‘Nigeria can achieve zero case of VVF’

Radtizai Ndhlovu

Radtizai Ndhlovu is the United Nation Population Fund (UNFPA) Country Representative in Nigeria. She spoke with EMEKA ANUFORO on what the UN agency is doing to reduce the incidence of Vesico Vaginal Fistula (VVF), in Nigeria. VVF is a subtype of female urogenital fistula (UGF). VVF is an abnormal fistulous tract extending between the bladder (or vesico) and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. Excerpts:

What is the current VVF situation in Nigeria and what are you doing about it?
Vesico Vaginal Fistula is an embarrassing situation for Nigeria. This is because Fistula is as a result of health systems that are not working very well. You don’t have the human resource; particularly the midwives who provide skilled care during pregnancy, delivery and after delivery. If we have enough midwives stationed in all our primary health care centres with the things that are needed in the hospital and women go to deliver there, we will not have fistula.

If people exercise good habit of bearing children, spacing children, not getting pregnant at tender age, if all that is done, it is possible to eradicate fistula.

For me, Nigeria should be an example of countries that will eradicate fistula in Africa because it has the capacity to do that.In the western world, in North America and Europe, they don’t have fistula any more. The very last hospital that treats fistula cases in United States (US) was closed over 100 years ago. This is because there was no need for any fistula surgeon or fistula hospital. We just need to do the right investments around the lives of women and I am sure we can eradicate fistula.So, the situation is embarrassing. Nigeria is the highest burden of Fistula and I feel we need to rectify all these.

Your organization is involved in this, what are the current success stories that you have recorded so far?
We provide a lot of training, building the capacity of our doctors, we have trained over 90 doctors to be able to do fistula surgeries, and we also trained nurses to be able to provide postoperative attention or care to the women who have gone through the surgery. We provided capacity building of the health facilities themselves by providing them with the surgical kits for fistula just to make sure that they have all that is needed for fistula surgeries to take place.

We do what is possible within the available resources, but when you look at the needs and what we are doing is so small even though we are doing so much. But why is it like that? We do so much is UNFPA but the needs continue to grow above what we can do. This is because we are not preventing more cases coming in. Every year we get 20,000 new cases across the country and we can only treat like 100,000 are being treated in a year because this is the capacity Nigeria has. This is like pouring a bucket into water without a base.

For me, we really need to see that the government take it upon themselves to ensure that we midwives in this country and that midwives who have been trained are not left to languish at home with no jobs. They are trained but they don’t get employed and at the end they leave the country or they just do other things apart from midwifery. ‘It is just about training; it is about having practicing midwives who are doing the work of midwifery.

In the course of your job, have encountered resistance from the people you have tried to assist?
I can say resistance. There are certain misconceptions around the issues that were are trying to prevent, especially around the use of contraceptives for women to space their births for young girls not to start child bearing too early. These missing misconceptions are some of the challenges we face.

People have actually given incorrect perception of what family is all about. Family planning is all about quality of life, is about keeping the woman, the baby, the young girl alive. This is because if you don’t, then you have what we call the risk pregnancy where the chances of dying is very high because, one; the girl is too young or the spacing is too close. They needed to rest for the body to regain energy and nutrient and all that is required. This is because giving birth is not a simple thing. It is a very huge complex biological phenomenon, which I think we tend to assume that it is simple. The body needs to be ready for this vigorous incident.For me, this misconception around spacing of pregnancies for people to be health is a big challenge.

Another challenge we have is just the fact that let little girls not fall pregnant. Let not get young girls pregnant. For me, it is rape. The majority of Fistula patients are young girls and most these fistula cases from these young girls become complicated and become inoperable.

These are some of the cases we at UNFPA are trying to help them to accept their condition and help them to be accepted by their communities so that the communities will still take then even though they are leaking and will never be repaired only because we are not using the right methodology of preventing risky pregnancies.

Is it safe to think abortion if a small girl is involved?
No, we don’t do that. We are here to maintain life. For us in UNFPA, we want to keep life that is why we have what is called obstetric emergency care. If it happens that the girl is pregnant, take care of that pregnancy until it reaches full term; monitor it more closely because you know that it is a risky pregnancy. Monitor it during antenatal care and during delivery you analyse. If it’s a midwife, she knows how to analyse it to know whether the girl can deliver the pregnancy without any complication.

