by Mervis Elebe
Adaobi Nwosu* was only 14 when she was ostracized from her community. She had been married off to a wealthy 58-year-old business man and fell pregnant in that same year. When her 22-hour labour resulted in a still birth and eventual Vesico Vaginal Fistula (VVF), Adaobi’s husband threw her out of his family home. No-one understood her plight and thus she was branded a witch. Her parents rejected her and she had to find respite in the Anglican community in her home town, Abakaliki; Ebonyi state. Her hope was restored when she received free treatment from the National Obstetric Fistula Center, Abakaliki. The center which was established in 2008 by Hajia Turai Yar’adua has offered counseling, rehabilitation and vital reconstructive surgeries to over 2,000 women in South-Eastern Nigeria.
May 23rd is the United Nations’ International Day to End Fistula with UNFPA aiming to put an end to this neglected health condition that affects an estimated 2 million women in developing world. Nigeria currently ranks highest in global maternal mortality rates and also bears the world’s highest burden of obstetric fistula. In November 2016, the United Nation Children Fund (UNICEF revealed that over 0.4 to 0.8million women suffer from Obstetric Fistula (OF) in Nigeria, ranking the country as highest prevalence of Obstetric Fistula in the world. Every year, 12,000 new cases of OF occur in Nigeria, with most of these victims unable to access quality healthcare. Ethnic rivalry, regional conflict, political unrest and internal insurgency as well as increasing poverty further hinders access to healthcare especially for the 49 percent of our population who reside in rural areas.
Obstetric fistula affects mostly girls and young women living in extreme poverty; thus indexes show a higher prevalence in North-Eastern Nigeria, currently rampaged by Boko Haram terrorist activities. However, more than 60 percent of our population live under one dollar a day, so for the 12,000 annual fresh cases of OF, paying 400 dollars for treatment can seem quite inaccessible. With child marriage still prevalent in our country; it is no gain-saying that early pregnancy, labour complications, infant and maternal mortality and Fistula remains a serious threat to the health of girls and women nationally.
Dr. Nkoli, who has performed repair surgeries at NOFIC, Abakaliki says birth injury is more likely to affect teenage mothers, as their bodies are unable to cope with the trauma of labour. WHO’s Statistics show that only 48 percent of births in Nigeria are attended to by skilled personnel; which means more and more girls and women labour at home for long hours without the supervision of a midwife, nurse or doctor. Such traumatic experiences lead to still births and fistula. Unfortunately, women and girls with fistula are often unable to participate in society, ostracized by their families and communities driving them further into poverty. Nigeria’s UNFPA Ambassador and Star Actress; Stephanie Okereke has emphasized through her campaigns that “women should not die while giving life. Girls have rights to choose who to marry and when to children and how many of them”.
For Zainab Abubakar*, her life turned around when she received free fistula repair surgery at Laure Fistula Center, Kano. This was possible through funding from Fistula Care Plus; USAID’s partner in the campaign to end Fistula which has provided funding for over 46,000 surgeries and training for healthcare professionals in Africa since 2007. At the time of interview, Zainab was scheduled to receive her second surgery, as she had suffered both Vesicovaginal Fistula (VVF) and Rectovaginal Fistula (RVF). “I don’t know how I could have been able to pay for treatment if I had not heard about the free surgery” she had said in her native language, Hausa. Fistula Care Plus has not only sponsored treatment and training of caregivers, they also support prevention-focused facilities and provide support for re-integration of patients into the society, and helping them reunite with their families. Unfortunately, while Nigeria remains at the mercies of International donors, Ethiopia leads Africa with a more direct approach to ending OF.
Hamlin Fistula Clinic: Ethiopia’s world biggest efforts to treat Obstetric Fistula
In Addis Ababa, East Africa, lies the world’s biggest hospital for Obstetric Fistula treatment: Hamlin Fistula Clinic. Established in 1959, Hamlin International has taking a front-role seat in combating Obstetric Fistula headlong, and has since established five regional hospitals, the Hamlin College of Midwives and Desta Mender, a farm and training center for long term patients. “We are internationally certified in training obstetrics and gynecology doctors coming from many African countries and Asia through the training program funded by FIGO where all of the trained doctors will go back to their country and treat the same problem,” says Aschalew Tadesse, Communications Officer at Hamlin Fistula Clinic.
The hospital facilities are remarkable for offering free surgeries to women who undergo obstetric Fistula surgery, as it also has world-class hostels to accommodate patients from far and near. “Almost all of our patients are from rural Ethiopia where women living in such rural villages are totally dependent on their husbands. When these women faced the problem, most husbands will run away and get married to another, which as a result, they left lonely and economically poor as well. They sometimes suffer in getting bus fare even after they hear the service is free. So for such poor women paying 600USD for the simplest surgery remains totally unaffordable. We even provide transportation allowance for those who cannot afford it” adds Aschalew as he justifies the hospital’s decision to run free services.
