Vesicovaginal fistula (VVF) and Female Genital Fistula (FGF) are two variants of the same disease affecting Nigerian women, particularly in the rural areas.
According to Dr. Sunday Lengmang, a family physician and fistula surgeon at the VVF Centre in the Evangel Hospital Jos, VVF is an abnormal health condition that causes a hole to develop between the vagina and the bladder, resulting in uncontrollable leaking of urine through the vagina.
He said once that hole is created, urine now bypasses the bladder and leaks through the hole into the vagina and then drain out continuously. So as a result of that the woman is always wet and smells of urine all the time.
“Any woman that has VVF can no longer control her urine, she cannot retain the urine any longer, the urine flows out freely all the time without the woman knowing,” he said.
Another variant of VVF is the type that affects the urethra which also makes a woman leak urine unconsciously.
Dr Lengmang said, “This is not the type that affects the bladder; this type affects the urethra, the tube that drains the kidney into the bladder itself. If there is an injury there, it also allows urine to leak in an abnormal way.
“There could be also a problem with the digestive system, which can cause leakage in the rectum or any part of the intestines into the vagina that can now lead into what we call Recto-vaginal Fistula (RVF); instead of urine leaking, it is faecal matter that leaks all the time.
“All these variants are collectively called Female Genital Fistula (FGF). So female genital fistula is an abnormal condition whereby there is an abnormal connection between either the faecal system or the urine system making faeces leak or urine leak all the time. The earliest and very popular variant is the VVF, but the health condition is more than VVF.”
The expert said the major cause of VVF is prolonged obstructed labour, adding “once labour becomes prolonged and obstructed, this get the tissues around weakened and damaged.”
He said other minor causes are Lympopagnema Vunerium infection, any injury a woman has in the pelvic area through an accident, and even HIV can lead to VVF.
“Rape can also lead to VVF, especially rape of underage girls whose tissues are still very tender and not matured for sex. Then we also have harmful cultural practices like female genital mutilation. It can also be caused by the activities of quack medical personnel,” he said.
Dr Lengmang, who is the director of VVF project at the Evangel Hospital Jos said, “The highest cases come from the North West, followed by North East, then North Central. From the southern axis we have more cases in the South-South, South-East and the least cases come from the South West”.
There are between 12,000 to 13,000 new cases of VVF and FGF every year and 70 per cent of these cases come from Northern Nigeria.
It is a disease that is associated with low economic status, and closely related to poverty and illiteracy.
Experts say Nigeria, would have eradicated cases of VVF and FGF since the last decade but for the insecurity in some parts of the country.
The trajectories of war against VVF in Nigeria indicate that Evangel Hospital Jos first launched the battle against the disease. The missionary doctors at the hospital began major work against VVF in 1992.
And because it affects the poor rural dwellers mostly, the hospital made the treatment free.
“It takes at least N100, 000 to treat a minor VVF case and N500,000 to treat a complex one.
“The cost of treatment alone scares away those that required the treatment, which is why the hospital made it free and it remains free till date,” said Dr Lengmang.
However, the increasing insecurity across the country has made it difficult for victims to access treatment.
Daily Trust learnt that many women in dire need of medical attention are lying critically ill in the rural areas across the country due to their inability to access medical care.
Medical personnel in some communities have abandoned their duty posts for their safety just as VVF centres, intended to take the treatment to the doorsteps of the poor rural women who are also scared of the unknown.
Dr Lengmang confirmed to Daily Trust in Jos that, “there are some patients that cannot even afford the means of transportation to Jos, and some could not come due to insecurity in their locations.
“So, we go on outreach to such persons to get them treated.
“We only bring those with complicated cases to Jos for surgery. But that was then, now it is risky to organise such medical outreaches in North East and North West; no doctor or medical personnel will want to go to such zones.”
Prior to 2010 when insecurity began to pose a hindrance to FGF treatment in Nigeria, the annual cases of the disease dropped drastically from one million cases a year to 150,000 cases. But from 2010 till date, it is difficult for hospitals to keep accurate record because victims are out of reach to medical personnel. This lead to fear in the medical cycles that the cases may have become as high as it was in 1992.
Realizing the burden VVF poses to poor rural women in the country, the federal government developed a national strategic framework for the eradication of the disease. This programme was meant to establish one VVF Centre of excellence in each of the six geo-political zones of the country.
Daily Trust found that the centre for the North West is located in Babanruga village in Katsina State, that of the North East is located in Ningi, Bauchi State and that of the South East is in Abakaliki, Ebonyi State.
That of North Central, South South and South West are yet to take off.
But in spite of these efforts by the government, the issue of insecurity has made it difficult for those who deserve the treatment to access these hospitals.
This is also already making it impossible for the government to meet its target t of eradicating the disease from Nigeria by 2030.
Dr Lengmang said there are 20 VVF centres currently in Nigeria.
He said people from Niger, Chad, Cameroon and Benin Republic come to Nigeria to seek treatment for FGF. “Many more would have come from our neighbouring African countries if not for the distance and cost of flight. This is the highest non-governmental referral centre in Nigeria and in the sub-region. It is the only VVF centre that provides urinary diversion for patients that have inoperable fistula,” he said.
He said it is also one of the very few centres in the country that can offer sigmo-neo vagina for women whose vaginas are completely blocked due to complications of VVF.
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