Addressing VVF stigma via health intervention in Borno

By Hamza S Doka

Fatima Mustapha, a 42-year-old divorcee, is one among thousands of women who lived under excruciating life conditions due to stigma in communities across northeastern Nigeria.

Mustapha, a resident of Maiduguri, Borno State capital and epicenter of the Boko Haram insurgency, was discarded and unwelcome by family and members of the community who could not bear the staunch smell oozing from her body.

Mustapha, a mother of six, believed that her condition is caused by uncontrolled discharge of urine associated with Visco Viginal Fistula (VVF).

In medical parlance, VVF is an abnormal congenital opening between the bladder (Vesico) and the vagina causing continuous involuntary discharge of urine into the vaginal vault.

It is often caused by prolonged labour, especially for teenage mothers during childbirth and can also be as a result of violent rape of minors.

Narrating her ordeal, Mustapha said she lived with the condition due to injuries sustained during child birth.

“I gave birth at 12, and got wound in my private part.

“At the beginning my husband endured the condition, but later he divorced me.

“I moved to my mother’s place to seek remedy to my condition.

“Nobody wants to associate or share anything with me.

“I faced a lot of rejections in the community as people always feel uncomfortable to relate with person like me. I almost gave up before I finally got help,” she said.

Another victim, Fatima Isa, 40, said that she got the problem during her fifth child birth and lived with it in the past 17 years.

“Life’s not really easy because I was separated from my loved ones, including my sisters. I have been stigmatised by my families, friends and members of the community.

“Nobody accept anything from me or share his food with me. I don’t go to social gathering because of stigma. Some people get irritated when I go close to them,” she said.

Isa said she was treated at a hospital but the condition continued unabated till she received medical surgery sponsored by humanitarian organisations.

“The organisation supported me along side other women with free surgery at the Borno State Specialist Hospital 10 months ago.

“It also empowered us with skills training through Borno State Ministry for Women Affairs and Social Development.

“Presently; I’m into cap knitting and I’m happy that I regain my normal life,” she said.

Mustapha and Isa are among the 600 fistula survivors who underwent repair surgery supported by the United Nations Population Fund (UNFPA) and Korea International Cooperation Agency (KOICA).

UNFPA and KOICA initiated a 5-year VVF support programme to be implemented between 2018 and 2022.

The project tagged: “Fostering Resilience and provision of basic medical services for women and girls in Borno State, Nigeria,” focused at providing free medical surgery and skills acquisition training to VVF survivors.

Mr kelvin Chukwuemeka, Sexual Reproductive Health Specialist, UNFPA, Maiduguri office, said that an ultra-modern Fistula Centre was established at Specialist Hospital, Maiduguri.

He said that 626 women, who lost the hope of living normal life free of the involuntary dripping and leakage of urine, benefitted from free Fistula repairs at the centre.

The project, he said, was also designed to build resilience through the restoration of access to basic medical and social services in conflict-affected communities.

“The project aim at enhancing access to comprehensive maternal and child care, fistula care and improve capacity for result-based data management system.

“We conducted 600 fistula repair surgeries, supervised 47,429 deliveries by skilled health workers while 108, 561 survivors of Gender-Based Violence received specialised services with health and social cohesion in the last four years.

“In spite the challenge of COVID-19 pandemic at the onset of the project, its implementation was not derailed throughout the 4 years,” Chukwuemeka said.

The UNPFA Official said that after the skills acquisition training the women received starter packs at the treatment centre to enable them to set up their businesses to encourage economic stability and resilience.

The beneficiaries are drawn from Jere, Konduga and Maiduguri Local Government Areas of the state.

Moreso, 40,361 people were reached with life-saving sensitisation messages on the prevention of Obstetric Fistula (OF), the exercise sought to mobilise communities and create awareness on fistula repairs.

The UN agency also trained 37 surgeons and nurses to update their surgical skills to conduct fistula repair surgery effectively.

“Also, 27,598 individuals were reached with direct comprehensive and lifesaving Sexual and Reproductive Health (SRH) services in supported health facilities while 126,099 individuals were reached through mobile medical outreaches to the most affected communities within Konduga, Jere and Maiduguri.

“Some 225 frontline health and social workers comprising doctors, nurses, community health workers and GBV case workers were trained on Minimum Initial Service Package (MISP), Emergency Obstetric and Newborn Care (EmONC), Family Planning and Maternal Perinatal Death Surveillance and Response (MPDSR).

“This is to adequately provide quality reproductive and maternal health as well as specialised GBV services in an integrated form,” Chukwuemeka said.

He said that 10 mini ambulances were procured for mobile clinics to support referral of individuals with emergency conditions from their homes to the health facility.

For her part, Hajiya Falmata Gambo, Director in the state Ministry of Women Affairs and Social Development, said the project tremendously made positive impact on the lives of women and girls in Borno.

Gambo said that the UNFPA supported the survivors from mobilisation to come to the fistula center to free surgery, provided accomodation, feeding, councelling and psychosocial support up to to the period they recovered fully.

“After the successful surgeries, they are being referred to the ministry for rehabilitation and psychosocial support through various skills acquisition and livelihood programmes.

“At the end, they are provided with grant and starter kits so that they can continue their lives and be accepted in the society and family members,” she said.

She said that studies identified several factors responsible for the prevalence of fistula in Nigeria, major among them being early marriage and pregnancy.

On causes of VVF, she said accidental surgical injury related to pregnancy, lack of education coupled with low socio-economic status and powerlessness of young women result to prevalence of the condition in the state.

“About 87 per cent of rural childbirths take place at homes,” she said.

Also, Hassan Abdulrahman, a maternal and child specialist, said Nigeria is one of the countries with the highest number of VVF cases globally.

Abdulrahman said that the prevalence of VVF in the country was due to failure of the government to address issues of sexual and reproductive health rights of women and girls.

To address the scourge, Hassan advocated for a law to ban child marriage, to save the country from witnessing increase in the number of women subjected to life of misery and stigmatisation due to obstetric fistula.