Fistula patients in Ethiopia
It appears the same problem about knowledge which is faced in Nigeria is also encountered in Ethiopia as Aschalew adds “most ordinary people in Ethiopia don’t know much about this problem. The ignorance is more acute in rural villages where the majority patients came from, the community may even consider the condition as a curse and incurable disease which as a result most families hide the victims somewhere for not to be blamed as a cursed family. Sometimes stigma begins from families where most families hide the fistula victims somewhere isolated and won’t disclose what has happened to them to anyone in the village fearing not to be blamed as a cursed family.”
On the other hand, the women with fistula hide themselves for fear of the stench which is inevitable in such rural villages with no access to water. Such women withdraw from any social gatherings out of intense shame. Achalew however seems hopeful about the Ethiopian government involvement in the fight to end Fistula in Ethiopia “In fact, in the past few years, government intensively worked in letting the rural villagers have access to health facilities and professionals leading the attitude towards obstetric fistula continuing to be changing through time. These days, fistula patients won’t stay long with the problem because of lack of information compared with 10 years before where we regularly used to receive patients who had stayed for many years before treatment.”
Here’s where the Nigerian government can borrow a leaf. The government of Ethiopia has offered tremendous support to Hamlin International’s efforts to treat Fistula. “The 5 outreach hospitals, the rehabilitation center and the college, I am happy to says are built on the land we got from the state.” Aschalew adds, “In recent years the Ethiopia government has set a goal of discarding obstetric fistula from the country’s major health problems in 2020. The goal is to identify fistula victims and send to Hamlin hospitals for treatment.”
Hamlin International also provides scholarships for aspiring nurses and midwives with the aim of increasing the number of healthcare professionals in the workforce. Many women and girls who hitherto couldn’t access world-class medical training have their dreams fulfilled “We have two types of trainees, one is of midwifery students where we have been giving a free scholarship for female students screened from rural high schools with B.Sc. degree in midwifery at our Hamlin collage of Midwives,” says Aschalew. With its limited intake, (only 25 per year), the college has produced 125 skilled female midwives since 2007 and deployed them into rural government health centers sited in the same areas they came from. These midwives don’t pay for their four year stay at the college, to receive their diploma/license!
As a cap in its reputation, Hamlin clinic is now certified internationally in training doctors from overseas mainly from developing countries of Africa, Middle East and Asia. Aschalew says “this training program is totally funded by FIGO, an international organization based in London responsible in screening and sending the trainee doctors. We got paid from FIGO for this training program.”
Volumes of surgeries per year
In its six treatment facilities over Ethiopia including the main hospital in Addis Ababa, the capital city, Hamlin Fistula Hospital now has the capacity of treating 4000 patients yearly. The task could be difficult sometimes. Aschalew reveals, “The fact that the poor women who need to be treated live in remote rural villages with no access to communication such as radio, TV and/or cellphone, makes identification a very tough work; as a result, our annual treatment statistics falls between 2500 to 3000 cases.” The hospital hopes to be able to reach it’s full treatment capacity by working with the government to take grassroots’ sensitization to the rural areas. Thankfully, the outcomes of treatment are impressive. “According to our treatment report the current surgery success rate in all Hamlin facilities is 90%.”
For 85% of women treated at Hamlin Fistula Ethiopia, it takes an average of one month to get totally cured and discharged. The patients stay put in the clinic dormitories while obtaining specialized psychosocial and basic skills trainings of post-cure diet needs.
“But 15% women with difficult cases such as a damaged bladder must stay with us for long time under treatment named diversion surgeries,” says Aschalew.
Child Marriage: the root cause
Child marriage – especially when underage girls fall pregnant – is cited by UNFPA as a leading cause of Obstetric Fistula condition. Is child marriage a common feature in some parts of Ethiopia? we ask the Hamlin Hospital. In Ethiopia’s case, early marriage below 18 is banned by law. However, child marriages have been a traditional feature for most rural communities and it still is happening in some of the remote rural villages of Ethiopia.
“In our over 40 years’ experience most of our patients coming to us for treatment are aged 14 to 24 and faced the problem on their first pregnancy. From this fact it would be easy to learn how big teenage pregnancy contributing to obstetric fistula to happen.”
Hamlin Fistula Clinic Ethiopia has candid advice to corporates, foundations and governments in Africa wishing to copy its astonishing success in treating Obstetric Fistula.
“Thanks to the founder Drs. Reg and Catherine Hamlin we are now the world’s first and best free fistula treatment center. We are a 100% donation-based charitable organization where we have Trustees in about 8 developed world including Australia where our biggest source of income come from, that exclusively raises funds to Hamlin Fistula Ethiopia’s holistic work. As our vision is to see a world free from obstetric fistula and other childbirth injuries we are always more than happy to share our experience to others interested in the area. For whoever comes to learn from us we always advise to follow patient focused holistic approach to be successful in the area, the living legacy of Dr Catherine Hamlin” sums Aschalew.
Op–ed pieces and contributions are the opinions of the writers only and do not represent the opinions of Y!/YNaija.
(Picture credit: Mervis Elebe, Hamlin Fistula Hospital Ethiopia)
(Story funding credit: The research and production of this story was made possible by a generous funding from the Swedish Alternative Nobel Right Livelihood Journalism Grant Prize)
*Name changed to protect identity
