‘Due to COVID-19 fears, I was neglected in labour room; then I began to defecate through my vagina’

When Mrs Ukachuku Amaka, a 31-year-old mother of two, fell into labour in July, she decided to patronise a hospital close to her residence. Restriction of movement due to COVID-19 lockdown in Lagos had prevented her from going to the family hospital where she originally planned to have her baby.

“When I got to the hospital, they said they would do COVID-19 test for me. Soon, I noticed that my husband and I had been left in the labour room. The nurse told my husband that the COVID-19 test came back positive and therefore I would have to be moved to another room,” Mrs Amaka recounted.

She was about climbing the stairs when she realised that the head of her baby was almost out. Her husband and the doctor had barely placed her on a bed in another room when the baby came out on its own. She sustained some tear in her vagina in the process, which the doctor told her was not much. However, what she experienced the next day was much more than she bargained for. She noticed during a visit to the toilet at their residence that faeces were coming out from her vagina. From her experience with the births of her two other children, Mrs Amaka knew it was abnormal for faeces to be coming out from the vagina.

“This is not my first baby, so I knew that it was abnormal. But I was too scared to go back to that hospital to complain because they almost killed me on the day of the delivery of my baby. At the second hospital, the doctor told me it was RVF (Rectovaginal  fistula  and it could only be corrected through surgery,” she said.

Mrs Amaka’s botched delivery had cost N200,000. Again, she had to pay N250,000 to the second hospital to get surgery to stop faeces from coming out from the vagina.

Sadly, however, three repair surgeries later, the problem persisted – and became even worse. She said: “Since that July, each time I looked at my baby girl, I cried. At times, I lied down on the bed and cried. Each time I went to the toilet and I saw faeces coming out from my vagina, I didn’t feel happy at all. I always felt depressed because this was an unusual situation to be in. I said to myself, ‘this is not me’. I felt like I was dying on the inside. It is not a good thing. I don’t pray that even my enemy should pass through this. It can kill.”

But Mrs Amaka’s referral to LASUTH gave her the opportunity to know of a free surgery organised by the Oyo State government, with support from Fistula Foundation of Nigeria, United Nations Population Fund (UNFPA) and Global Affairs Canada, has resolved her problem of abnormal expulsion of faeces

“I had the surgery here two weeks ago, and since then, there has been no complaint. But they asked that we abstain from sex for the next six months and that we eat more of vegetables and light foods to prevent having a hard stool. The surgery was not as painful as the previous ones that I had. Then I could not sit comfortably. This one is different. The pain is not much and I have not experienced what I experienced with the other ones. This is the best.”

Mrs Ruth Afolabi, a 62-year-old daycare centre proprietress, had lived with VVF since 1991 after she had her fifth baby in a Lagos hospital.

“I had prolonged labour. In fact, the delivery was taken by a white man. I went to have a surgical repair in Ilorin, but after six months, urine started leaking again through my vagina,” recounted Mrs Afolabi.

Her solace had been in prayers and her family’s support. But she had kept her incontinence hidden from many people for the past 28 years. “I had been able to cope by maintaining good personal hygiene and my condition is known only to a few members of my family and some people around me,” she added.

Mrs Funmilayo Adelere, a 41-year-old resident of Lagos, will only know if she will be able to have a baby if her VVF surgery is successful.

Mrs Adelere remarried only two years ago but since 2007, she had been looking for a solution to urine leakage from her vagina. The problem started after she had a baby through a caesarean section in Eruwa, Oyo State. She is also without any child of her own.

She had spent over N300,000 seeking solution from different hospitals, including undergoing two futile surgeries. Her husband has abandoned her.

“I was to be delivered of a baby in 2007 at a private hospital in Lagos but the labour was a prolonged one. When the labour persisted, my parents brought me to a hospital in Eruwa. It was a stillbirth. I had a caesarean section but by the time they removed the catheter, urine refused to stop. After three months, I had another surgery at the hospital, and another one in Abeokuta, Ogun State, but the urine problem persisted.

“Here, in Ibadan, before the surgery, I was told that during the previous surgeries, they messed up my privates and my chances of giving birth to a child are remote if this was not corrected through surgery,” said Mrs Adelere.

