By Lola Seriki- Idahosa, Kaduna, North West Nigeria
Jummai Joseph, 35, is a house wife and a native of Wutere, Keffin Gwari community in Kaduna state of Nigeria’s north west region.
For divine intervention, she would have been dead as a result of an ailment known as Vesicular Virginal Fistula (VVF).
Vesico Vaginal Fistula (VVF) is a substype of female urogenital fistula, an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vagina vault, in addition to the medical sequelae from these fistulas, they often have a profound effect on the patient’s emotional well-being.
For the past five years, Jummai said She has been battling with the condition in which there has been uncontrollable leakage of urine from her bladder.
Narrating her ordeals in an emotional ladden voice to Trace Reporter in her small village, about 10 kilometres to Kaduna State capital, Jummai expressed the pain, agony and discrimination she passed through when she was diagnosed of VVF.
Unlike many VVF patients whose husbands and relatives abandoned them upon contracting the sickness, Jummai’s case was however different as her husband stood by her.
“My name is Jummai Joseph. I am from Wutere, keffin Gwari community, aged 35, I am a survivor of VVF and right now I help other women in my community who are living with VVF.”My husband’s love, encouragement, and support helped me to gain a new hope. As we speak, we’ve identified twenty of our women that are suffering from VVF”..
Apart from being ravaged by the scourge of VVF, fate of pregant women in the community which is located along Kaduna-Zaria road is that of uncertainty due to lack of adequate medical facilities and healthcare providers.
“My survival in my five pregnancies was by the grace of God,I view my community as a death trap for our women who are still giving birth, majority of our women are illiterates.
My problem started after the birth of my fifth child who eventually died after birth, sharing her experience, “I had VVF when I was giving birth to my fifth child, when I was pregnant, I had complications due to prolong Labour and I was taken to Kawo hospital, the closest Primary Health Care Center, there it was discovered that I had VVF after I was operated and then taken to Gambo Sawaba hospital in Zaria for treatment.
“Since i became victim of VVF, my life has not been the same again, i gave birth to four without complications not until the fifth one which led to this and I still lost the child during delivery and spent a lot of money for me to be cured.
Women in Keffin Gwari find it extremely difficult visiting hospitals for antenatal Care or child delivery , and in most cases they rely on unskilled traditional birth attendants to deliver their babies.
Some of these deliveries according to her, “end up lossing your child or the mother, only very few of our women survived it.
“I was fortunate to delivere all my Children in the hospital but ended up with VVF while given birth to my fifth child.
Many women, like Jummai, went through the harrowing experience of living with VVF, with some carrying the burden for decades.
One of such women is a 50-year-old widow, Hadiza Usman from the same community. The mother of six who is undergoing repairs at the Hajiya Gambo Sabawa VVF Centre in Zaria . She developed VVF about 20 years ago.
“It has not been easy. I have been at home suffering from it before my husband died seven years ago. My children are the ones supporting me but life has been very hard,” she maintained.”After I discovered the abnormalities in me, my husband was so supporting and helpful to me, as he never neglected me, he stood by me and was so good to me when he was alive.
“Although I suffered silently, at first it seemed like nightmare but as time went on, I began to realise what was actually happening to me, I withdrew into my world of pain and isolation.
“Everybody in my community noticed that I had changed, everyone distanced themselves from me except my husband. I have to develop ways to cope with the VVF, I was experiencing. I got used to it; it became a normal part of my life until I was treated and became normal.
The United Nations Population Fund, UNFPA, observes that although Vesico-Vaginal Fistula, VVF, is a preventable birth injury, it has affected more than 800,000 women in Nigeria with several new cases every year.
According to the Fund, VVF occurs as a result of the tear between the birth canal and the rectum or bladder, leaving a woman incontinent of urine or faeces or both.
Recalling her experience, Jummai told Trace reporter that “I was in labour for 24 hours before I was taken to Kawo Primary Health Care hospital. Unfortunately, in the hospital there was no one to take my delivery, i was there and no one to attend to me.
“After a day in the hospital, a nurse decided to assist me, but sadly, I lost my baby and when I realised I was incontinent of urine, I felt terrible and was confused.
“I was later referred to Hajia Gambo Sambawa General Hospital in Zaria, a specialist hospital where I was treated with support from UNFPA.
In the light of this, medical experts noted that the health of the teen can be compromised by early marriage which may result in VVF.
They warn that other health consequences of early marriage among adolescents apart from VVF may include early child bearing, prolonged or obstructed labour, social exclusion and increased risk of sexually transmitted infections.
They observe that in most cases, victims of VVF are from the poor and illiterate young mothers who live in rural areas with low access to quality maternal healthcare.
They express concern that although some cases of VVF are operated successfully, unlucky victims may have to live with the condition for the rest of their lives.
According to them, if untreated, VVF often leads to social isolation, frequent infections, kidney disease, painful sores and infertility.
Linking VVF prevalence to the rate of Maternal Mortality Ratio, MMR, in Nigeria, Isaac Adewole, the Minister of Health, said Nigeria had the highest MMR.
Maternal mortality is the death of a woman in pregnancy or within 42 days of termination of pregnancy.
But UNFPA has assured the public that it will continue to work with governments and other stakeholders to end VVF and reduce the rate of MMR.
