Vesico Vaginal Fistula (VVF) is an abnormal fistulous tract extending between the bladder, vesico and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.
Simply put, VVF, according to a Surgeon and Medical Director of National Obstetrics Fistula Centre Abakaliki (NOFIC), Prof. Sunday Adeoye, is an occurrence of abnormal hole between the bladder or rectum and the Vagina which is characterised by continuous and uncontrollable leakage of urine.
In addition to the medical squeals from these fistulas, they often have a profound effect on the patient’s emotional well-being.
It is often caused by childbirth (in which case it is known as an obstetric fistula), when a prolonged labour presses the unborn child tightly against the pelvis, cutting off blood flow to the vesico-vaginal wall. The affected tissue may necrotise (die), leaving a hole.
Vaginal fistulas can also result from violent rape. This injury has become common in some war zones, where rape is used as a weapon against female civilians.
It can also be associated with hysterectomy, cancer operations, radiation therapy and cone biopsy.
According to figures released by the National Demographic Health Survey, no fewer than 12,000 women develop Vesico Vaginal Fistula (VVF) every year in Nigeria.
Studies also show that most of the women affected by the condition come from the remote villages which lack motorable roads, health care facilities and numerous barriers that hinder easy access to health care delivery.
The condition is common where ignorance and poverty are prevalent, even as it affects young, teenage girls of poor social economic background and women who are delivering babies for the first time.
The condition is also common among older and even elderly women as well as uneducated women living in the villages with the latter mostly affected.
Studies show that 90 per cent of VVF cases are caused by prolonged, unattended and obstructed labour while other causes include harmful traditional practices such as female genital mutilation, among others.
Though VVF is prevalent both in the northern and southern parts of Nigeria, it is more conspicuous in the North and occurs wherever maternal mortality rates are high.
Sadly, VVF accounts for 75 per cent of loss of baby and is responsible for 55–60 per cent of divorce rates in the country.
In the yesteryear, the disease ravaged women of Ebonyi State in particular and the Southeast in general. There was no hospital that could adequate treat the ailment in the entire region.
Women with the infection suffered serious stigmatisation from family members and community who, in some instances, ostracised them.
Dr. Adeoye said: “Patients back then were referred from Ebonyi State to a VVF centre in Akwa-Ibom State owned by a missionary. In a bid to reduce the scourge, the management of the then Ebonyi State University Teaching Hospital (EBSUTH) became desirous of establishing a fistula unit within the teaching hospital and that was how I came into the picture in 2002.
“The unit was established in 2002 and between 2002 and 2007; we were able to operate on over 120 VVF patients. But our major handicap was that of funding. Then, many patients who wanted to come for repairs had to go back because they couldn’t afford to pay. We had sponsors from United Nations Development Programme (UNDP) and the United Nations Population Fund (UNPF). We were grateful for their contributions then.
“Whenever the fund given to us by our partners got exhausted, we will not be able to operate because the patients will not be able to pay for the services.”
Ebonyi Governor’s wife to the rescue
Adeoye’s perseverance and hard work as well as the challenges of the unit, unknown to him was being noticed by the wife of Ebonyi State Governor, Mrs. Josephine Elechi who, in 2007, established her pet project, the Mother and Child Care Intiative (MCCI).
The initiative aimed at reducing maternal mortality; eradicate maternal morbidities such as Vesico-vaginal Fistula (VVF) among women in the Southeast zone of the country, to facilitate the establishment of cancer screening centre in the zone, to promote mother and child survival and to promote rural girl-child education, among others.
Prof. Adeoye further said: “The wife of the governor, Mrs. Josephine Elechi came on board and decided to take over the VVF Unit having noticed the suffering of the women living with the ailment. She brought national attention to their plight through her mother and child care initiative programme, with the target to eradicate the burden of obstetric fistula which involved the actual screening of women who were leaking urine.
“Under that particular project, the centre was established as one of the major VVF Centres in the Southeast zone. By the time we started, people said we are not going to have patients because VVF had already become a very big problem in the country.
“We knew better that the common denomination of fistula is prolonged obstructed labour. And prolonged obstructed labour is a condition you find everywhere not just in Nigeria alone but also in every developed country of the world. You begin to ask why a woman should wait until her labour became prolonged and obstructed.
“Several reasons which border on poverty; she doesn’t have the money to go to the hospital to receive treatment, another problem is cultural belief. Most women believe that they must deliver through their vagina and they are afraid that when they go to hospital, they will have caesarian session.”
Prof. Adeoye also blamed poor health care service delivery to the people, especially in the rural areas, as another reason for the increasing cases of the infection.
