Agony of 46-year-old Woman Living With Irreparable VVF , RVF
Zuwaira Iliya, 46, sits quietly on her hospital bed with catheter showing from the side of her
wrapper as she slowly narrates her 30 years of struggle, living with continuous leakage of urine and faeces.
Iliya of Makarfi Village in Makarfi Local Government Area of Kaduna State has been grappling with Obstetric
Fistula but has kept hope alive in spite of what appears to be a hopeless situation.
She told a correspondent who was at the Vesico Vaginal Fistula (VVF) Unit of
Gambo Sawaba General Hospital, Zaria in Kaduna State, on a special interview to mark the 2023 International
Day to End Obstetric Fistula (IDEOF) that she would be healed against all odds.
She had lived with VVF and Rectovaginal Fistula (RVF) for 30 years, as she contracted the
condition at the age of 16 after her marriage.
Iliya said that she became pregnant soon after her marriage but experienced prolonged labour during childbirth,
adding that she lost the baby and also developed both VVF and RVF in the process.
VVF or Obstetric Fistula, also known as fistula, is a childbirth complication which leads to abnormal opening between
the bladder and the vagina, causing continuous and unremitting urinary incontinence.
The condition is among the most distressing complications of gynecologic and obstetric procedures which can
cause discomfort, and if left untreated, it may lead to serious bacterial infection, which may result to sepsis, a
dangerous condition that can lead to low blood pressure, organ damage or even death.
Similarly, RVF is a communication between bladder and rectum, where faeces pass before getting to the anus, leading
to intermittent leakage of faeces into the vagina.
The development of these conditions, therefore, plunged the young Iliya into a life of agony, and for the past 30 years,
she said she had been struggling with depression, rejection, ridicule and abandonment.
She said “I was married off at the age 16, and immediately became pregnant. When it was time to deliver the baby,
I went into labour for three days.
“I was taken to the hospital for delivery but had a big cut to enable the baby to come out and that was how I developed
VVF and RVF.
“Thereafter, I was taken to a hospital in Kano, where I underwent surgery three times without success. And from
there, I was taken to another hospital in Jos, Plateau State but instead of performing a surgery, the doctor referred
me to this VVF Unit in Zaria.
“Here in Zaria, I was operated twice but still I continue to leak urine and faeces. Notwithstanding, I am still hopeful
that maybe, just maybe if I undergo another surgery, I will be healed.”
Describing her life as “a very sad one”, Iliya said that her husband divorced her in Kano because of the condition
and she returned to her parents’ house.
She added that while trying to get better when her parents took her to the hospital, her mother and father died, leaving her all alone.
She explained that “my life is a life of agony because I was with my mother here in the hospital when she became ill and died,
four days after my second surgery. I went to her burial with this catheter on me.
“And just when I was waiting for another surgery, I received a message that my father was ill. I left the hospital to look after him
and he also died.”
However, in spite of the visibly hopeless situation, relentless Iliya said she would not give up, saying she hopes to get better and
one day give birth to a child.
She said “I have seen how some VVF survivors were operated on and were healed, went back home, became pregnant and
then returned to the hospital and delivered their babies through Caesarean Section (CS).
“This is why I am still hopeful that all is not lost and I have resolved to stay and get well so that maybe God will give me a child,” she said.
On her part, Hajiya Fatima Umar, the Head of the VVF Unit at the Gambo Sawaba General Hospital in Zaria, said there are
more than 20 irreparable fistula cases on the hospital list waiting for help.
Umar said some of the women have even made the hospital their homes, while others live in communities but maintain
contacts with the facility.
She added that “actually, the women have not been finding it easy staying in their environment or in their homes.
Sometimes if they come and they are examined, or if they hear that other doctors are coming from somewhere, they will come.
“If they come, the doctors will examine them. Even if the doctors say they can’t operate on them, they
will still come after a while because they are already comfortable with the hospital environment.
“They prefer to be in the hospital than their homes because nobody is rejecting them here.’’
Also, Dr Ado Zakari, the Fistula Surgeon and Consultant, Public Health Physician, said most of the irreparable
fistula cases were caused by quacks.
According to him, there is nothing doctors can do if the fistula is too wide, and the damage is extensive.
