proper place for a Cesarean Section, they go to those who don’t know how to do Cesarean Section, they do Cesarean Section poorly and they come up with fistula.

“The research that we just did show that about 67% of fistula we have in this part of the world is caused by Cesarean Section.”

It is on this backdrop and the need to prevent both primary and recurrent obstetric fistula, that the centre decided to commence maternal services from Tuesday 18th August, 2020.

Flagging off advocacy, sensitization and case identification activities for journalists in Ebonyi state, recently, Prof. Obunna, stated that NOFIC is now running maternal services in order to help women manage the delivery to avoid fistula.

According to him, fistula patients who have been repaired in the center will receive maternal services free of charge including child delivery, while those who have no recorded case of fistula are allowed to access maternal services at a very cheap rate.

“We did a small research work. We went round the facilities in Ebonyi to know how they charge to deliver and we made our own the least for those who don’t have fistula.

“I can assure you delivery here is the cheapest in the whole of Ebonyi state. By April, 2021, the center will be commissioned. We discovered that if a tap keeps on running and you do not close it, the tap will keep on running. That is why we said let’s start maternity services that will help these women to access free maternity services, including care for their newborn,” he added

At NOFIC Abakaliki, women walking slowly, carrying bowls and elastic pipes that pass through their private parts to the bowl, is a common spectacle. They look very weak and pitiable. The pipes and bowls ensure they don’t leak urine and feces.

But within a short period of time, they are completely repaired and they return to their strong health condition before they were down with Vesico Vaginal Fistula (VVF) ailment.

Some of the women said they suffered all manner of discriminations where they live.

One of the repaired patients, Helen Dike, who hails from Rivers state said that her own case was so serious that she became object of ridicule by her neighbours who discriminated against her by avoiding her because of the offensive odour emanating from her body as a result of the sickness.

“I suffered a lot in this sickness because people stigmatized me a lot. In our yard, people used all manner of bad words on me. Even a medical doctor who also lived with us one day said that whoever knows that she is the one smelling very badly here should be ready to leave the compound, and I entered my house and cried that day. I wept all through that day and I couldn’t come out till the following day.

Not a few say that after listening to the heartbreaking experiences these women pass through, the Center must be commended for coming up with the running of maternal services.

With this development, a lot of women would be saved and recorded case of fistula would drastically be reduced since the center has taken up the responsibility of carrying out deliveries as well as cesarean sections.

Also, reducing the cost of maternal services by the Centre will encourage women to access quality health care and curtail maternal mortality.

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