I was in my early twenties the first time I saw a VVF (vesico-vaginal fistula) patient. She was much younger. She was in a sea of women recovering from the same disease – all sitting on mats, row by row, their urine in bowls in front of them. I was there as a member of an entourage, visiting them as an act of charity. We asked after their health, what they needed, the necessary resources they were lacking; and provided help when we could. Eid was days away and we went round each row, giving each woman a fabric to sew for the festivities of the religious holiday. I remember wondering “what happened to them?” but not being confident enough to ask.
It was years later that I found the courage to start asking questions and the answers are even more horrific that I would have thought. VVF has been described as a “devastating injury in which an abnormal opening forms between a woman’s bladder and vagina, resulting in urinary incontinence.” While this explained the urine bowls in front of the women in the home, it does nothing to explain why most patients – at least, the ones present the day of my visit – were so young. Upon further research, I discovered that although VVF was rare in developed countries, it is widespread in developing countries. Apparently, 30,000 to 130,000 new cases are developed in Africa annually and as of 2018, 3 million women in poor countries were reported to have unrepaired vesico-vaginal fistula.
According to the UN, VVF can be avoided by delaying the age of first pregnancy, the cessation of harmful traditional practices and timely access to obstetric care. Early marriage largely contributes to this and as reported by UNESCO, 12 million girls are married in childhood annually. Without much acceleration, it is expected that by 2030, more than 120 million more girls will be married off before their 18th birthday; by then, the UN hopes to eradicate the practice globally. Child marriage is more harmful than beneficial – from the hindrance to their education to the many medical problems (VVF, early pregnancy, early-onset depression, STDs and STIs, etc) child brides are likely to develop.
In many African communities, girls are married off at a young age, which increases the chances of obstructed labour because their pelvises are not yet developed to full capacity. Because of this, research has shown that many girls “will have their lives destroyed” by obstetric injury before they reach adulthood, since the patients can be as young as 13-years-old. This is worse for girls from underprivileged backgrounds, as is the case in many communities in northern Nigeria. Girls from such backgrounds are undernourished, which restricts the expansion of their pelvis; in such cases, although pregnancy is very much possible, the chances of obstructed labour are extremely high.
The social isolation of VVF patients can also have psychological impact on their development. Some of the women I met in the home had been there for years but had not stepped out because of the way they are seen and treated by other people, who would cringe at the sight of the urine bowl and might make rude or insensitive remarks. But VVF is not shameful; it is a condition. In understanding this, the UN Population Fund and its partners launched a Campaign to End Fistula, which aims to “prevent and treat fistula and rehabilitate and empower fistula survivors. The campaign is currently active in 55 countries and has supported over 113,000 surgical repairs since 2013; its partners supporting thousands more.
On our part, we need to speak much louder and more frequently against child marriage and early pregnancy; educate ourselves and others about VVF; and be as welcoming and accommodating to patients as we possibly can. These are girls who found themselves in their conditions; girls who are suffering as a result of the lack of care in our society. It’s left to us to either choose to facilitate their healing, or further ostracise them. The choice is ultimately ours to make.