What we need to do is to restate and advocate unhindered women and girls’ right to education and access to reproductive healthcare, information and family planning
In scale and in severity, maternal mortality is the most neglected tragedy of our time; a tragedy that disproportionately affects developing countries, especially in Africa,” according to Abdulraman Suleiman a gynaecologist with Rukaya memorial hospital, Kaduna
He noted that the costs of not taking action on maternal health would mean that poverty eradication efforts would be undermined.
“We need high profile public advocates for maternal health and the rights of young people to reach their full potential in Africa,” he said.
He also noted that more than 55 per cent of pregnant women still gave birth without any assistance from a skilled health worker.
However, observers note that as part of the efforts by the federal government to curtail the situation, Mr. Adewole had, on July 25, inaugurated a task force on accelerated reduction of maternal mortality.
At the inaugurating in Abuja, the Minister was quoted as saying that the high MMR was unacceptable and had become imperative to address the challenge as soon as possible.
“It is noteworthy that a woman is a primary caregiver, nation builder and contributes significantly to the economic and social development of our great country.
“Safe motherhood, therefore, is critical to national development and no woman should die while giving life,” Mr. Adewole said.
By and large, concerned citizens solicit pragmatic approach to some teenage reproductive health issues and the engagement communities and women in the formulation of policies that affect their health.
They, nonetheless, call for the implementation of the National Health Act, 2014, which makes provision for mothers, newborns and under-five year old children to have unhindered access to relevant health services.
This organization saved my life. It was there that I met caring and wonderful counselors and caregivers who prayed with me and gave me encouragement . I had lost the will to live. Their love, encouragement, and support helped me to gain a new hope. I did not know that total strangers would give their all to a woman like me who felt rejected, neglected, abandoned and unloved.
When I fully recovered I began to volunteer in my community as a counselor. From that moment my life took a whole different turn, and I began to give encouragement and support to other people who were living with VVF.
Since then, I have continued my work as a survival of vvf and an activist as well as an advocate for the rights of girls and women who have been living with vvf.
I share this today to thank the Trace Reporter for helping me become who I am today, and to let others know that there is hope. This media did not give up on me, even when I had lost my will to live. They stood by my side even when my community has given up on me, For several months, they were always checking on me, care for my needs and helped me to rebuild my life.
Reacting to the issue of VVF in Kaduna State , the Commissioner for Health Dr. Paul Dogo said , he said ” With respect to VVF, a lot is happening. I want to remind you that the centre is Hajia Gambo Sawaba General Hospital Zaria .It is actually one of the best centres that offers a complete care for patients that is down with VVF because the centre is not only reparing but also doing full rehabilitation where the survivors will be taught some skills that once they go back they can easily get integrated into the communities because many of them have been abandoned by their husbands because of leaking urine.
“But having surgery done, they are dry before they get another suitor or perhaps reconcile with their husbands and go back to their homes. Whether they do so or not, we do provide them with skills that will enable them take care of themselves.
“Kaduna is one of the centres that is doing that holistically. We have been working together with partners. We have brought again our working plan for the year which is being prosecuted in detail. I will request that you visit the facility yourselves to see them and possibly engage them.
“We are proud of that centre. Talking about the distance, it shouldn’t be a barrier from accessing the service. You see, when you are providing services not too many people have the skills. And so it is better you concentrate it in one place so that you can give patients the best. If somebody is leaking urine I’m sure such a fellow will be able to find herself to that centre as long as they are within Kaduna state. Or why do we receive patients from other states. So I don’t think distance is a barrier. We are also looking at the possibility of extending the service to other parts of the state but then, it has to be gradual as we build capacity because we have to train the doctors that will do the surgeries.
“We have to train those that will provide them with skills during admission. So it’s beyond just opening the centre but the centre been able to provide the service. We have this in mind but for now, the centre in Zaria is offering the service. We are also collaborating with developing partners to arrange VVF repair in Kafanchan. These are done occasionally as adhoc arrangement.
“Let me explain something that differentiates the centre in Zaria from other repair terminal. I can do the repair anywhere. But that is not enough, what makes the centre in Zaria to stand out is a complete rehabilitation of the women. You can do the surgery in any hospital but you cannot call it a VVF centre. Barrau Dikko hospital does carry out the repair for instance but the Zaria centre has concentration of services.
“In the provision of healthcare, there are supply and demand sides. That is why we need to consider both in anything we are doing. We have people within the communities that we have trained to help us in providing some essential services. For example there are Traditional Birth Attendants (TBA) that we have trained for conducting delivery in the community. We trained them to understand the danger signs of pregnancy and how they can appropriately refer them to the hospital. This comes with some incentives. What happened in most cases is that, many of them will want to deliver at home and that will lead to prolonged labour and eventually develop VVF after delivery.
“And if you are following, our National Health Survey (NHS) 2013, only about 34 percent or so try to deliver at our facilities. Many of them think they are considered weak if they go and deliver at the hospital hence the VVF occurred.
And to Jumai Joseph ,”After struggling for years, I have come out to speak publicly about my ordeal. I am determined to be a role model for others from similar backgrounds. I want those who are struggling to know that with help like the love and care I received from my husband, they too can change their lives and change the world. She gives thanks to her husband that stood by her and inspired her to help others.