Fistula a Men's Issue, Too

KATSINA, Nigeria—About 30 men, seated on scattered plastic bags and straw mats, gather under the meager shade of a nim tree on the grounds of the Babbar Ruga Fistula Hospital. Despite the heat of the midday Nigerian sun, the men, who have accompanied their wives and daughters to the hospital to seek treatment for their fistula injuries, listen attentively to the five women assembled before them.

“We know you are here because you care for your women,” said Beatrice Eluaka, the focal person for Gender, Women’s Health and Development for the Federal Ministry of Health. “We need you to help them. The women have this problem, because they didn’t get to the hospital on time and something went wrong.”

Eluaka journeyed from the Nigerian capital Abuja to Katsina State to counsel prospective patients, their husbands and their families for the “Fistula Fortnight,” the largest surgical effort to treat hundreds of women living with obstetric fistula in northern Nigeria. The Government, at federal, state and local levels, has joined forces with UNFPA, the private sector, NGOs and international and national surgical and medical volunteers to make the two-week event a reality.

Obstetric fistula is a preventable childbirth injury that occurs when a woman endures obstructed labour for days on end without medical intervention to relieve it. Often the child dies, and the woman is left with a fistula injury that causes chronic incontinence.

“In Africa we have a saying that a woman should not be in labour long enough to see the moon twice – for two days,” said Eluaka in English before one of the Katsina social workers translated her words into the local language Hausa. “When you see the first signs of labour, you must take your women to the hospital.”

" Most men don’t know what going through labour is, and things can go wrong at any time. In Africa, we often don’t give men the chance to be part of the labour process. Maternal health is not only a woman’s issue but also a man’s issue and important to society as a whole. "

-- Dr. Lucy Idoko, Assistant Representative for UNFPA Nigeria

An estimated 800,000 women are living with fistula in Nigeria and another 20,000 new cases develop each year. In Nigeria, a woman has a one in 18 lifetime risk of dying from complications from childbirth. By contrast, that figures falls to one in 2,400 in Europe.

“The problem is a result of a number of factors including illiteracy, poverty and the low status of women,” said Eluaka. “We are trying to prevent this problem by sensitizing these women, their husbands and their families so together they can protect themselves and spread the message to their communities.”

UNFPA believes that men are essential partners with women in the fight to reduce maternal mortality and morbidity.

“When men know what to do and actually do it, then we will surmount the challenges relating to maternal health,” said Dr. Lucy Idoko, Assistant Representative for UNFPA Nigeria. “Most men don’t know what going through labour is, and things can go wrong at any time. In Africa, we often don’t give men the chance to be part of the labour process. Maternal health is not only a woman’s issue but also a man’s issue and important to society as a whole.”

Eluaka and the other social workers take the opportunity to discuss other issues with the men, including the importance of girls’ education, income generation, hygiene, access to appropriate and timely medical care and adequate nutrition.

“You are looking very well fed here. We hope your women and children are looking so well,” Eluaka jokes and the men break into peals of laughter. “You must make sure that your children are well fed, particularly the girls. That is because small women, when they start having children, can have difficulties.”

Muhammadu Abubakar accompanied his niece from Zamfara State after hearing about the Fortnight on “Voice of America” radio. Twenty-one-year-old Hauwa delivered a stillborn baby boy after three days in labour. She started leaking urine the same day. After listening to the social workers, Abubakar is committed to helping other women who suffer from fistula.

“Even if I have to use my own money, I will help other women come to the hospital for God’s blessing, the health of the land and being our brother’s keeper,” he said.

Mohammad Sani, from Zamhara State, agreed. His 16-year-old daughter, Ubaida, had been operated on Monday, the first day of the project, to repair her fistula.

“I know other people in my village that have this problem,” he said. “Immediately when I go back, I will tell them to come here for treatment.”

Each of the women who come for the surgery receives both pre- and post-operative counselling. Laraba Samaila is a social worker with the Nigerian Red Cross based in Katsina who is counseling many of the young women who seek treatment.

“I tell them fistula is a preventable and treatable condition,” she said. “Many of them didn’t know that they could be operated on. They have lived a life in depression psychologically, because they thought they had to live with this their whole lives.”

Part of the social workers’ job is to help the young women integrate back into their communities following their successful operations.

“They, themselves, tend to withdraw from the community, and we have to encourage them to mix with people again. They had thought that their fistulas were something evil to punish them,” Samaila said. “After the surgery, they become good health educators in their communities – giving light to other patients, their relatives and even their communities as a whole.”

Wrapped in a bright yellow scarf, Zuwaira Yusef journeyed more than 200 kilometres alone by bus from her town of Dubai to be operated on for her fistula. She painstakingly etches black tape with a razor carving patterns to be used for henna decoration as she talks to Samaila. The 19-year-old is awaiting her fifth surgery to correct the complicated rectal and vaginal fistula that she suffered after her baby boy was delivered stillborn.

“I’m pleading with the pregnant women that they go to the hospital as early as possible,” said Yusef, who hopes to eventually continue her education so that she can help other young women like herself as a health care worker. “I have been encouraging people to treat their fistulas, and I will continue to enlighten them.”

—Angela Walker