Expert Harps on Prevention, Emergency Obstetric Care of Fistula

A Fistula Surgeon and Consultant, Public Health Physician, Dr Ado Zakari, has blamed the rise in obstetric fistula cases in rural communities on the absence of preventive and emergency obstetric care.

Zakari stated this in an interview with the News Agency of Nigeria (NAN) in Zaria on Tuesday in commemoration of the 2023 International Day to End Obstetric Fistula (IDEOF).

NAN reports that the day is celebrated annually on May 23, and has “20 years on – progress but not enough! Act now to end Fistula by 2030” as this year’s theme.

Obstetric fistula is a hole between the birth canal and bladder or rectum, caused by prolonged, obstructed labour without access to timely, high-quality medical treatment.

It leaves women and girls leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty.

The surgeon lamented that fistula prevention was the weakest area of intervention in the country, saying “we are getting more and more cases every day.

“The only way we can prevent obstetric fistula is to ensure that pregnant women have access to emergency obstetric care, that is, care during pregnancy and childbirth.

“Once a woman will have access to emergency obstetric care, then there will be no fistula.

“No matter how little she is, no matter how big the parapelvic proportion is, no matter what complication she may have, there will not be any problem.”

The Consultant Public Health Physician also stressed the need for functional health facilities where women would go for ante natal and have the progress of their pregnancy supervised, and deliver when the time for delivery comes.

According to him, many health facilities in rural areas hardly operate for up to eight hours a day, morning and afternoon shift.

He added that even when they operate at night, the equipment are usually inadequate.

“Also, traditionally, our people do not believe in giving birth at a health facility if there is no problem. They feel that you go to a facility only if you have complications.

“Therefore, we need to do a lot to convince our women to go to the hospital to deliver their babies; We need to do a lot to make our facilities ready for any pregnant woman to go and deliver.”

Zakari also identified the activities of quacks as a major contributor to the increasing cases of fistula, particularly among rural dwellers.

According to him, the country needs to do a lot to control the activities of quacks that have been opening facilities anyhow.

He said “can you imagine a Community Health Extension Worker opening a clinic, operating, doing Caesarean Section to women, and damaging their reproductive system, causing fistula.

“Most of the cases we see, especially from some of our rural areas of Kubau and Igabi local government areas of Kaduna State are as a result of the activities of the quacks. We need to address these issues otherwise we will continue to see so many fistula cases.”

He thanked the Kaduna State Government, the Commissioner for Human Services and Social Development, Hajiya Hafsat Baba, the UN Population Fund (UNFPA), Fistula Foundation Nigeria (FFN), other partners for supporting the Vesico Vaginal Fistula (VVF) Unit in Gambo Sawaba General Hospital in Zaria.

He said that the support in the provision of food for patients and consumables for surgical repairs was significantly helping to provide quality care for the VVF survivors.

He appealed to UNFPA to support routine surgery in the facility, disclosing that with adequate consumables and food supply he can operate about 500 patients a year.

The Head of the VVF Unit, Hajiya Fatima Umar, equally thanked UNFPA, Bashir Foundation, Minister of Finance, Budget and National Planning, Mrs Zainab Ahmed, and other partners for supporting the centre.

Umar appealed for sustainability of the support and urged the government, development partners and philanthropists to assist
in training more doctors and nurses to bridge the manpower gap in the facility.