Life is important, you should never think about abortion. Never dream or think about it because that life is God’s creation. That is why we have mechanism to still make that girl survive.

Do you think it is possible for us to have zero cases of Fistula in the country?
Yes. It is possible, but the question is, are we ready to make it possible? It is very possible. We know what needs to done. For example, the Federal Ministry of Health has introduced the one functional PHC in every ward, where each of these PHCs will have four midwives and the head of the PHC will be a midwife. That is excellent programme. If we make it work and we really have one functional PHC in every ward in this country with all those midwives functioning and working and also helping the community to come get services from these PHCs, definitely, we will eradicate these problem. If we also help the communities to understand that the use of family and contraceptives is just about quality of life, getting a family that is happy including good food, good education up to the levels that your children can go, Nigeria is blessed with intelligent people, all of them, but we loose all those intelligent young girls by the way side. We never support them to go to school. It is possible. But we also need to address that beside the midwives, the health facilities, and the issue of changing of what family planning is all about so that people can accept it with no fear. Family planning is just more than contraceptives.

For me, it is possible to have zero case of Fistula in the country but people need to change their perception of planning their life, which is family planning.

Have you encountered VVF in the Internally Displaced Persons (IDPs) camps? ‎
Recently we received a request from the Borno state government because its like they observe the increase in women with Fistula in the state including the IDP camps.

Following the request, the UNFPA went to Borno state to access the situation and see what level of support they need from us. Research shows that there women with fistula in the state.

You know with the improvement in the security situation in Borno State, areas that were previously cut off are becoming more accessible and women are now able to come out from their communities. Women who have fistula in the communities and people are not aware are now coming out which shows that there is an increase in women with Fistula in Borno State.

When we access the situation, we discussed with the Borno State Governemnt and what we agreed is that we will support the VVF centre in the state with equipment because the centre have been abandoned since the insurgency started many few years ago. We are supporting them so that they can be able to provide quality fistula services. We are also supporting the centre with consumables for routine surgery so that when these women come in and need repairs will get it.

We also collaborate with the Borno State branch of the Society of Obstetric and Gyneacologists of Nigeria (SOGON) so that the cost of these repairs will be less for the UNFPA.

When we went there, we were able to count physically on the ground 25 women, but by the time we spent two days there, we already had 50 women. It is obvious that the two doctors we have on ground are not able to contain with the increasing cases of women who are coming up with the condition.

Again, we have plans on ground to support the state with expert surgeons who will now go and take care of the difficult cases.You know Fistula; we have simple and complex cases. We are bringing experts from different parts of the world to Borno State to repair those complex cases.

For the long term plans we for the state, we want to build the capacity of the resident doctors in the state so that they will be able to manage that complex in which for now they rely on UNFPA to handle.

Can we now say that Borno need to be declared as a state of emergency as regards Fistula issues?
Let me say the entire Nigeria, not just Borno State. In Nigeria, every day we have 55 new Fistula cases. We need to declare the state of emergency in the entire country. Don’t forget that Fistula is a sign that the health system in the country is not working. Again, there are socio cultural issues that presuppose Fistula including lack of education for girls, early marriage and childbirth and other issues of harmful traditional practices in our communities. Until we tackle these practices all over Nigeria, Fistula will continue to remain an issue for us.
Assuming we are a gathering of local government chairmen, talk to us.

First, I will say fistula is a national problem in Nigeria. We have fistula because we the decision makers, even though we have the needed information on what causes Fistula, but we lack the political will to take action.

Preventing Fistula is the same thing as preventing maternal deaths because they are related. In Nigeria, every day women die as a result of the pregnancy related complications, it is the so-called lucky ones that end up with Fistula. When the Fistula victim ends up with leaking urine, smelling and suffering from stigma, is she really lucky?

For local government chairmen, I will advice them to support agencies like UNFPA and other partner agencies on Fistula and maternal health to improve access to obstetric care and family planning services and tackle socio-cultural issues.