How BFF Is Reintegrating Obstetric Fistula Patients Back To Society After Free Surgical Intervention

Four years after her first child, Pamela Omeire was heavily pregnant with another in 2019. The Imo state indigene, who couldn’t wait to meet her baby boy, happily announced to her parents in-law immediately her water broke.

 As soon as she got to the hospital, she requested to see the doctor but the nurses on duty denied her access to him. As if she had a hunch of what would happen to her, Omeire insisted but was deceitfully told to wait for him in her ward upstairs.

A few hours later, she was induced for her contractions to start. Although she still hadn’t seen the doctor, the expectant mum said she was not worried because she was also induced for the birth of her daughter.

As her contractions progressed, she was wheeled into the labour room and attended to by two nurses who she believed were under qualified. 

“I was told to push and I started pushing. All of a sudden I started hearing the nurses arguing between themselves. One said, see the baby’s head, give her an episiotomy. The other one said the baby has to come out very well. My baby’s shoulder was stuck; one couldn’t come out. When the other nurse saw that it was not going to be easy as the baby could suffocate and die, she rushed out to call the doctor,” Omeire recalled.  

When the doctor brought out Omeire’s baby, he had stopped breathing and had to be resuscitated with oxygen. In the midst of everything, the new mum was concerned for her baby while in pain and bleeding.

She was later moved to the theatre where she was sutured for about eight hours. 

“The delivery happened around 12pm in the noon and I came out from the theatre around 8pm,” she said.

On the third day after delivery, the new mum was taken aback by the discharge that came out of her. When she perceived it, she noted that the smell was bad.

Even though Omeire’s mum and some nurses assured her that the discharge was normal, she insisted on showing the doctor. 

“When the doctor saw it, he screamed. I was so scared and I asked if I was dying. He said no but that I had an infection. He collected my folder, wrote a lot of things and asked my family to buy some antibiotics,” Omeire said.

That, however, did not stop the discharge.

“The discharge was poopoo mixed with blood. Blood is red but when poopoo starts mixing with it, you’ll now be seeing brownish particles. It got worse by the day. If I eat anything, everything will come out.”

Wondering how she got the infection when she was still in the hospital, Omeire decided to find out more about it.

“I had to ask the doctor what kind of infection I had and he responded by saying Obstetric Fistula. That was my first time of hearing about fistula. I had not heard about it before,” Omeire recounts, her face aghast like when she was being told the first time.

What is Obstetric Fistula?

The United States Agency for International Development states that Obstetric Fistula (OF) occurs when complications during delivery result in a hole between the mother’s birth canal and either the bladder or rectum — usually exacerbated by a lack of quality medical treatment.

According to United Nations Population Fund (UNFPA), OF is marked by incontinence of urine, faeces or both, adding that the main types are vesicovaginal fistula (connection between the bladder and vagina) and recto-vaginal fistula (connection between the rectum and vagina).

It further noted that Nigeria contributes about 150,000 cases to the estimated global burden of 2,000,000 cases with 12,000 new cases occurring every year. Sadly, thousands of them are languishing on the waiting list for corrective surgery.

Blaming the inexperienced nurses for her predicament, Omeire said if they had quickly brought out her baby, she wouldn’t have had any business with OF.  In her own case, she had recto-vaginal fistula as she couldn’t control her flow of faeces.

“OF makes you pass out gas through your vagina uncontrollably. It doesn’t alert you that it’s coming. I may be on the bed or in the kitchen and poo will just come out.”

The burden of OF

UNFPA describes OF as the worst maternal morbidity affecting women and girls, noting that patients undergo extreme physical, emotional, and psychological suffering, which persists until it is surgically corrected.

For Omeire’s first surgery, doctors couldn’t finish suturing the opening because it was inflamed. A month later, she went in for a second surgery and it failed the following day. The third surgery failed a few hours after she left the theatre.

The new mum was left to manage her condition while her husband travelled from Owerri where they resided to Lagos in search of help.

“The kind of pain I went through with the various antiseptic products they used to clean my vagina. After cleaning, they will stuff it with gauze. That place would be so intense and I would be feeling pain. I would ask for fan and be crying and pleading”

Omeire said the condition made her isolate herself as she stopped going out and didn’t socialise with people. According to her, she was indoors with her baby.

The new mum also took extra measures to ensure that she kept herself clean.

