VVF in Nigeria mostly due to CS – NOFIC MD

Johnson Obuna, a Professor of Obstetrics and Gynecology, is the Medical Director of National Obstetric Fistula Centre (NOFIC), Abakaliki, Ebonyi State. In this interview, he said 67 per cent of fistula cases in Southern Nigeria is caused by Cesarean Sections unlike in the Northern region where obstructed labour is the major cause, UCHENNA INYA reports

There is a pool-effort repair campaign currently ongoing in the National Obstetric Fistula Centre (NOFIC), Abakaliki. What is it all about?

This pool-effort is aimed at repairing and rehabilitating about 50 to 100 obstetric fistula patients. It will last throughout this week. The patients are already in the wards and more are coming. The patients came from the 17 southern states and Benue State. Their admission, feeding and surgeries are free.

This campaign is being cosponsored by the Office the wife of the Ebonyi State Governor, Chief Mrs. Rachael Umahi, Gender Unit of the Federal Ministry of Women Affairs, Fistula Foundation and the National Obstetric Fistula Centre (NOFIC), Abakaliki. A team from the Federal Ministry of Women Affairs is already here to take details of the patients with a view to determine how to rehabilitate and empower them. It will interest you to also know that apart from this on-going campaign, daily repair of obstetric fistula cases also takes place in this centre.

Until Covid-19 disruption of services, activities and movement of which Nigeria and Ebonyi State are included, an average of 15 fistula cases is repaired weekly in this centre. So far from 2008 till date, about 4,000 obstetric fistula patients have been treated free in this centre. We have also operated about 3,000 uterine prolapse cases. All fistula repairs here are free.

We have routine repairs which are free and this one we are doing now in a group is called pool-efforts and it is also free. In pool efforts, sometimes, we invite Fistula surgeons from other centres so that there will be enough surgeons to repair these patients as they come. Every day, we repair at least ten and there are many hands repairing at the same time and that is why it is called pool-efforts. We pooled them together to do them at the same time and they are all free irrespective of the method used in the repairs; everything is done free.

What do you think is the major cause of fistula in women?

One of the major causes of obstetric fistula is poor or default obstetric services. Many women due to poverty or ignorance on how to access standard obstetric services, resort to quacks or deliver at home and therefore come up with obstetric fistulas due to absence of supervised labour or poverty. Currently, we are observing ugly and worrisome trends where poorly done cesarean section is increasing, becoming the commonest cause of obstetric fistula in our southern region which is not the same in the North. In the north, it is obstructed labour because many of their children especially girls marry early; their pelvis are not yet developed and they have obstructed labour.

But here, the people that have fistula in this southern part of the country are people that are 28 years, 80 years and their pelvis have grown. They have four, five children but they didn’t go to a proper place for a cesarean section, they go to those who don’t know how to do cesarean section; they do cesarean section poorly and they come up with a fistula.

The research that we just did shows that about 67 per cent of the fistula we have in this part of the world is caused by cesarean section. We have also observed that some of the successfully repaired and rehabilitated patients who got pregnant again still present with recurrent fistulas because they still resorted to quacks for delivery of their babies. It is on this backdrop and the need to prevent both primary and recurrent obstetric fistula, that our centre decided to commence maternal services from Tuesday August 18, 2020.

To what extent can quacks be allowed to conduct this stressful practice of cesarean section?

The issue of cesarean section is a worrying trend. People think that cesarean section is just to open a woman’s tummy and bring the baby out, it is not; there are lots of issues involved. I want to tell us that Nigeria is one of the countries that its health system is abused and the media have to help us. If you go to pharmacy shops, you will see people queuing up buying drugs without prescription. If you do it in Ghana, they will arrest you. If you go to our various laboratories, you will see people doing lab tests the way doctors prescribe it. If you do it in Ghana, they will arrest you.

You will see a lot of people establish private hospitals and no medical doctor is manning it. If you do it in developed countries, they will arrest you but in Nigeria, it is free for all. I wouldn’t even say that lack of education is the cause of all these things because many women that we interviewed when we want to discharge them are graduates and they have a fistula unlike in northern Nigeria where many of them didn’t go to school.

They are graduates who know what they are supposed to know and if you tell them, let us do CS and deliver you, they will say over my dead body. They will go to one place where they will labour, the baby will die and they still do the CS. So, the poor health-seeking behaviour of our people is the underlying factor, that is the truth.

And when you come to CS, there are some that new doctors can do, there are the ones that experienced doctors should do. Under that critical condition, nobody cares who does it again because they are now interested in saving the woman’s life. But if the woman has attended standard antenatal care services, if it is a complex CS, a more experienced person should handle it. So, the underlying problem is poor health-seeking behaviour. We are not really implementing our laws to guide health services.

What other services do you offer in this centre apart from these normal repairs?

Here, we offer free antenatal and delivery services including free caesarean section to all successfully repaired patients who are pregnant and who wish to deliver in our centre, while we offer antenatal and delivery services as well as newborn services at a very subsidised costs to the general public, especially the indigent in order to discourage them from seeking maternity services from untrained and poorly trained birth attendants. The Antenatal services are available Mondays to Fridays while delivery services are available 24 hours every day.

We hope that with this, the tap of the fistula will be closed in our environment. We offer free training for doctors and health workers who are interested in managing fistula cases. As I am talking to you, three doctors from western Nigeria, are here to receive that training and that’s what we have been doing and very soon, we start awarding Master’s Degree and PhD because we are working with Ebonyi State University to make it more interesting so that when we finish, we can award these degrees.

Other services available at the centre include; Renal (kidney) dialysis, free cancer screening and treatment, Invitro fertilisation and embryo transfer (IVF-ET) and family planning services. Our centre has also been designated as the centre for management and rehabilitation of victims of gender-based violence by the UNFPA/FHI 360. This includes victims of rapes and other sexual assaults such as female genital mutilation (FGM), etc. These treatments are free.

People are saying that IVF is no longer effective. How effective is it?

When a man meets the wife during a fertile period, the chances of the woman getting pregnant is 25-35 per cent. Even when he has seen the eggs released, the sperm is fine, she will still not get pregnant. Those who are married know this. The same way it is in IVF.

For IVF, the percentage success is 25-35 per cent. It can be 0, it can be 100 but when you take the average, it is between 25-35 per cent just like you can go once and you get pregnant. Just like you can go once and you get pregnant, you can go several times before you get pregnant but when you take the average for normal conception, it is still between 25-35 per cent. So, IVF is the alternative to the normal method of conception. It is not the first choice, when every other method has failed and there is no other way you can get pregnant, you should come for IVF because there is no other choice.

These women that are being repaired by this hospital need to be rehabilitated after their repairs. What does it take to do this?

We need a rehabilitation centre here because these women need to learn trade. Empowerment is very important and if you just repair them and they don’t have anything they are doing, they will come back. We wouldn’t mind if the state government can help us and build the centre for us. We also need structures; the place we are using for maternity are just temporary and we will be very grateful if the Governor of Ebonyi State can remember us in that regard too and then give us a befitting maternity complex to serve our people.


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