By Hadiza Musa Yusuf
Hauwa Garba, a 43-year-old trader and resident of Rano town in Kano, has been battling with Vesico Vagina Fistula, VVF, for more than seven months since her last pregnancy.
The mother of nine children told DAILY NIGERIAN that her condition was worsened by the lack of adequate care at her community’s health facility where she first sought help.
“It started when I was having issues during my pregnancy and I could not get necessary medical attention at our primary healthcare centre. I sought for help at Rano General Hospital and the doctor that attended to me told me I would have to do Cesarean Section operation.
“After the CS operation, I found myself in a pool of blood. The doctors reopened me and operated on me again. A day after I was discharged from the hospital, I noticed I started wetting myself. I couldn’t hold my urine. I went back to complain at the hospital and I was informed I have a fistula. That was my first time of hearing such. They told me to wait until my operation heals.
“After eight weeks, the doctors at Rano General Hospital referred me to Murtala Muhammad Specialist Hospital in Kano where I was operated on twice. The first one turned out unsuccessful and they had to redo it again,” she recounted.
Another resident, Maimuna Ishaq, 21, faced labour complications during her second pregnancy. She laid several complaints at the nearest PHC to her house and was always asked to come back. After continuous visitation to the facility, she opted for Rano General Hospital and was admitted for two days, before going for Cesarean Section (C.S) operation.
“After the operation, my baby was still born. This then led to my VVF. A pipe was inserted into me for about two weeks and was later removed. I soon noticed that my urine became more uncontrollable and was later referred to Murtala Muhammad Specialist Hospital, Kano for treatment.
Habiba Isiaku’s story is even more pathetic. Mrs Isiaku, a resident of Gwarabjawa, Danbatta Local Government Area of Kano State, got pregnant at the age of 15 after she was forced into an early marriage. For her antenatal, she visited Danbatta PHC all through her pregnancy and was not given proper medical care. During labour, there were no professional medical personnel on ground to help.
“During labour, I was told to push harder that my baby’s head has been sighted. I kept at it but there was no progress. The PHC noticed there were some complications and couldn’t handle my situation. I was referred to Danbatta General Hospital and had to be operated on,” she said.
Soon after she was delivered of the baby, it died, and more complications started unraveling and she couldn’t control her urine. She was later referred to Murtala Muhammad Specialist Hospital, Kano metropolis.
How Kano’s weak primary healthcare system is contributing to high VVF cases
Findings by this newspaper showed that while it is true that cases of VVF cannot be handled at the primary healthcare level, the lack of qualified personnel and inadequate medical infrastructure is a leading contributor to high statistics of the condition in Kano state due to complications from patients whose first port of call is often the PHCs.
Analysis of VVF cases in Kano paints an appalling scenario. According to statistics, Kano state recorded 14,228 VVF cases across its LGAs from 2009 to 2018. In 2009, there were documented 1,560 cases of fistula with a VVF prevalence of 54.7 percent. In 2010 and 2011, there were 1,345 and 1,986 documented cases of fistula with VVF having a prevalence rate of 73.8 percent and 65.3 percent respectively.
There was a slight decline in 2012 and 2013 as 1,876 and 1,984 fistula cases were documented with prevalence rates of 52 percent, and 50.3 percent respectively. In 2015, there was a sharp increase in fistula cases with VVF prevalence rate of 77.2 percent.
A study conducted on the demographic characteristics amongst VVF patients attending fistula centers in Kano state showed that, out of 250 women with VVF attending fistula centers, majority constituting 101 patients (40.4%) were between 19-28 years of age and followed keenly by those between 9 and 18 years of age representing 32 percent of the population. The study also revealed that the major predisposing factors of VVF are prolonged labour, and early pregnancy. Findings revealed that these factors are poorly managed at most rural and community health facilities in Kano state due to a number of challenges including funding constraints, poor infrastructure and ineffective management.
Although management of PHCs constitutionally falls within the purview of the third tier of government, poor funding due to the skewed federal allocation system in the country and lack of prioritization of healthcare by state and local government administrators has rendered most of the PHCs in Kano state ineffective.
“All ages can get VVF” – Doctor
Dr. Amiru Yola, head of VVF ward, Murtala Muhammed General Hospital Kano, said that VVF is not age specific although there are some conditions that predisposes people to the condition.
He said prolonged obstructed labour leads to necrosis in the vagina. The necrosis causes sloppiness of the tissues in the vagina and bladder thereby resulting in tunnel-like opening where urine from the bladder empty into the vagina instead of going through the urethra.
Yola added that complications arising from surgery conducted on the pelvic, abdomen, cervix, urethra and rectum trauma, as well as traditional rite like female circumcision, treatment of cancer like radiation can result into a patient having VVF.
Mr Yola disclosed that Murtala Muhammad General Hospital has operated on quite a large number of patients from Kano and environs, with patients from places like Rano, Gwarzo Nassarawa, Minjibir, Danbatta, Wudil and Tudun Wada more prominent.
Hassan Gama is the Project Director, Friends of Community Organization, FOCO, a civil society organization focused on promoting the quality of life of children, women, and youths. He said other major causes of VVF in Kano is the use of traditional herbs, and poor hygiene.
Mr Gama’s organisation is currently conducting sensitization on VVF for adolescents and young adults in Rangaza, and Rimin Kebe in Ungogo LGA and Unguwa Uku in Tarauni LGA. He said a common deduction from the field work conducted is the poor hygiene amongst women and girls adding that this can degenerate into VVF at the slightest exposure to predisposing factors.
Way forward
Dr. Aliyu Isah works at Muhammad Abdullahi Wase Teaching Hospital. He emphasized the need for a strong primary health system so as to reduce the burden of VVF cases in the state. He said that VVF and PHCs are connected since most PHC is often the first point of contact for rural communities.
“It is in the PHCs that most of the cases are first noticed. Most PHCs lack the necessary emergency equipment to do the needful. If the required equipment and quality management are not provided, the high rate of VVF cases in Kano will persist,” Mr Isah said.
He said that patients don’t make early detection of VVF easy adding that most of them prefer home delivery and also receive treatment from traditional birth attendants who sometimes worsen the situation before they visit PHCs.
On solutions to the problem, Mr Isah said: “Sensitization on how to manage labour especially in rural communities should be carried out periodically. Malnutrition should also be addressed and prevented as it might aggravate the situation.
Mustapha Aliyu, a medical doctor at Aminu Kano Teaching Hospital proffers more solutions.
“The first thing after educating the masses is to get at least one midwife, a standby obstetrician and physicians for each PHCs. They should well trained on normal contractions, and vacuum delivery, amongst others,” Mr Aliyu said in an interview with DAILY NIGERIAN.
He stressed that midwives should know the child’s active phases, adding that the management of the first, second and third stages of labour should be taken into cognizance, as well as the signs of obstructed labor, complications and fetal distress.
