Living with Vesicovaginal Fistula (VVF)
Picture yourself, a young girl living in the villages of northwest Nigeria. The flatness of your chest slowly filling out into mounds. Making it so that when you jump and run around the dusty streets of your village they bounce with you. You are not the only one who sees this change. The men of the village do and they start telling your father about it.
Soon after, Henna is drawn on the length of your arms and feet, your body and clothes are doused with turaren with smoke and you are sent to your husband’s house. Months after you notice changes once again. Your belly swells and you find yourself bringing a life into this world. The pain is unbearable.
What early marriage does is take a child who should be in school or learning a trade, a child who should be playing, laughing and carefree and forces her to grow up, to become a wife and mother when she is hardly an adult. What comes next is foul-smelling and takes away your self-esteem. You sometimes sit and find your clothes soaked in urine.
Your husband leaves, and your child cannot be cared for by you alone because of the accidents and the weakness. So your sister and your mother move you back home. The girls you ran around with have all been forced to become women. Most of them are married out now, not all of them have this affliction.
This is Vesicovaginal fistula.
This might not be you or anyone you know, but it is 44 per cent of girls who live in Nigeria. The reality of over 22 million girls. According to a 2018 study by the UNICEF, 48 per cent of the girls live in the Northeast and west of the country. Vesicovaginal fistula (VVF) is defined as an abnormal passageway between the bladder and the vagina. VVF along with other obstetric fistulas occur 65 per cent of the time amongst girls who have children under the age of 18. Nigeria has the highest number of VVF cases in the world, between 400,000 to 800,000 women living with the problem and about 20,000 new cases coming up every year. Northern Nigeria has the highest rate of VVF and 83.8% of girls in the northeast who have the problem developed it at 14- 16 years.
Samaila Hyelhirra Malgwi, a sexual health educator and community manager at the RevaginateNg and Dr Ogochukwu Okpala, OB-GYN(Obstetrician and gynaecologist) spoke to Document Women on clearer picture of what VVF is.
Dr Hyelhirra defined VVF (Vesicovaginal Fistula as an abnormal opening or tear between the bladder and the vagina that causes continuous urinary inconsistency. “The most common cause of VVF is obstructed labour. Other causes include urogenital malformation, gynecologic, pelvic and urologic surgery,” Dr Hyelhirra said. “Causes are usually dependent on the areas. 90 per cent of the causes of VVF in third world countries is obstructed labour. Usually, it’s more psychological pain for the patient. Because they are in a state where they can’t help themselves. They are usually weak and embarrassed because they have to be often catered for.”
Dr Ogochukwu noted that early childbearing can cause it because younger women tend to have protracted or obstructed labour. This tends to be the case in developing or resource-poor countries. In the west, it’s caused by surgeries and radiation for cancer. Diagnosis is usually made when a woman complains of painless urinary leakage from the bladder (in the case of vesicovaginal fistula). You can have a passage of faeces through the vagina in the rectovaginal fistula.
The diagnosis is confirmed by instilling dye or sterile milk into the bladder with a catheter and then checking the vagina or inserting a tampon in the vagina to check for that same dye colour. Treatment is with a stent or catheter placed for a few weeks if the fistula is small (5mm or length). Otherwise, the only other treatment is surgical by excising the fistula tract and closing up the different layers.
"I have treated It, yes. It was a small vesicovaginal fistula that was diagnosed by the lady leaking continuously. She had had a 4th-degree tear during delivery in America about 8 months back. I had her put in a tampon and then backfilled her bladder. The top of the tampon became orange. Took her to surgery (at 8 months I didn’t think it would heal by itself) and repaired it,” Dr Ogochukwu said, “I haven’t treated a young girl like that but that would be terrible and heartbreaking. I would imagine if she’s already having babies, she may find it difficult to go back to school and then with these symptoms, going anywhere, having more kids, going to the bathroom may be difficult, not to talk of the PTSD.”
Dr Ogochukwu underlines the importance of using a c-section for an immature pelvis. She says education, strong laws, and poverty alleviation schemes would better prevent this. The only form of legislation that prevents child marriage specifically in Nigeria is the Child Rights Act, of 2003 specifically criminalising the betrothal of a child less than 18 years of age But it is not enforced in 11 states in the country which include all the states in the Northeast.
The other form of legislation that guides marriage in Nigeria, the Marriage Act which applies to all the states in the country states that the consent of the father or any other guardian is necessary where the bride is a minor and it sets the age of maturity to 21 years old.
In northern Nigeria, a child who is a Muslim, who has not attained the age of 18 years has the right to contract a marriage under Islamic Law and the marriage contracted will be valid and he shall not be liable for any offence under the Child welfare and protection laws of Kaduna state. Draft Child Protection Bills of Borno, Gombe and Yobe states make similar provisions as Kaduna State’s Law.