Source: allAfrica

Victims of Vesico Vaginal Fistula (VVF) in North West Nigeria are being rehabilitated after treatment to ease their reintegration into the society without discrimination, a check by the News Agency of Nigeria (NAN) has revealed.

The states of Kano, Kebbi, Kaduna, Jigawa, Zamfara, Sokoto and Katsina make up the region.

The reintegration programme being supported by health officials, donor agencies, families and community leaders have helped the victims to return to their communities and enjoy normal lives after the treatment.

However, some of the victims are still asking for more especially in the area of skills training to enable them cater for their financial needs.

In Kano State, the Fistula Foundation Nigeria, said it has adopted social and physical reintegration approaches to return VVF patients to their communities.

Musa Isa, who heads the organisation, told NAN in Kano that the intervention helps the women to overcome social, physical and socio-economic challenges which were identified by the women themselves.

He said that the women had complained that those challenges deter most of them from going back to their communities.

According to him, the physical approach involved the surgery where the women are operated upon, while the social integration involved fighting stigma among the patients and building their capacity in many ways to ease their stress.

"We first identified 368 patients who were inoperable from Kebbi, Sokoto, Kano, Kaduna and Jigawa states for the reintegration.

"With support from the United Nations Population Fund (UNFPA) and Fistula Foundation California, we were able to provide social and economic support to the patients," he said.

He explained that the foundation secured free accommodation for the patients and set up literacy classes and empowerment initiatives for them.

Mr Isa further explained that they paid advocacy visits to communities of the patients and organise interactive sessions in order to clear misconceptions about the illness.

"We also follow up on those that were reintegrated back to the communities to ensure they were using their skills and have no challenges," he said.

He added that the foundation had also conducted reconstruction of the neo-vagina for the inoperable patients, to enable them remarry.

"With support from the UNFPA, about 30 women went through the reconstruction surgery successfully and five of them have already been remarried."

Mr Isa revealed that some of those reintegrated to their communities had returned to the cities due to challenges and resorted to street begging.

He expressed optimism that with continuous support of NGOs, the reintegration of VVF patients would be much easier in the state.


In Zamfara, the Executive Director, Centre for Community Excellence, Adamu Abubakar, said a robust enlightenment programme has been going on to sensitise communities on the illness and the need to embrace the VVF patients.

Mr Abubakar told NAN in Gusau that the centre has been collaborating with another organisation, Engender for Health, in the last three years on the sensitisation programme.

"Most communities now understand the danger of VVF and more women are attending Antenatal clinics.

"The awareness campaign is done through community leaders and has succeeded in making husbands allow their pregnant wives to go for routine check-up."

The executive director, however, said that the major challenges still remain in the area of transportation of victims from rural areas to hospitals, poverty and poor personal hygiene.

He also noted that healthcare facilities for VVF patients were grossly inadequate, as the state has only one centre attending to the patients.

Mr Abubakar, therefore, urged the federal government to set up at least one VVF centre in each senatorial district in the country.

A member of Religious Leaders Advocacy Champion involved in health issues in the state, Abubakar Abubakar, noted that discrimination against VVF patients in the state has drastically reduced.

"People have begun to understand ways they can help patients as against discrimination and isolation.

"Husbands and relatives now take their patients to hospital even without any intervention due to sustained advocacy campaign especially in Maru, Bukkuyum, Tsafe and Zurmi Local Government Areas which recorded more cases of VVF," he said.

Mr Abubakar explained that the campaign is being conducted in public places including palaces of traditional rulers, schools, mosques, markets and during weddings.

Fatima Alti, a VVF patient at Farida General Hospital, Gusau, said she was brought to the centre by her husband and has not experienced any form of social discrimination from her family members.

The Coordinator of the VVF Centre, Rakiya Abubakar, told NAN that cases of VVF ware declining in the state.

Ms. Abubakar said: "Now we are receiving less number of clients as against previous years, I think people are more proactive on the matter."


In Kebbi, Abubakar Dakingari, the Medical Director of the State VVF Centre, said cases of stigmatisation of fistula patients has reduced by 80 per cent in the state.

He told NAN in Birnin Kebbi that the victims now enjoy support and encouragement from their husbands and relatives.

"In 2013, when we came in, we met a statistics of stigma on women affected by the VVF so alarming and painful that over 40 per cent of women affected by the ailment were divorcees; they were divorced simply because they were victims of VVF.

"We embarked on awareness campaigns, involving traditional and religious leaders that VVF is not a communicable disease and is preventable.

"We educated the society through the leaders that the victims found themselves affected because the father and husband or the government were not doing enough, and the fault was not from the women.

"The awareness campaign assisted tremendously in the reduction of stigmatisation of the VVF victims.

"Almost all the women that are here have husbands and their husbands are still with them supporting them at all levels," Mr Dakingari said.

He said most patients were affected by the disease due to prolonged labour or through genital mutilation.

