End Fistula -By Sesugh Akume

Yesterday, 23 May was the International Day to End Obstetric Fistula, set aside every year for promoting action towards preventing and treating obstetric fistula, a condition that affects many girls and women in developing countries. Cultural and economic factors, as well as available medical services mean fistulas are practically unheard of in the developed world. Nigeria can achieve same with willingness and commitment.

Obstetric fistula is a hole in the birth canal caused by prolonged labor without prompt medical intervention. It’s the most devastating of all pregnancy-related disabilities. Sadly, Nigeria accounts for 40% of fistula cases worldwide.

Approximately 80-95% of the causes of Obstetric fistula occur when a female experiences prolonged obstructed labour and has no access to a Caesarean section. The obstructions occur because the female’s pelvis is too small (in the case of child ‘marriage’ and adolescent pregnancy; the vulnerability for these ones is higher, as the condition is more likely to afflict those who become pregnant while still physically immature); the baby’s head is too big, or the baby is badly positioned.

Those without access to modern maternal health services labour for days, sometimes up five days or more without medical help. Often, the baby dies, many times along with the mother. If the mother survives, she’s left with extensive tissue damage to her birth canal (obstetric fistula). The results are life shattering. She’s henceforth incontinent, unable to control the flow of her urine or faeces. Nerve damage to her legs also makes it difficult to walk.

Rather than being comforted for the loss of her baby, she’s is often rejected by her husband, shunned and left to live a life of social stigmatisation, shame, and isolation by her family, friends, and community. If she remains untreated she could die prematurely from an infection or failed kidney.

Let’s all agree that no woman or girl should be allowed to endure this. 
Obstetric Fistula is both preventable and treatable. Yet more than 400,000 females remain untreated in Nigeria, according to the United Nations Population Fund (UNFPA). Being a preventable and treatable condition, its persistence is a sign that health systems are failing; especially to meet women’s essential needs.

Obstetric fistula can largely be avoided by:

• delaying the age of first pregnancy;

• cessation of harmful traditional practices; and

• timely access to adequate maternal and obstetric care.

Reconstructive surgery by properly-trained, expert fistula surgeons can repair the injury, with success rates as high as 9 out of every 10 for less complex cases.

Unfortunately, the official health policy of the Buhari regime is that the doctor to patient ratio of 1:5,000 is not only adequate and acceptable, it is ‘in excess’ therefore Nigeria may ‘export’ her doctors to other countries.

Further to this, that doctors do not need to specialise, they may go on to be farmers, carpenters, tailors, and seek other vocations, according to both the minister of health, Isaac Adewole and Chris Ngige, minister of labour and productivity both medical doctors.

On the other hand, minister of health has released a list of 14 states in Nigeria that have shown absolutely no interest in the basic healthcare provision fund meant to improve basic healthcare. Both scenarios simply can’t acceptable.

It’s time to end to obstetric fistula and to boldly address the circumstances that perpetuate it, we know them. Let’s all concede and resolve that obstetric fistula is a human rights violation, end it now!