Oluwakemi Ajibuwa, a 16-year-old JSS3 student from Akoko in Ekiti State, was transferred from a primary health care centre to a private hospital in Ikare to have a caesarean section in May. She had been in labour for four days but couldn’t deliver her baby. She eventually had a baby boy but her dilemma started after her baby died the next day, the man that impregnated her deserted her and she was unable to stop urine from trickling down her legs.

Oluwakemi’s mother, Comfort, a widow and a mother of six, had spent over N500,000 to ensure that Kemi was okay but all had been to no avail.

Cases like these medically termed vesicovaginal fistula are common even in south-western Nigeria, despite the region’s high level of education and its high number of health facilities. Oyo State had planned an intervention to repair VVF in 30 women but ended up with a list of about 150 women who were seeking help in this regard.

Professor Dosu Ojendegbe is leading 10 other doctors to carry out the repairs. He said: “I didn’t know the place would be flooded. We sent about 40 patients away when there was no space for them. We got their names though. Even when we end this particular set, people will still come and if we don’t continue to do the cases, they will keep accumulating.”

Ojendegbe, an obstetrics and gynaecologist, stated that most VVF cases were from prolonged obstructed labour and in places where access to quality maternity service is poor. He listed factors that contribute to the VVF to include illiteracy, early marriage, poverty, deliveries at home with the assistance of quacks or traditional birth attendants, and non-utilisation of formal maternity services.

Dr Ayodele Olagunju, a senior registrar at the Department of Obstetrics and Gynaecology, University College Hospital (UCH), Ibadan, described vesicovaginal fistula, a tear from the bladder to the vagina, as the most common form of fistula. The unusual opening can also be between the vagina and the rectum, the lower part of the large intestine.

Due to the opening between the vagina and bladder, urine will constantly leak from the bladder into the vagina. This can make a woman unable to control urination. Where the opening is between the vagina and rectum, faeces will constantly leak from the large intestine into the vagina.

Dr Olagunju declared that VVF was becoming a public health challenge, saying that the condition is better prevented than treated. “It comes with psychological disturbance; it causes emotional trauma and so it is better prevented than experienced,” he declared.

Permanent Secretary, Oyo State Ministry of Health, Dr Mufutau Ayoola, said ideally, pregnant women should attend antenatal care at facilities where there are skilled officials and a case should be referred promptly when there is the need for a caesarian section or an emergency operation.

He, however, said that in many cases, referral for a caesarian section or emergency operation is late even when it is obvious that there is prolonged labour, thus contributing to some of the VVF cases.

Dr Ayoola added: “Some women that need caesarian section or emergency operation refuse to go; their people say whatever is going to happen to the patient should happen. They say that they cannot afford the cost of treatment. So, there is the need to re-orientate our people. They need enlightenment on where they can get proper care, especially when a woman is in labour, as well as on post-operation care.”

According to Dr Ayoola, “these cases of medical negligence should be investigated appropriately.”

The Oyo State Commissioner for Health, Dr Bashir Bello, said many people do not know the appropriate places to seek treatment for VVF and even when they have an idea of where to go, the cost of surgical correction poses a barrier.

Bello, an obstetrics and gynaecologist, stated that when VVF occurs in a well set up centre, within three days, the condition is corrected.

“They do the necessary surgical repairs, put the catheter in place until it heals,” he stated.

Dr Bello said the state’s recently launched mapping of TBAs and CBOs was intended to further ensure safe motherhood and healthy babies as it was now becoming possible to know hot spots for women dying from pregnancy and its complications and readily take appropriate actions.

According to him, “we will be able to call them to order, educate them and advise them on what to do.”

The commissioner expressed surprise at the large number of women requiring VVF repairs. “Really, I am surprised. At international fora, people take Oyo State to be ahead of these complications. The government initially thought of doing 50 cases, but we have over 100. These surgical corrections cost between N150,000 and N300,000. But this surgery changed their lives entirely. Before, they had limited places to walk to, they had limited gatherings to attend or else people would suspect they smelled of urine. It is an unfortunate case but thank God, Governor Seyi Makinde has been able to come to their rescue,” Dr Bello added.

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