THE phenomenon of Fistula continues to plague many countries including countries in Africa. One of such countries is Nigeria. Despite efforts made by stakeholders towards eradicating this traumatic disease, it remains an urgent enduring problem often rendering sufferers incapable of functioning meaningfully in society. Before delving into some of the myths surrounding the disease, it is fitting to first define what fistula is. Fistula occurs when a baby’s head and/or shoulders are too large for the mother’s pelvis or due to prolonged labour. Fistula was labeled by the World Health Organisation as the single most dramatic aftermath of neglected childbirth. The organisation also notes that more than 75 per cent of fistula patients endure labour lasting more than three days and that for every one woman who gets treated for fistula, 50 more women go without treatment. The disease disproportionately afflicts infant and first-time mothers and millions of women globally including in Nigeria have this illness. Despite this, many women endure the sickness for many years in silence, never seeking help and eventually dying. This is largely because there remains a shroud of secrecy or myth surrounding the illness.
Popular Nigerian Actress and Producer, Stephanie Okereke Linus, in 2015 produced the film ‘Dry’ to capture the issue of fistula and the often socio-psychological trauma it creates for victims within the broader Nigerian landscape. The film narrates the ordeals of 13 year’s old Halima whose life suddenly took a dramatic turn from childhood playfulness to adult problems. Married off to a 60-year-old man by her poor uneducated parents, she experiences rape and other emotional abuse in the hands of her husband. She eventually develops fistula and was drivven off as an outcast in the society. A humanitarian doctor from the UK named Dr. Zara, who is Halima’s biological mother, although unknown to both of them, tries to save her. However, the help came too late.
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Having suffered physically, emotionally and psychologically, Halima died. As depicted in the film, a strong factor in Halima’s death is the belief that her illness is supernatural, resulting from witchcraft or a curse. The Nigerian culture or Pan African belief system encourages strong belief in the existence of a creator. Sometimes this belief system makes it possible to maintain a positive outlook and to be happy despite worrisome situations. It is little wonder then that Nigerians all over the world are known as jolly fellows who always manage to stay cheerful. However, this same belief in the supernatural creates an ever present blame hole for many societal problems including the psychological, financial, domestic and medical. Nigerians may be more likely to seek solution to problems first via this belief system before trying other practical routes. Fistula unfortunately falls into this blame hole. Thus, many rural residents instead of seeing fistula as a physical ailment curable with the right treatment, perceive it as a curse from the gods, or a direct result of witchcraft. Sufferers are then either ostracised and abandoned. In some other cases, they are taken to prayer houses often resulting in delay in treatment, complications and possibly death.
Fistula is a very serious illness with bed wetting as a major symptom. It is not the same as episodes of involuntary bed wetting. However, this is a popularly held belief, especially among rural dwellers. Fistula leaves girls and women continually leaking urine or feces and frequently leading to abandonment by partners, friends, and family. Moreover, physical pain often accompanies the disease and in later stages, death. Interestingly, many individuals do not understand this and often view the disease as a simple case of uncontrolled bed wetting that can easily be stopped or controlled by the individual. Again, contrary to popular belief, fistula is not limited to one region, nationality, ethnicity, continent and so on. In short, it is not limited to one space and time. It is true that the disease is experienced by higher percentages of child brides and thus regions practicing child marriages report higher cases. Also it is popularly referred to as a disease of poverty as many sufferers are too poor to receive treatment. However, and this is very noteworthy, adult women have likewise been reported to have cases of fistula especially women who bear children without adequate spacing. Another group belongs to women who insist on natural birth when complications clearly reveal that a Caesarean session may be the safer option.
Fistula needs a name in Nigerian languages: while this may not directly be called a myth, many professional health workers do not grasp the link between the scope of ignorance and the lack of indigenous name for fistula. The word fistula is from the Latin word fistulae which literally means tube or pipe. However, in Nigeria this word is a double foreign word. It is neither a local word nor English and despite its usage in the medical field, locals do not relate to it as there is no corresponding local word or symbol. This further contributes to myth number two, namely that fistula is a supernatural disease, a curse or the result of practicing witch craft. Many diseases with English names have corresponding names in Nigerian local languages. For example, malaria is called Iba in Yoruba and Ibo, and Zazzabin cizon sauro in Hausa. This distinct name clearly identifies malaria and makes it easier for treatment to be made whether through local cultural herbs or orthodox medicine. Another example is diabetes which the Urhobo call Oga-Ewe. Due to its similarity with diabetes in terms of symptoms, fistula is often confused with diabetes. The Hausa’s equally have a name for normal bedwetting Amalala which reinforces myth number three; that the disease is simply a form of adult bedwetting which would resolve itself on its own.
As stakeholders are constantly trying to proffer permanent solutions to this disease, a local language project where linguists attempt to create specific corresponding indigenous language names for fistula may be worth consideration and generate profitable results in terms of creating awareness for and eradicating the disease.
Moving forward, films can help but fistula is hardly featured.
The Nigeria film industry, Nollywood, has evolved over the last decades as a formidable industry especially with its cinema films. The industry has the capacity to reach millions of people in the country, a platform that many media houses may not easily be able to access. Many young people are more likely to tune in to watch films in the evenings and catch up with the latest TV series than watching the 9pm news.
Sadly, aside from the film Dry by Okereke and a few others, many Nigerian films do not critically depict the issue of fistula as regularly as HIV and birth control issues are depicted. In a 2017 study done in the Sabo area of Ibadan, Oyo State Nigeria, the film Dry was screened before viewers for a number of days, and it was discovered that movie was a profound tool in cultivating attitudes and perceptions regarding the disease. Viewers who commented on the movie said if the message in it was addressed through a book, they might never understand it.
For Fistula sufferers and their families, knowing and understanding these myths can be the difference between getting treatment and remaining positive or spending years alone and being traumatized. On the other hand, all stakeholders can benefit from having this information especially when offering sustainable solutions.It is vital for all in society therefore to take note of what is real concerning the disease “Fistula” and what is a myth.
- Omoweh, a researcher and student of Cultural and Media Studies at the Institute of African Studies, University of Ibadan, writes in via harrietedeyanomoweh@gmail.com
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