He said “there are situations where the damage becomes extensive and there is nothing we can
do because it is just the question of getting available tissue to repair.
“A situation where the entire tissue has been damaged, there is no way it can be repaired.
“This is because most quacks have no knowledge of anatomy; they operate anyhow. They take out everything,
even the bladder tissue and when you look at it, there is no way you can repair it.
“You cannot create any tissue anywhere and close the fistula. Fistula is a hole, it is a communication, and if it is so wide,
where will you get the tissue to repair it?.
“We have such cases; they are irreparable. We cannot repair them,” Zakari said.(NAN)
Why no Woman Should Die From Cervical Cancer
Cervical cancer is the second most common cancer affecting women in Nigeria and the fourth most common cancer among women globally, according to World Health Organisation (WHO).
Current estimates for Nigeria in 2023 by the Human Papillomavirus (HPV) Centre indicate that every year 12,075 women are diagnosed with cervical cancer and 7,968 die from the disease in the country.
About 3.5 per cent of women in the general population are estimated to harbour cervical HPV-16/18 infection at a given time, and 66. 9 per cent of invasive cervical cancers are attributed to HPVs 16 or 18.
However, with proven interventions to prevent and manage the disease, experts say that no woman is expected to lose her life to cervical cancer.
Prof. Isaac Adewole, a former Minister of Health, Nigeria and Co-Founder, African Cancer Coalition, told in Lagos that cervical cancer had become a public health issue.
Nevertheless, Adewole, a professor at the University of Ibadan and Northwestern University, said the disease which was caused almost entirely by a virus, could be tackled.
He said cervical cancer was preventable and treatable, if presented and diagnosed early.
He said part of the strategies to eliminate cervical cancer included, vaccination of about 90 per cent of girls between ages nine and 14 with HPV vaccine to prevent them from having the cancer.
According to him, it takes about an average of 20 to 30 years for cervical cancer to develop, and the HPV vaccination offers a window of opportunity to kick against the cancer.
He said screening of no fewer than 70 per cent of women using a high-performance test by the age of 35, and again by the age of 45, was also a strategy to save women from cervical cancer.
“When we screen women who are asymptomatic, we have no complaints at all.
“When we screen them, we’ll be able to determine and diagnose stages that occur before development of cancer. We call these stages pre-malignant stages.
“We are able to detect them and when we offer appropriate treatment they will be cured,” said Adewole.
A third way of addressing the cervical cancer menace, according to Adewole, is prompt and appropriate treatment when detected early.
“Even those who develop cervical cancer, when we pick them in the early stages, we can almost uniformly cure them.
“Treatment of women with early presentation as well as invasive cancer management helps.
“When you look at the three factors of prevention, screening, which is secondary prevention; and treatments of early stages, we have a disease on our hands that applying public health principles, we can control,” explained the professor.
Adewole advocated allocation of resources for cancer prevention, detection, treatment and management.
“Cervical cancer disease is common in areas that are not developed or areas where they have not allocated appropriate resources and attention to this disease.
“It is a disease of under development.
“And where you have infrastructure well developed, where you have appropriate policies that are well-resourced, where you have leadership showing interest in this disease, we collectively can eliminate cervical cancer.
“And this has been amply demonstrated through projections scientifically showing that if you do this, then cervical cancer can become something of history,” said Adewole.
According to him, the challenge in Nigeria, just like in Africa and many developing countries, is that a lot of people are largely unaware of the situation with cervical cancer.
Therefore, he said when cases were presented to the hospitals, they were largely in advanced stage, for quite a number of reasons.
The former health minister also noted that the non-availability and affordability of vaccine hindered efforts in the drive to eliminate cervical cancer in Nigeria.
“It is very expensive if you go to the shelf to buy it and then, globally, the developed countries have ‘cornered’ the vaccine for their people because they recognise the value of the vaccine.
“So, we are left at the mercy of Gavi, the Vaccine Alliance (GAVI) and multilateral donors to fund us.
“The prices are coming down gradually but it is still out of reach for most groups.
“But, there is a window or door of opportunity for many as countries that were previously giving two or three shots can now give one and that will free some of the supplies,” continued Adewole.
He said by adopting, introducing and implementing the Global Elimination Agenda for Cervical Cancer Control https://www.cervicalcancerdeclaration.org/, eliminating cervical cancer as a public health issue would be realised.
