Dr. Halima Mukkadas, a consultant obstetrics gynaecologist, former Commissioner for Health in Bauchi State and currently, a Director of Women, Children and Youth Health Education Initiative (WCYHEI), in this exclusive interview with ALI GARBA, talks about the dangers of early marriage, why VVF is common in the North and other issues
Why is VVF prevalent in the North?
Ninety per cent of VVF patients are divorcees, some are being divorce on their admission bed, while community, husbands rejected and abandon by relations.
As you know Vesco Vagina Fistula (VVF) is not a problem of the developed countries now, but problem of developing countries and this is because they have being able to addressed most of their obstruction emergencies. They have a good system towards handling obstruction emergencies while in developing countries we have challenges with addressing Obstructic emergencies. The most common cause of VVF in the North is more of obstructive labour that usually occurs when the back canal is not adequately in a safe exit of the baby. This occurred because the baby is either too big for back canal or is not laying properly, let me use pelvis as an example, there are bones and soft tissue while the bladder is soft the vagina is also soft tissue, the head of the baby which come press those tissues against the bone of the back canal which is the pelvic and that compression would now injure the bladder and cause a hole between the bladder and the vagina that urine normally stays. Hence, the bladder starts leaking and coming out from the vagina.
If it is a supervised labour by somebody who is experienced, either a midwife or a doctor, she would be able to recognise that this labour is not going very well and she would now take action or refer quickly where action can be taken. However, in the North we have deficiencies of those skilled personnel that would stay with a woman to monitor that labour while in the south, there are more of midwives and doctors to monitor, you can see why we have VVF common in the North.
The second reason is that even if the midwives are available in the North, most of our women would prefer to deliver at home instead of going to hospital where those skilled personnel would monitor the labour. While in the south, the number of those who deliver in hospitals is more than those at home.
Another reason is that if the woman is not well matured, her pelvis is not matured and adequate enough to carry a baby; she can end up with obstructed labour thereby ending up with VVF.
In the North, we have many girls that marry early before their pelvis is matured and then they can end up with pregnancy and end up with labour problem.
And if that labour is not supervised, she will end up with obstruction that can result into VVF. But not all obstructed labours result into VVF. If obstruction is recognised early and caesarian section is done to bring out the baby, then that woman is save from VVF, now if the obstruction is left, labour became prolong and obstructed which may end up with VVF. That is one of the reasons VVF is common in the North.
Another reason, even if a woman is matured however, during childhood when a young girl or as a child she did not have adequate nutrition, such a girl would not attend her optimal state, the pelvis would not mature optimally and would end up being small. Despite the facts that she is matured, the pelvis remains small and she would not be able to deliver on small size pelvis. VVF also occurs in the south however, the number is much more in the North than that of the south.
What is your nonprofit organisation doing to tackle/ prevent girl-child marriage?
There are various preventive measures that we are taking in order to stop or reduce the scourge of VVF in our society. One of it is women empowerments making sure that they are enlightened, making sure that the women have skills in some small trade, so that they generate income and reduce the poverty level of the family. Such ways, there would be food on their table and girls would be given proper nutrition, they would eat well and attend their optimal growth. Other things we are doing include, encouraging girl-child enrollment into school because when you educate a woman she is more likely to be part of decision taken in the house, she is more likely also to delay pregnancy and delay delivery.
Most of these early marriages occur because of poverty and lack of enlightenment.
We are going to the root causes of why the first instance lady is allow to get pregnant when she is a child, when those things are prevented from happening, the parents are encourage to educate the girl- child, she will be part of many decisions that would be made in relations to her upbringing.
We do other things inform of advocacy to policy makers, encourage policies and legislation for the girl-child, we encourage parents to keep the girl- child in school so that we will not have girls taken out of school to be married off before the completion of secondary school. We also encourage that girls are educated free till the end of secondary school so that they would have attained the age of their reproductive system.
For those affected, what are the respite measures in place to help them overcome the stigma surrounding VVF?
There are various issues that are associated with VVF, it is not just the leakage of urine, feaces leak as well. The most important thing is to build them for surgical care, counselled in times of their condition because some come depressed, they have being separated from their husbands, they are rejected by the society because of stigmatisation and their smell, we addressed them in phase and the initial pre-counselling is for them to take care of her hygiene, making sure she clean herself properly so that she doesn’t smell. We also build her up if she has nutritional deficiency or anemia. Some of them even required blood transfusion; some of them come with infection and treat them. The most important part of the treatment is the surgical. The surgery is conducted to close the opening that is causing the leakage so that it becomes dry.
How do husbands of VVF victims treat their wives?
Most of them come in divorce, what we notice is that it usually occurs in first pregnancy. 90 per cent of our patients are divorcees, those that stay with their husbands are those that the VVF occurred after fifth to 10 pregnancy that they have had children with the husbands. The stigmatisation actually starts from their husbands, they reject their VVF wives, blame them for their miserable condition. We have had instances where the husband would follow her to the hospital and tell her go and pack your luggage out of the room, I want to marry another woman to put into that room. Most VVF victims have been living with the condition for years. It is only because of the establishment of this center in Ningi and because the treatment is free that they would now venture to come out for help. They have many social problem because of stigmatisation attached to their conditions.
What about their parents especially in the area of girl-child marriage?
Child marriage is a very sensitive issue because we live in a society where there are various aspects to look at. Some people would say culturally they are used to it and some would talk about the religion aspects, but a girl maturity starts from when her menstruation startsand for a girl to be fully matured to carry a baby, she would have to reach the age of 18. However, a few numbers of girls would have full body maturity that is very fast and their pelvis is big enough to carry a child but most often full maturity would be towards the age and above 18. The Nigeria constitution has clearly stated that any woman below the age of 18 has been taken as the age of adult in Nigeria. So any marriage below that age is child marriage. We try as much as possible to show what is happening all around us because VVF is real. QUOTE-Every year, we do up to 500 surgeries minimum in just one hospital in Ningi. Let’s assume there are so many more out there in their villages that have not come for treatment and come to the number of those that are being operated upon all over Nigeria, those are the ones that have been treated which constitute 10% of those that already have the VVF. So, we are not even talking about those that have VVF those that would develop VVF and die and if care and prevention is not put in place to stop it from occurring. I am calling on parents to delay a little there are so many ways that we can empower these girls, we educate them on how to take care of a child proper before they get married. Those are the things that parents need to know that, if you educate a woman, you educate the whole society.
So, we are encouraging girl-child education as much as possible so that we empowers those girls when they educated they would take care of their children and take proper care of their husbands better than when they are not educated. So we are doing a lot of sensitisation programmes all over. We are using different forum to reach out to parents, communities, traditional leaders, policies makers and with the message that VVF is common in our environment. more common in certain local government than other local government. We want to eliminate VVF in our environment and the way to prevent it is through prevention at various levels.
As a former Commissioner of health, officer in charge National Obstructed Center, what were the health challenges women faced aside the VVF that you recorded?
I am a gynecologist, I have practice for more than twenty years of my life. I have seen so many maternal child health challenges that is bedeviling the state despite all the efforts and support that we have been given at the state. If you go to certain hospitals in Bauchi State, they are many poorly managed primary health centers that suppose to have all the basic services.
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