End Fistula: Voices from the frontline

Dr. Gloria Esegbona, obstetric gynaecologist
“The main problem with having Fistula in Nigeria is that you can’t be part of society. You find it very difficult to mingle, not just with your family but with the outside world.

As a woman, that’s very difficult. Something as simple as going to the market, going to get water, social events, going to pray and going to celebrations. You can’t do any of these things while you have this terrible problem.

The surgery gives women back their lives. It gives them hope.

Especially in this part of Nigeria, we find that many of the women are coming from backgrounds where they have traditionally depended on their families for support, so they’re usually housewives. When you become outcast as a housewife, you have no skills to fall back on to support yourself. So, we’re giving them training to produce an income to support themselves.”

Sulana Hassana, 17, patient at Babbar Ruga Fistula Hospital
“[When I went into labour I was] brought to the hospital. First, a doctor was brought to perform an operation immediately, but when he came he said he couldn't do it. So I was taken to [another] place that was full. They passed us on to another hospital. So we went there, and they took a report, but they said ‘look, we're busy.’ They kept saying that we were rural people and they didn't accept me with this [problem].

They left me there for two days, in labour.

I was there lying exposed in this deserted building, and they came and said this was all that could be done, and there were so many women that I couldn't be seen.

It was from the labour that I developed this problem of urination and also defecation.

It's been about 14 months now that I've had this condition.

Fistula has many physical manifestations. You feel discharge that it makes; you see the urine that will fill up and spill out, which did not spill out before.

[At Babbar Ruga] I noticed a change right when the surgical thing was done to me, and there was no hole! It is now that I realize my spirit has been relieved. Clearly [it is] something that I have overcome once and for all.”

Said, community educator, Kankara
“We mobilise the men in the community to ensure their wives go for ante-natal care. We try to identify where these clients are so they can arrange for them to go to the hospital. A challenge is that some men refuse to allow their wives to go to the hospital.” (Said is working with local community leaders to encourage more families to embrace the care offered at hospitals, rather than relying on home-based treatments.)

Moussa Issa, Community nurse & educator, Nasarawa
“It’s terrible, the woman goes through agony. These women are divorced, rejected by their husbands, and ostracized. They end up as outcasts, and are rejected from one village to the next.”

Shimua Hussein, Development Officer, Nasarawa Local Government
”Life for women living with Fistula is not sweet. There are lots of problems, it affects them almost completely. “

Mariam Masanda, nurse, Babbar Ruga Fistula Hospital
“Fistula is just heartbreaking, seeing urine all about. Some [women] will be depressed, some develop psychological problems, so you just have to be patient.

Community mobilization is needed. We must enlighten the villages that if a patient is in labour, let them try as much as possible to see that the patient goes to the hospital to get assistance.

People from the cities don’t develop this kind of problem. Really, these are poor patients—they come from the village, and they have no assistance. Their families leave them, they wind up begging.

Here, we take care of them, we give them pre-operative care, counsel the patients, help correct their nutrition. Some women are so depressed, they don’t want to eat—we need to get them fit for surgery.

Some face stigma, they think maybe it’s not natural to have Fistula. We try to give them therapy, to take away their fear and disturbance.

What makes me feel good about this job is to see the women go home at the end—a high percentage of the patients we operate on heal and go home. They look fit and their system works naturally. They marry again, they deliver again. They become normal.”

Zainab Ali, 40, patient at Babbar Ruga Fistula Hospital
“My labour lasted one day and two nights. [My baby] didn't survive.

When I developed the condition that made me so ill, I was told that there was no place that had the treatment except for this hospital.

A friend of my mother said I should come here, because she had come to have an operation, and she was successfully relieved.

I was operated on. Praise be to God, the operation was successful. Oh, I feel great, I feel great!

I am thankful to God. And I am thankful to those who operated on me, who really helped me out.

May God provide relief to all the workers here and the women here. Yes, every one of them, may God comfort them, may God give them happiness, may God relieve them.”

Maria Ibrahim Mustafa, Primary Health Department, Nasarawa Local Government
“The first thing we need to eradicate Fistula is that we need to get good mobilization for the community, so they know what it is.

The women also need jobs, so that they aren’t alone, and so that the community won’t drive them away.

We face a lot of challenges [in our work] but we have to say a lot of thanks for this project, we are happy this project has been brought [here].

We’ve had a lot of reaction. These women are coming up—before they’d refuse to come, but now they are welcoming the project.”

Sa'adatu Lawal, community educator & former Fistula patient
Sa'adatu Lawal spent two days in labour without adequate obstetric care, resulting in Fistula which caused her chronic incontinence. In contrast to most women’s experience, her husband has been very supportive of her, staying by her side rather than abandoning her.

Thankfully, Sa'adatu was able to receive reparative surgery and is now fully healed.

“I feel good. I have taken steps to improve my situation. I'm recovered and doing well!”

After receiving training from Virgin Unite and UNFPA, Sa'adatu is helping to educate her community about how to prevent Fistula.

“We get together to advise women, and we educate them, and then they go on to spread the word to those who are not well.”

Sa'adatu feels that the stigma around Fistula is lifting as more women begin to talk about the condition and educate one another. Additionally, she believes that events such as Natalie’s visit help raise awareness and make it easier for the community to talk about the issue.