“Hence, we call for urgent action to make cervical cancer elimination a global priority, with high-level commitment and resources to make it a reality.
“No woman should lose her life to cervical cancer when we have the tools to prevent, and, especially when diagnosed early, to treat it,” he said.
HPV is mainly transmitted through sexual contact and most people are infected with HPV shortly after the onset of sexual activity.
Twelve leading health experts from around the world have initiated a call to action in the fight against cervical cancer through The Global Declaration to Eliminate Cervical Cancer.
The Declaration was formally launched at the World Health Assembly in Geneva on May 22, with signatures from more than 1,200 global health leaders and advocates representing no fewer than 100 countries.
Top among them included former Prime Minister of New Zealand, Jacinda Ardern, CEO of Amref Health Africa, Githinji Gitahi; President of the International Federation of Obstetrics and Gynecology (FIGO), Jeanne Conry, and President-elect of the International Pediatric Association, Naveen Thacker.
Adewole and Prof. Margaret Stanley of Cambridge University, UK and Past President of the International Papillomavirus Society (IPVS), are among the experts championing the declaration.
Stanley told NAN that it was worrisome that 90 per cent of women with cervical cancer lived in low and middle income countries.
According to her, in high income countries like U.S., UK, Europe, there are highly organised medical services which women can access easily.
She added that same services should be replicated in low income countries like Nigeria.
Stanley also agreed that no woman should die from cervical cancer as eliminating the disease was achievable with urgent action in three areas – vaccination, screening and treatment.
“Vaccinating girls aged nine to 14 against HPV is the primary way to prevent cervical cancer.
“HPV vaccines are safe, effective, and can prevent up to 90 per cent of cervical cancer cases.
“Cervical cancer can also be prevented through screening and treatment of pre-cancerous lesions,” said Stanley.
She also recommended the ‘new’ one-dose HPV vaccination regime as part of routine programmes for girls.
The British virologist and epithelial biologist also called for provision of X rays for screening for cervical cancer, while advocating increased access to adequate health facilities and trained health personnel.
According to experts, tools are available to eliminate cervical cancer and everything must be engaged collectively to eliminate the disease and save women from losing their lives to cervical cancer. (NANFeatures)
Bleeding After Intercourse May be Sign of Cervical Cancer— Prof. Adewole
Prof. Isaac Adewole, a former minister of health, Nigeria, says many people are unaware that contact bleeding especially during bleeding or just after sexual intercourse can be early sign of cervical cancer.
Adewole, Co-Founder, African Cancer Coalition, told in Lagos on Thursday in a telephone interview that cervical cancer was preventable and treatable , if presented and diagnosed early.
According to the World Health Organisation (WHO) cervical cancer is still the second most common cancer among women in Nigeria and the fourth most common cancer among women globally.
It is the most common among women ages 15-44 years, claiming 7,900 women’s lives each year from the 12,000 cases reported in Nigeria.
Adewole said: “The challenge in Nigeria, just like the challenge in Africa and many developing countries, is that a lot of people are largely unaware of the situation with cervical cancer.
“Therefore, when they present to the hospitals, they present largely in advanced stage, for quite a number of reasons
“One, they are not aware of the symptoms of early stages which include contact bleeding especially during bleeding or just after sexual intercourse.
“What most women with such incidents usually do is to stay away from their men believing that the bleeding was caused by the man.
“They probably thought it was due to trauma, and some form of injury. And interestingly, when they do that, they bleeding will stop but the disease will continue to progress.
“So, by the time they will have a resurgence of the disease in terms of symptoms, the disease will be far advanced.’’
Adewole, a Professor at University of Ibadan and Northwestern University, said: “So, you have these women moving from one care giver to the other and healing homes to another.
“By the time they finally present at the final destination, maybe a Teaching Hospital, or a private facility manned by a Specialist, the disease would be advanced, and at that stage, it is beyond cure.’’
The former minister of health said about 80 per cent of cases of cervical cancer presented were in advanced stages, and that many healthcare practitioners also missed some of these early signs/stages of cervical cancer.
Adewole told that the trajectory of late presentations could be moved to either no presentation at all or early presentation.
He said that according to the WHO, symptoms of early-stage cervical cancer might include: “Irregular blood spotting or light bleeding between periods in women of reproductive age.