“The activities of quack health attendants, lack of medical personnel in the rural areas, the attitudes of paramedical personnel in attending to the women are so bad so much so that it deters them from coming to the hospital to receive treatment,” he said.
Continuing, he said: “Poor road network is among some of the reasons that delay women from getting medical attention on time when they are in labour. This results in prolonged obstructed labour and, of course, the next thing is obstetric fistula, especially when the baby is too big. About 90 per cent of women with prolonged obstructed labour lose their babies and as well would develop obstetric fistula, which is double tragedy.”
Prolapsed treatment
In 2012, the centre began treating women who suffer from another deadly disease, uterine prolapsed.
Prof. Adeoye gives clarification of what the uterine prolapsed is all about and why the centre, which was opened mainly for treatment of women suffering from VVF decided to go into treatment of uterine, prolapsed.
He said: “Uterine prolapsed is a condition in which a woman’s uterus (womb) sags or slips out of its normal position. The uterus may slip enough that it drops partway into the vagina (birth canal), creating a lump or bulge.”
He attributed the hospital’s success in treatment of the disease to Mrs. Elechi’s compassion, generosity and burning desire to uplift the women folk.
“In 2008 when the governor’s wife was going round communities in the state to find out women suffering from (VVF), it was discovered that many of those who turned out rather had the uterine prostrate.”
Mrs. Elechi, who felt very saddened at the plight of the women, decided to foot the bills for their treatment at the hospital. But the centre had, before then, concluded arrangements to treat those with the VVF, even though it could not look into their plight immediately.
“Due to the support and encouragement of the governor’s wife, the centre was encouraged to begin treatment for the uterine prolapsed women early in 2012 and in the first batch, 65 women were treated,” Dr Adeoye said.
Federal Government’s take over
Impressed by the success of the centre, the Federal Government, in 2011, upgraded it to an Obstetrics Fistular Centre of Excellence in the country.
The Federal Government’s take-over of the centre added more impetus to the it as it led to injection of more funds into the centre which has been judiciously managed by the Prof. Adeoye-led administration
The centre, which before the take-over by President Goodluck Jonathan’s administration, started in a small apartment, with low staff strength, now has witnessed greater development through the establishment of cancer screening unit and laboratory services and others.
Last year, the centre began breast and cervical cancer screening of women and prostate cancer for the men. Over 500 people have been screened of prostate cancer, while free breast and cervical cancer screening figures for women stand at 7,289 from across 20 states of the federation. The number keeps increasing by the day as more people take advantage of the facilities at the centre.
The activities of the centre in the area of cancer screening led to it being recognised as the Southeast screening centre.
These achievements are fallout of the vision of the man at the helm of affairs in the centre, Prof. Adeoye.
It is due to his hard work, dedication to service and tenacity of purpose that the centre has gained international recognition. He had envisioned taking the centre to greater heights of development in accordance with the agenda of President Jonathan in improving the health sector.
At the last count the centre has trained over 100 medical personnel on VVF and prolapsed treatment, thereby increasing the expertise of Nigerian doctors in the treatment and management of VVF and prolapsed cases.
With the takeover, Adeoye expressed optimism that the centre has attracted great development not for the state alone but for the Southeast zone
Prof. Adeoye praised the efforts of President Jonathan’s administration in providing modalities to eradicate various diseases affecting citizens of the country, especially those in the rural areas.
“The Federal Ministry of Health is equally doing a great work in that regard to reduce the high rate of obstetric fistula in Nigeria,” he said.
Despite the efforts of the Federal Government in funding the centre, Dr Adeoye said more funding is needed for the centre to meet the ever-increasing influx of patients who flock the centre daily for treatment, especially in the area of uterine prolapsed.
“Uterine prolapsed procedure is very costly. We have been able to operate on over 400 women. We equally used the opportunity to provide training for younger gynaecologists. But we still have over 400 women waiting to be operated on.
Fistula campaigns/treatments to other states
The National Obstetric Fistula Centre Abakaliki has also started the fistularcampaigns/treatments to other states tagged“Identification /free Surgical Repairs of Patients with Obstetric Fistula Campaigns.”
While adducing reasons for the outreach, Prof. Adeoye pledged the readiness of the centre with the help of the Federal Ministry of Health to provide health care services to people in the villages who may not have the opportunity to come to Ebonyi.
“One of the pathetic stories was a woman from Cross River State who lamented that she could not afford to raise N3, 000 to come to Ebonyi to receive free cervical treatment. Instead of waiting for her and others like her to come, we decided to meet some of the patients in their respective states,” he said.
