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Tackling VVF scourge

•Doctors, patients reveal challenges

From Jude Dangwam, Jos

 

•Some of the women undergoing treatment at the VVF Centre during their reunion day

 

Nigeria is one of the African countries battling with the scourge of vesicovaginal fistula (VVF), an abnormal opening between the bladder and the vagina of a woman that results in leakage of urine and, in some cases, faeces, due to prolonged labour, among other factors.

Some Tiv women performing during the reunion celebration at the centre

 

The country has continued to witness a rise in the number of women with VVF condition, with only six professional doctors that can carry out surgery of all kinds of complicated VVF across the 36 states of the federation and the Federal Capital Territory (FCT).

For poor families like Madam Janet Abegah, from Benue State, who is at the VVF Centre, Jos, Plateau State, with her daughter for surgery, a condition she suffered as a result of prolonged labour during childbirth, the centre is their saviour. She recalled with pain the huge bill of N200,000 requested of them at the Jos University Teaching Hospital (JUTH) before her daughter could get the surgery after visiting five different hospitals in Benue State with final solution got at the VVF Centre, Bingham Teaching Hospital, Jos.

• Little Zulai who is undergoing treatment at the centre

She said: “I heard about the treatment centre in Jos while in Benue State from some of our Tiv people but I didn’t know that the hospital was located here. So, I left Benue for Jos; my daughter is two months and five days now with the condition. I went straight to JUTH and we spent nine days there. They told me to bring N200,000 and I asked them: where would I get N200,000 from?

“They asked me, why did I come there? I told them that I heard that the treatment was free and that was why we came. They said I should bring N150,000, I said I didn’t have it.

“So, they told me to wait for my tribesmen coming the next day. They said there was a doctor who was a Tiv too, if he showed up, I should ask him; he may help us.

•Prof. Lengmang

“So, on Tuesday, the doctor came and asked me. I told him everything, that I had gone to five hospitals. JUTH was the sixth hospital I went to with my daughter over this condition.

“He removed N1,500 from his pocket and gave me. He said I should enter a car to VVF Centre, Bingham Teaching Hospital. So, they billed me N28,000 for bed, which I paid before coming.

•Dr. Kate

“When we came here, they told me to get a card, which I did, and they did the surgery for her. She is on bed rest now. We don’t have any problem now. she is recuperating.

“The only challenge we have is communication, because my daughter cannot even speak English or Hausa. She can only speak our Tiv language. I am the one that often struggles with the English. I don’t know Hausa. So, I am the one that usually communicates with the doctors in broken English language.

“Whenever doctors come, I have to be there. Whatever they ask, I tell her in our language before she responds and I tell the doctor too.”

Mr. Timothy Geoffrey, from Wokos District of Pankshin LGA in Plateau State, whose wife was also treated at the centre, appreciated them for restoring the dignity of his wife and taking away their pains.

Associate Professor Sunday Lengmang, the director of the Evangel Vesicovaginal Fistula Centre at Bingham Teaching Hospital, Jos, shared his experience over the years with Daily Sun.

As a young surgeon, Lengmang started work at the VVF Centre, Uyo, Akwa Ibom State, before proceeding to Jos, where another centre was established 25 years ago.

He disclosed that the centre has so far treated more than 12,000 women since inception, apart from those treated during medical outreaches in other states of the federation at various times.

He said: “I just came back from Gombe on a medical outreach, where we treated 30 women there. They brought another set of 20 women with complex conditions waiting for surgery, again, giving a total of 50 women.” 

He said the centre has four doctors and has over the years continued to receive patients from such states as Gombe, Kano, Katsina, Sokoto, Lagos, Benue and Taraba, among others, for treatment and care, free of charge.

Lengmang called on government at the state and the federal levels to carry out financial interventions towards addressing the plights of women with leakage of urine and faeces, which most times affects their marriage, leading to divorce.

According to the director, “We have four doctors that are involved in the treatment. Three of us are permanent staff, having two, four, seven patients. One of us moved her services to Jos University Teaching Hospital and now only comes on visit to see them on clinic days and to do her surgery on Friday. 

“We have treated over 12,000 with fistula in this hospital. We often visit a lot of centres to do the surgery because a lot of them are so poor that they can’t even afford the cost of fare to come to Jos.

“So, we visit places like Taraba, Gombe, Kano, Sokoto, Lagos and Katsina, one of the oldest VVF centres, and we are planning to go to Kebbi before the year runs out. I go to Uyo four times a year at the oldest fistula mission hospital. Also, I visited Abakalaki where I am a visiting consultant. Apart from that, we travel to different parts of Africa too.

“Part of the challenges we have is that fistula is a lonely area. There are not many specialists globally. In Nigeria, they’re not more than six people that can actually do all the complicated kinds of fistula.

“So, it is a challenge because, wherever I am, I have a long waiting list. There are times that patients will come and they will say it is only Lengmang that can do this surgery and at that time maybe I travelled somewhere, so they have to wait for me.

“There are simple and moderate cases all our doctors can do but the complex cases have to be left for me. So, wherever I travel to, it is complex cases that are waiting for me. It is sometimes challenging that it is only you that can do some type of work and sometimes you get over-burdened by work.”

The director reiterated that the only way forward is training and retaining of more personnel in the field despite the avoidance of the field by medical practitioners.

“You know, people are not interested in an area where people are so poor that they cannot be pay. So, if you are a fistula surgeon and you want to be a successful one then you have to be a good programme manager. You also have to learn how to raise funds. You have to learn how to write reports; you also have to learn several other skills.”

VVF treatment at the Jos centre is totally free, apart from the card patients obtain at the initial entrance of the hospital, leading to an upsurge in the number of persons seeking care at the centre.

“So, you need a lot of resources to take care of them for comprehensive healing because you cannot take care of the surgery without taking care of their needs for nutrition.

“We are talking about a complex kind of surgery that some need to go through three, four to five times for different surgeries before they are healed. We are talking about patients who are so poor that they cannot afford the cost of care, so you have to raise funds to take care of them.”

The total neglect of the field is already posing serious threats to the health of women who might find themselves in this condition and those battling with the condition without the knowledge of a free treatment place like the VVF Centre, Jos.

“There are times we have to go to work beyond our hospital in other states and we need the permission of government to be able to do the surgeries in their hospitals. Sometimes, it is so challenging because it has to go through a very long bureaucratic process and sometimes we just give up.

“Most of the patients are poor and illiterate. So, communicating with them is sometimes a big problem. Most times you have to give instructions up to four or five times before they understand.

“You have to go through two or three interpreters to understand because there is nobody that understands your language. So, you may have to tell someone who will tell someone that will talk to the patient.

“And by the time that communication goes through different carriers, what you are getting may not be the accurate information. So, that gets really frustrating for us even in managing the patients.”

Dr. Kate Burnett, a physiotherapist from the United States working with the centre towards comprehensive healing of the women, said she often engaged some of the women in exercises to enable them walk properly again.

“Some of the women have problems with their legs as a result of child delivery, their legs become so weak that they cannot walk. In such cases, there is no need for surgery, just physiotherapy. So we work as a team with the doctors,” she said.

Chief medical director of Bingham Teaching Hospital, Prof. Stephen Anzaku, said the centre was one of their most cherished units.

He said: “This centre has been in existence for about 25 years, serving these women we believe are the poorest of the poor.

“With the support of funders both within Nigeria and in the US, we have been able to invest in taking care of them. Many of the women stayed with this condition of leaking of urine for over 10 years. We need more funding to further touch lives and expand the centre.”

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