Surgeons launch drive to cure incontinence caused by difficult pregnancies

"Fistula Fortnight", a campaign to end the painful and embarrassing childbirth injury that leaves women incontinent, has kicked off in northern Nigeria this week. The United Nations Population Fund (UNFPA) said on Wednesday that 94 women had undergone surgery in the first two days of the drive. “There’s no nice way to talk about it. They (the mothers) leak urine or faeces, or both,” and that results in their being ostracized by their families and the rest of society," said spokeswoman Kristen Hetle. “Fistula is unpleasant to talk about, but easy to cure.” Although fistula was wiped out 100 years ago in Europe and the United States, the World Health Organisation estimates that more than two million people are living with the condition in developing countries, with up to 100,000 new cases being added each year. "These figures are based on the number of women seeking treatment and are likely to be gross underestimates," UNFPA says. Fistula is a condition is often associated with child brides, whose birth canal is not yet fully developed to cope with the pregnancies that usually follow soon after marriage. The end result is several days of obstructed labour. The baby dies in about 95 percent of cases, and the lack of blood flow to the mother's pelvic tissues causes holes in her internal organs, allowing urine and faeces to seep out. Nigeria has one of the highest rates of fistula in the world, with an estimated 800,000 women living with the condition and 20,000 developing it each year, according to UNFPA figures. The condition can be cured by reconstructive surgery that is relatively straightforward. But in the operation costs about US$300 on average and that is well beyond the means of most women who suffer from fistula. Fistula is most common in the mainly Muslim north of the country, where girls as young as 12 years are married off. They often become pregnant before their body has fully developed and this frequently leads to complications at childbirth. Fistula is less common in the south, where women tend to marry at a much later age. Fatima, who comes from the northern state of Kano, was 14 when she married and she fell pregnant soon afterwards.

Fatima's community rejected her when she began leaking urine

“I was in labour for six days. For six days I did not pass stool or urine," Fatima, who eventually gave birth to a stillborn baby, told experts at UNFPA. "When the urine finally came, it came non-stop. That's when I knew I had a problem.” "Urine, the oppressor of the world" Even though sufferers try to keep clean, the smell of urine or faeces is hard to eliminate and many are stigmatised by the community and ostracised by their family members. "The whole community rejected me,” Fatima recalled. “I didn’t go out at all. Anywhere I went, they laughed at me.” In Jos in Plateau state, fistula victims from the Hausa ethnic group have composed a song to deal with the problems they suffer, entitled 'Urine, the oppressor of the world', according to Leonard Wall, a professor at the Washington University in St Louis. "My husband threw me out because I was leaking. If this sickness 'catches you' they'll carry you out and throw you away too," is how the song ends. It is in northern Nigeria that the latest UNFPA campaign is focused. Four volunteer doctors from the United States and Britain have teamed up with 24 Nigerian counterparts to treat hundreds of women at four hospitals in northern Nigeria over the two weeks. All those who are treated have access to specialist nurses after the operation, as well as social workers on hand for counselling. “We hope that the ‘Fistula Fortnight’ will help to heal wounds and renew hope for hundreds of women suffering from fistula in Nigeria,” Thoraya Ahmed Obaid, the head of UNFPA, said in a statement. “It is one step to help address the tremendous backlog of patients and get care to those in need.” Reconstructive surgery, even years after the pregnancy, can cure the condition and treating sufferers is crucial, campaigners say. But so too is preventing women developing the condition in the first place and that means improving maternal care and allowing women with complicated labours the possibility of a Caesarean section. UNFPA launched a campaign to end fistula in 30 endemic countries in Africa, the Arab states and South Asia in 2003. The Nigerian drive started on 21 February and runs to 6 March.