“Postmenopausal spotting or bleeding, bleeding after sexual intercourse; and increased vaginal discharge, sometimes foul smelling.’’
On the causes of cervical cancer, the WHO says, two Human Papilloma Virus (HPV) types (16 and 18) were responsible for nearly 50 per cent of high grade cervical pre-cancers
HPV is mainly transmitted through sexual contact and most people were infected with HPV shortly after the onset of sexual activity.
No fewer than 90 per cent of them cleared the infection eventually and Cervical cancer could be cured if diagnosed at an early stage and treated promptly.
Proffering some solutions, Adewole said a new research on the efficacy of a one-dose HPV vaccine regimen was among several of the factors that could prevent and bring the world closer to eliminating cervical cancer.
He urged increased sensitisation on the disease by governments and stakeholders.
He encouraged that HPV vaccine be given to young girls from ages nine to 14 to prevent them from having the cancer.
He also advised women with symptoms to present early at health facilities for diagnosis.
NAN reports that Adewole is among the 12 leading health experts from around the world moving the powerful call to action in the fight against cervical cancer through The Global Declaration to Eliminate Cervical Cancer.
The declaration was formally launched at the World Health Assembly in Geneva on May 22, 2023, with signatures from more than 1200 global health leaders and advocates representing over 100 countries.
Top among them included former Prime Minister of New Zealand Jacinda Ardern, CEO of Amref Health Africa, Githinji Gitahi; President of the International Federation of Obstetrics and Gynecology (FIGO) Jeanne Conry, and President-elect of the International Pediatric Association Naveen Thacker. (NAN)
Health Professionals Urge Sani to Prioritise Sector in Kaduna
Some experts in the health sector have advised the new Governor of Kaduna State, Uba Sani, to prioritise the sector in order to improve the well-being of the citizens.
The health experts spoke on Wednesday in Kaduna.
Madaki Sheyin, Kaduna State Chairman of the Nigerian Medical Association (NMA), urged the new governor to reverse the trend of brain drain that hit the State especially in the last six years.
According to Sheyin, he should prioritise the health sector because of its importance to the masses.
“Emphasis must be made on human capital development; without a good human resource whatever structures built will not bring the needed gain or positive change,” he said.
He added that training and development, career progression and other incentives would attract manpower to the state.
“Kaduna needs to retain its best hands in the sector and attract many more through improved welfare packages.
“Also, attention must be given to capacity building and development with the right kind of equipment and infrastructure put in place.
“A needs assessment should be done and consultations with relevant stakeholders carried out with the stakeholders being carried along in various stages of policy development and implementation.
He added that public private partnership (PPP) was worth looking at, to curb wastage and improve service delivery and efficiency in the sector.
Dr Nuhu Yusuf, another medical doctor, said improved staff welfare, good working conditions should be one of the priorities the governor should have.
He added that the governor should build good state- of- the- art facilities in the state.
“Fully equipped hospitals, like those obtained in developed countries with modern equipment and should discourage increase in medical tourism.’’
Mr Morakinyo Rilwan, National Chairman, National Association of Nigeria Nurses and Midwives, said the governor should embark on mass employment of nurses and doctors.
“The “japa” syndrome affected health workers in Kaduna seriously and their “japaing” is not to overseas, but to neighbouring states that pay better.
“We congratulate the new administration of governor Sani and our prayers are that God Almighty will guide him to do what is beneficial to the populace.
“However, the expectations of health workers in Kaduna state are not different from what was presented to him during the campaign period when he met with Kaduna state health workers forum and the presentation to the transition committee on May 16.
“So, he should try as much as possible to keep to his campaign promises.
“Hazard allowance should be reviewed upward and we expect him to be workers-friendly unlike his predecessor and dialogue with them on areas that may seem difficult to accomplish.”
He added that health workers, especially nurses suffered in the hands of kidnappers due to lack of security in the hospital and some of these facilities had no perimeter fence.
“Upward review of workers allowances as a motivation for those who are ready to stay back.
“Lastly, he should pay all the arrears of unions and Association check off dues not remitted, to allow professional associations to concentrate on their activities and pay their workers.
“Health facilities should be upgraded with adequate consumables and other working tools,’’ he said. (NAN)
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