“When I go to the bathroom to have my bath, I spend like one hour before I come out. As I’m washing, poo poo is coming out. Sometimes, I refuse to eat for days to avoid going to the bathroom to spend the whole time.”

One year after her bitter experience with OF, Omeire got in contact with an initiative dedicated to helping patients with OF. 

A timely intervention

The Bashir Fistula Foundation (BFF), a non-governmental organisation uses four methodologies including providing free surgeries and rehabilitating patients back to society to fight against the menace of Obstetric Fistula.

The executive director, Adewale Barakat, said about 98 women have been reached with 99% rate of successes recorded since September 2018 when the foundation started. 

Omeire is one of the 98 women that benefitted from BFF’s free surgical intervention. Recounting the day her husband called to tell her that he had found help, the mother of two recalled he said someone would call her.

Later, she received a call from Adewale who asked questions about her health, assured her that she would be fine, and told her to meet their partner doctors at Ibadan where the surgery took place.

Two years after the surgery, Omeire happily shares her story to help others like her.

Rehabilitation

Reconciling women with OF back with their families and society is another aspect of the work that BFF does in tackling the condition.

According to Adewale, before a patient is treated, her spouse is invited and educated on the cause of the condition, and the importance of his support for her.

“We ensure that their family members are involved in the treatment procedure so that they are accepted from the hospital before being discharged and taken back home. That could mean inviting the husbands, and even traditional rulers if it gets to that,” the BFF director said.

Adewale also noted that the women are empowered with vocational skills so that they can be financially independent.

According to Adewale: “When such a woman has a source of income, there’s this level of confidence that says I have my money. They now have something to offer the family and so family members cannot outrightly ignore them anymore,” she said.

The beauty of collaboration

So far, BFF’s work is largely dependent on their partnership with relevant stakeholders.

To ensure sustainability, the foundation engages patients’ families in the process of recovery; employs the help of community leaders to reconcile patients with their families; partners with UNFPA for surgical materials; and made a Nollywood actor Boma Ilamina-Eremie their brand ambassador to increase awareness about the problems of OF.

Talking about the impact of this collaboration in regards to Omeire’s case, Adewale said:

“Her husband reached out to us through Boma and they were supposed to come to Zaria for the surgery but while we were on that, UNFPA reached out and said they were doing free surgeries in Ibadan so we linked them with our UNFPA contact in Ibadan.”

How far can BFF go?

Although the Nigerian government is committed to eradicating OF, UNFPA, however, notes that the country would not achieve its goal of eliminating Obstetric Fistula within a generation at the current pace.

While Adewale is doing her best with BFF, she feels that she is yet to scratch the surface due to the challenges she faces in helping more women. For the executive director, funding is the major challenge she encounters in carrying out interventions. 

According to her, the surgery is free in Kaduna State where the foundation is based, but the government does not provide surgical consumables needed for fistula patients.

“The government gives us the hospital, theatre, doctors, nurses, and all but the materials needed are provided by us and UNFPA. A lot of times, UNFPA provides a certain amount in a year but we have to fill in the loopholes. What we do is ensure there is a steady supply of consumables at the hospital,” the BFF director said.

Adewale also noted that there are more women in their isolation point; completely isolated in the bushes, uncompleted buildings, and ostracised from the community that they were yet to reach out to.

“We are only reaching out to those who have the courage to come to the hospital and that’s a failure for me. There are thousands who are yet to be able to find themselves in the hospital. That’s a huge challenge. It feels like there’s a lot to do but you are doing nothing. Until I get good money, we can’t go to the communities and fish out these people.”

The BFF director also decried the lack of specialist doctors who can attend to the various degrees of fistula cases in Nigeria. She noted that there are only two fistula surgeons in Kaduna who can only attend to uncomplicated cases.

Where cases are very complicated, they have to wait for foreign doctors from developed countries.

“The fact that we have very few fistula surgeons in the country is also a challenge. We have to import surgeons for complicated cases, wait for when it is convenient for them, and also give them some allowances,” Adewale said.

According to the BFF director, not just any gynaecologist can dabble into fistula surgery. She recalled a research carried out by the United Nations and quoted in a journal by the National Library of Medicine that barely 33 surgeons provide fistula repair services in Nigeria.

“That’s very low compared to over 500,000 women who are suffering from fistula. So, even if there’s been an increase in the number of fistula doctors we have now, I know it cannot be substantial. So, the fact that we always have to wait for surgeons to be available is another issue.”

“This story has been supported by Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems, solutionsjournalism.org”