Women
How Informed Are You About VVF?
VVF, a known
abbreviation for Vesico Vagina Fistula, is one health challenge that has constituted itself a nightmare to women.
Ambiguous as it sounds, experts explain it as an obstetric trauma, occasioned by wrong or poor obstetric practices. But what meaning does that hold for a layman?
In a very simple term; VVF has to do with holes resulting from the breakdown in the tissue between the vaginal wall and the bladder or rectum caused by unrelieved obstructed labour.
The consequences of such damage, experts say, are urinary or faecal incontinence, and related bodily discomforts such as dermattis and erosion of the skin and other tissues in the vulva and vagina from the constant leakage of urine or faeces. In extreme cases, the urethra, bladder and vaginal wall can be completely eroded.
According to medical findings, if nerves to the lower limbs are damaged, women can develop Foot-drop, a loss of co-ordination with one or both of the lower limbs.
Victims of this health phenomenon however, consider the physical challenge, a lesser problem to an acute social problem that comes with it.
Due to constant leakage of urine or faeces, and the accompanying odour, most communities stigmatize these women hence cutting them off from all social activities. Like the biblical story of the “haemorrhage woman” , commuting in public vehicle and engaging in activities that congregate people become extremely difficult.
Aisha (surname withheld) relieves her ordeal as a victim as she said “my husband divorced me because of this problem. Out of shame, I left my father’s house to this city where I feel I’m not known”.
Even where a victim is not overtly stigmatized there is usually a loss of self worth as victims naturally exhibit a withdrawn attitude as if nature has refused to be fair to them and always thinking that everybody is aware and conscious of their predicament.
VVF was first referenced in 1550 BC otherwise it was observed in the mummies of Ancient Egypt in 2050 BC. It was later linked to obstructed labour in 1030 AD
Like a minor problem observed in just a few women, VVF gradually became a problem to contend with in most of what is today known as developed world, including US and Europe between the 17th and 19th centuries.
In 1855, the first world VVF specific hospital was established in New York. However, the incidence of VVF decreased in the face of development.
The Nigerian experience however, appears a far-cry from that of the developed world. Despite the availability of VVF repair facilities in some Nigerian hospitals for some decades now, the problem persists.
Some health analysts have ascribed the reasons to general underdevelopment of community health services structures and widespread poverty, while others blame it on underage marriage/teenage pregnancies, awkward traditional practices (symphysiotomy) and obstructed labour/forced delivery.
While various reasons have been suggested as possible causes of this health phenomenon, it may also be rife to say that individuals’ attitude towards self medicare counts a lot. To many, even in the face of good medical facilities at their door steps, because it is a deviation from the traditional method they patronize, these facilities are never accessed and explored.
However, research indicates that there appears to be a concentration of victims in northern, South-Eastern and middle belt regions of the country.
According to the Federal Ministry of Health between 500,000 and 1,000,000 women/girls are living with VVF, and an estimate of close to 80,000 new cases annually.
The prevalence of VVF seems high in areas poverty is high, especially among women. Also, in areas where education is low, or some cases non existent. It accounts for 75% of loss of babies & 55-60% of divorce rate.
Regrettably, most victims, due either to cost or distance, never make it to any formal medical establishment for appropriate attention.
VVF can be repaired surgically unless they are too large or associated damages to other tissues makes repairs impossible. Treatment is only available in a few specialist hospitals.
More so, once VVF is incurred, and possibly repaired, it is adviceable to have subsequent deliveries by caesarean section to avoid a reopening of the hole.
However, promotion of quality, accessible, obstetric care can be a major step towards reducing the incidence of VVF while prevention and awareness of the problem are equally important.
Sylvia ThankGod-Amadi
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