He explained that the centre offers treatment free to patients from within and outside the country.

"We have patients from Benin and Niger Republics as well as some states within the country as we have the best VVF treatment centre in the country," he said.

Mr Dakingari stressed that most women affected by the condition were from remote villages that lacked roads and functional healthcare facilities.

He said the centre was supported by USAID and some NGOs.

"We have received hospital equipment, theatre beds, surgical tools, family planning items and examination lamps by the Fistula Care Plus (USAID) as a donation.

"The facilities would be utilised to boost the capacity of the centre and effectiveness of the service being delivered."

The surgeon said the centre had assisted 50 pregnant women treated of fistula ailment to deliver from January to date.

"Because of the nature of their condition after undergoing treatment, we instructed them to come when their expected date of delivery were due in order to assist them have smooth and complicated free delivery," he said.

A pregnant fistula victim, Habiba Shehu from Augie Local Government Area of the state, said that she was affected by the ailment two years ago when she was undergoing labour.

"But now, you can see I am pregnant again waiting for the coming of another baby with the assistance of the doctors in the centre.

"I was told If I had pregnancy again to come when my expected date of delivery came nearer and here I am with my husband," she said.

Hadiza Sani, another VVF victim, said she had fistula problem five months ago but was fully treated at the centre.

"I am living with my husband and five children, but I have never had any fistula until my fifth delivery."

On his part, the Director of Health, Birnin Kebbi Local Council, Shehu Muhammad, urged the State House of Assembly to enact a law against stigmatising VVF patients.

"Most of the VVF patients have lost confidence in seeking treatment sequel to stigma from their husbands, relations and the public.

"The law against stigmatisation would relieve patients of feeling unwanted and isolated by the society and relations, especially considering that culture and society are responsible in the way women emerged VVF patients.

"The stigmatisation had resulted in patients becoming traumatic and affected by hypertensive related diseases," said Muhammad.

Tsahara Bawa, the Kebbi State Commissioner for Women Affairs and Social Development, said that the state government was providing assistance to treated VVF patients as part of effort to reintegrate them into the society.

"We empower the victims by training them and giving skills on tailoring, knitting, beads and soap making, as well as sewing and grinding machines."


In Kaduna State, some of the VVF victims urged the state government to scale up intervention, access to treatment and psycho-social support.

The victims also urged the government to come up with ways to ease the victims' reintegration into the society.

One of the women suffering from VVF, Jummai Joseph, aged 35, said she got the condition following prolonged labour she suffered in delivering her fifth child.

She said: "I had complications due to prolonged labour and was taken to Kawo hospital for delivery.

"I lost the baby which had to be removed via Caesarian Section; but my greatest shock was when the doctor told me I have VVF.

"My life has never been the same ever since. I spent a lot of money to get treated."

She said that a reasonable number of women are suffering from the disease with no health facility within their reach and appealed to government to provide modern healthcare facilities for VVF victims.

She called on husbands to be patient with their wives having fistula by being loving and caring.

Another woman, who identified herself simply as Martha, said she also got the condition after prolong labour.

She added that the absence of health facility in their community made her to patronise old women with little experience of how to tackle complications during child birth.

"Most of the victims are been treated as outcast by their families and even the society; government must do something about it for us to live a normal life."

A resident of Kaffin Gwari in Igabi Local Government Area, Esther Marcus, said not less than 20 women in the community are suffering from VVF due to lack of health facility.

"We do not have anything in this community, not even a patent store to buy medicine. We have to go to Kawo for everything. One can only imagine what we go through during medical emergency.

"We do not even have trained traditional birth attendants. We have to fall back on old women with a bit of experience about child birth whenever our women want to deliver and we have lost quite a number of children in the process."

In Zaria, a Lagos based NGO, "Hope Ambassadors", have intervened in the area of moral support, encouragement, love and care to VVF patients at Gambo Sawaba General Hospital, Kofar Gayan, Zaria.

The President of the organisation, Mandy Olowu, told NAN in Zaria that the intervention was due to the great work being done by the hospital in the last 26 years.

"These people need moral support, encouragement; love and care from people to enable them live a normal life.

"VVF is a disease that can be cured and is non-communicable. Therefore, we should not run away from our relations, friends or loved ones because of the problem.

"Our mission is to come and appreciate the efforts of the hospital, doctors and present some little gifts apart from words of hope to VVF patients responding to treatment here.

"Am happy with what I saw in the hospital, the patients are well accepted and being taken care of. However, this is not the case in the west, there is stigma, people feel that the disease is not curable at all," she noted.

Yunus Ibrahim, the Imam of Sunnah Mosque, Kababari, Zaria, advised people to embrace rehabilitated VVF patients to enable them live normal life.

"There is every need for people to accept the rehabilitated patients to give them a sense of hope to live like any other individual.