Adeoye led a team of fistula experts to Delta State to kick-start the outreach. The team was made up of two obstetric fistula surgeons, one anesthetic nurse, a pre-op nurse, a post–op nurse and the centre’s Public Relations Officer.
The team was received on arrival in Asaba, the Delta State capital, by the Permanent Secretary, Ministry of Health who represented the Commissioner for Health. Details on logistics were discussed.
The team left Asaba for Warri Central Hospital where the fistula repairs were to be carried out. The team began work immediately with screening of patients and surgery.
Screening and Surgery ran concurrently throughout the 10 days stay in Central Hospital Warri. At the end of the stay, 28 Clients were screened, 14 were repaired at the Warri Central Hospital, while eight were referred to the National Centre at Abakaliki, because of the complexity of their cases and the anticipated intra- and post-operative complication.
The Managing Director also presented one-hour continuing medical education lecture on “Management of Obstetric Fistula” to Residents, Consultants and other practising doctors in and outside the Central Hospital Warri.
IVF Unit
Recently, the centre added another feather in its cap with the inauguration of its In- vitro Fertilisation Unit (IVF).
While inaugurating the unit, Senate President, Senator David Mark said President Jonathan is committed to improving the health of the citizens.
This is in realisation that quality health care system was critical for the country to attain national development.
He noted that the critical import of the health sector to a nation’s overall growth and development informed the importance the National Assembly attaches to the sector, hence the need to appropriate more funds to the centre.
“I want to emphasise the importance the National Assembly attached to our health care sector as a critical factor to its development, hence the quick response to stem Ebola Virus Disease in the country.
“I thank the efforts of the National Obstetric Fistula Centre for the remarkable progress recorded since inception, especially its free medical treatment rendered to women.
“This humanitarian attachment to your services is worthy of commendation. And I want to assure you that the National Assembly Appropriation Committee would always look favourably to the centre, “he said.
The Senate President also praised the numerous inputs made by the Federal Ministry of Health to the development of the centre.
“The Ministry of Health has really accorded the National Fistula Centre the attention it needed to operate efficiently, and I also thank Governor Martin Elechi and the amiable wife for their dogged efforts in making this project realisable” he said.
Governor Martin Elechi thanked members of the National Assembly for their approval and appropriation that ensured the upgrade of the centre.
“No doubt, the appropriation of the National Assembly contributed immensely to the establishment of this great centre which is gradually attaining international recognition.
“The centre is, indeed, a national centre; thanks to the National Assembly for this feat,” Governor Elechi said.
He, however, enjoined the National Assembly to take issues concerning the centre seriously as this would help in sustaining it.
The Minister of Health, Prof. Onyebuchi Chukwu appreciated the support of the National Assembly to the National Obstetrics Fistula Centre, Abakaliki.
The minister paid special tribute to President Jonathan for approving the Federal Government’s takeover of the centre.
“The National Obstetrics Fistula Centre Abakaliki is a comprehensive centre which provides free treatment programme for all Nigerians, treats Vesico-vaginal Fistula and provides Pelvic organ prolapsed surgical intervention.
“The centre is designated as the National Cancer Screening Centre for the Southeast. I therefore thank Governor Elechi for the state government’s continued support to the centre and Senator Chris Nwankwo for including the centre as part of his constituency projects,” he said.
The Chairman, National Fistula Obstetrics Fistula Centre and the wife of Ebonyi State Governor, Mrs. Josephine Elechi said the centre had provided free treatments for 1,728 fistula clients with 57 urethral implantations.
“412 women with pelvic organ prolapsed have equally benefited from the centre’s free surgical repairs.
“The centre had provided training for over 80 medical and paramedical personnel in both vesico-vaginal fistula and pelvic organ prolapsed surgical intervention,” she said.
She urged the National Assembly to appropriate more funds to the centre to enable it serve the country efficiently.
Ongoing projects
The centre has two ongoing building projects, namely Administrative/Theatre/Library Complex and Guest house/Call Rooms for medical and paramedical personnel/Physiotherapy/Biomedical Engineering Units.
The construction of the Administrative/Theatre/Library Complex is ongoing at the centre and it has reached advanced stage of completion. When completed, the three-storey complex will house the main administrative offices, four ultra-modern theatre suites, library and a conference hall.
The Theatre suites will allow for expansion of the services including endoscopic services such as hysteroscopy, laparoscopy, among others.
The centre recently acquired a three-storey building complex through the Federal Ministry of Health. Currently, it is being renovated to provide accommodation for the centre’s trustees; call/duty rooms for medical and paramedical personnel on call; Physiotherapy and Biomedical Engineering units.
The building is undergoing renovation and will be ready for use soon.