"This is a sickness from our creator and we thank Allah (SWT) that such sickness is being healed; therefore, we have to reintegrate them into the society without discrimination.

"I enjoin us all to accept them, love them, sympathise with them and give them all the necessary support to feel normal and loved."

A mother to one of the victims, Malama Bilkisu Umar, expressed appreciation to the hospital management as well as international donor agencies for the rehabilitation exercise.

She also thanked some NGOs for extending hands of fellowship to the patients and urged them to sustain the tempo.

A VVF victim, Rebeca Dodo, also called on government at all levels to consider the possibility of introducing a special after care programme for VVF patients.

"We want a situation where government will introduce a programme to give rehabilitated VVF patients special training to assist them after the treatment.

"Most times, when a woman is rehabilitated she will find it very difficult to be reintegrated into the society because of stigma.

"However, when we are given entrepreneurial training, this will certainly go a long way in assisting us," she said.


Reports from Katsina State indicate that no fewer than 31,200 VVF patients were successfully treated at the National Obstetric Fistula Centre, Katsina, from 1984 to 2017.

Aliyu El-Ladan, the Medical Director of the centre, told NAN that the centre conducts between 400 and 500 surgeries on VVF patients annually.

He revealed that the centre is also a VVF research institute where patients from across the country and beyond patronise for free and effective treatment.

The medical director noted that the centre has one of the biggest VVF rehabilitation centres in Africa that train victims after treatment to reintegrate them into the society.

He further said that of recent, about 53 women were rehabilitated and given knitting and tailoring machines as well as N20,000 cash to set up their own businesses.

Mr El-Ladan said that was done with the support of the Katsina State Government.

He said that they conduct enlightenment campaign in the media on the causes and preventive measures against the disease.

He added that they have also identified VVF high risk areas in the state with a view to involve all stakeholders on how to address the problem.

Mr El-Ladan said that financial constraint was one of the challenges affecting the centre because their services were free.

But the medical director decried the attitude of some of the victims who after treatment develop another complication.

"Some women after being discharged, and when having pregnancy, they don't attend Ante-Natal Care (ANC).

"Such women usually develop complication that leads to another VVF operation.

"So, we decided to open ANC care and offer CS operation free of charge for them just to prevent them from series of surgeries.

"As I am speaking to you now, we already have maternity unit reserved for such women in the centre," he said.

Mr El-Ladan also urged state governments and NGOs to support the rehabilitation of VVF victims and full reintegration into the society.


From Sokoto State, Lawal Bello, the Chief Medical Director of Maryam Abacha Hospital, Sokoto, says various governmental, non-governmental organisations, community and individual efforts is facilitating the reintegration of VVF patients with their respective families.

Maryam Abacha Women and Children Hospital, VVF Centre, used to illustrate the story. [Photo credit: International Centre for Investigative Reporting]

Mr Bello told NAN in Sokoto that different organisations approached the hospital on one way or the other with the sole aimed of improving the lives of patients.

The state Commissioner for Health, Balarabe Kakale, said all VVF patients are treated by the government free of charge in the state.

"Besides treating them free of charge, Gov. Aminu Tambuwal has directed us to ensure that all of the women were trained and supported with a trade to smoothen their reintegration back into the society.

Sokoto State Governor, Aminu Tambuwal signing the 2018 budget into law

"So we are empowering them socially and economically through various means," Mr Kakale said.

"We have introduced various measures to ensure that all pregnant women go for antenatal examination in health facilities as a measure to prevent prolong labour and prevent occurrence of VVF among our women," he added.

Speaking to NAN on the VVF issue, the Permanent Secretary, Sokoto state Ministry of Women and Children Affairs, Aisha Dantsoho, said various programmes were introduced at empowering VVF patients to become productive in their respective settlements.

Mr Dantsoho said huge amounts were being spent on the programmes, noting that the beneficiaries are trained on soap and detergent making as well as how to prepare various types of perfumes, body sprays, disinfectants and antiseptic.

According to her, in September 2017, no fewer than 100 VVF patients received empowerment training in a joint programme conducted by United Nations Population Fund (UNFPA) with Sokoto State government on soap making and other cosmetics production skills.

She said the knowledge impacted on the women would prepare them to manufacture cosmetics and educate others in their respective communities.

"During the exercise women have indicated enough commitments and embraced the modern trades as they learnt the skills diligently.

"They are now empowered to sustain themselves when they return to their communities," she said.

The permanent secretary said the state government in collaboration with the National Directorate of Employment (NDE), conducted another set of training programme for 200 women comprising VVF patients where they were taught different trade and skills to make them self-reliant.

A scholar, Rilwan Muhammad, described VVF as a destiny and advised husbands and patient families to always accept them after treatment to enable them enjoy normal live.

Mr Muhammad said the treatment along with medical doctors' guides after treatment indicated that they can become normal, stressing that religion consider them safe as it is not a disease that is communicable or that could endanger lives.

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