ABSTRACT

The problem of vesico-vagina fistula still remains a ravaging scourge in resourcepoor

countries of which Nigeria is visibly prominent. A majority of the cases are

attributed to prolonged complicated labour due to inaccessibility of adequate and

immediate obstetric health care. Complicated labour arises as a result of narrow

pelvis bones of victims due to suffering from poor nutrition. While the above

factors are noted as the direct cause to the prevalent of VVF, there are other

socio-cultural conditions which predispose victims to this disease. Notable

among them are the following: poverty; marital age; illiteracy; hazardous

traditional practices, such as female circumcision. VVF victims often live an

unworthy life. Many of them have been abandoned or divorced by their husbands

and become ostracised by families and societies because of their repulsive smell

and inability to engage in sexual activity and bear children. VVF victims suffer

both physical and social consequences, many of them find it difficult to engage in

any economic activity, surviving the hardship is very complicated and pathetic;

some victims turn to street begging, while others survive through hawking of

“bagged” water and selling firewood.

Most studies conducted on the problem of Vesico vaginal fistula are done from

the medical perspectives, often neglecting the psycho-social consequences

faced by the sufferers. This study, however, discusses the socio-cultural and the

psychological consequences of the disease. Locally and internationally, attempts

are being made to eradicate the problem of VVF, however, if the Nigerian

government does not recognise the incidence of VVF as a major public health

issue, it will continue to ravage lives of Nigerian women, hence increasing

maternal mortality in the country. This study proffers recommendations to help

eradicate or alleviate the problem in Nigeria.

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CHAPTER 1.0 INTRODUCTION

“In Vast areas of the world, in South East Asia, in Burma, in India, in parts of central America,

South America and Africa 50 million women will bring forth their children this year in sorrow, as in

ancient Biblical times, and exposed to grave dangers. In Consequence, today as ever in the past,

uncounted hundreds of thousand of young mothers annually suffer childbirth injuries; injuries

which reduce them to the ultimate state of human wretchedness.

Consider these young women. Belonging generally to the age group of 15-23 yrs, and thus at the

very beginning of their reproductive lives, they are more to be pitied even than the blind, for the

blind can sometimes work and marry. Their desolation descends below that of the lepers, who

though scarred, crippled and shunned, may still marry and find useful work to do. The blind, the

crippled and the lepers with lesions obvious to the eye and therefore appealing to the heart, are

all remembered and cared for by great charitable bodies, national and international.

Constantly in pain, incontinent of urine or faeces, bearing a heavy burden of sadness in

discovering their child stillborn, ashamed of a rank personal offensiveness, abandoned therefore

by their husbands, outcasts of society, unemployable except in the fields, they live, they exist,

without friends and without hope.

Because their injuries are pudenda, affecting those parts of the body which must be hidden from

the view and which a woman may not in modesty easily speak, they endure their injuries in silent

shame. No charitable organisations become aware of them. Their misery is utter, lonely and

complete.”

RHJ Hamlin and E Catherine Nicholson

(Hamlin & Nicholson 1966)

The above quote gives a good grasp on the understanding of the miserable and

gloomy life of young girls who are victims of VVF, a gynaecological condition

which results from childbirth difficulties. The story illustrates the condition of

women who go about during the day with big smelly and tattered clothes in

between the upper cleavages of their legs. At night they go to sleep, albeit

sleeplessness, and wake up in the morning in the middle of wet and stinky

beddings. Getting up from the bed becomes so embarrassing and humiliating.

Theirs is a story of young girls whose first child was born still, and who may

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never have the opportunity of getting married or having babies again. Thiers is a

condition that is avoided in the public discussion because of the high level of

stigma attached to it. Coping with this condition is done in isolation and

loneliness!

It should be noted; however, that medical repair and treatment of fistula is

possible. Whether treated or untreated, its effect on the psychological well-being

of the victims can not be over emphasised.

1.1 BACKGROUND

In most societies of the third world, women are often seen as a vulnerable

gender group, however, the attendant devastating and humiliating effects of ill

health, e.g. VVF further make them more vulnerable in these societies, thus

exposing their emotional instability. These women often see themselves as being

different from other women in several areas, in spite of the fact that their sexual

freedom has already been curtailed, they find it difficult to enjoy their sexuality;

other infectious diseases may also arise; and they age more easily and quickly

than their contemporaries who have not had their womanhood curtailed. This

disrepairable and demoralizing condition thus destroys the psychological wellbeing

of the victims. When someone loses confidence in enjoying a quality life,

she often lives a miserable life throughout her life. This condition is typical of a

Nigerian woman who is a victim of VVF.

The term “vesico” according to the medical profession is called urinary bladder.

Vesico-vaginal fistula is thus the abnormal connection between the urinary tract

and the vagina such that there is an uncontrollable leakage of urine into the

vaginal tract. According to Villey VJ (2006), “VVF is an abnormal communication

between the urinary bladder and the vagina that results in the continuous

involuntary discharge of urine into the vaginal vault”.

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Several literatures reveal that the condition has many causes with variation

depending on the social and educational status of people. Undoubtedly, women

from low and poor social and educational status are more often than not ravaged.

Kabir et al (2003) observed the following to be possible causes of VVF:

prolonged obstructed labour, trauma during operative delivery, infections and

irradiation necrosis from treatment of cervical carcinoma. According to Villey,

numerous factors contribute to the development of VVF in developing countries,

among other cultures, which promotes marriage and conception at a young age,

often before full pelvic growth has been reached.

Thus, an early child-bearing stage, poor physical growth and health of the mother

coupled with poor medical facilities are all contributing to the prevalence of

obstructed labour, hence VVF condition among women in low socio-economic

status of Nigeria.

In spite of the medical consequences (diagnosis, treatment and so on) accorded

the victims of VVF, the psycho-social consequences seem as more unbearable.

In most Nigerian communities, affected women are ostracized from their local

community, divorced, abandoned and remain childless. Since the urinary is

uncontrollable, the affected women always remain wet and smelly, leading to

discomfort and humiliation from people around. According to Sadik (2001),

victims of VVF “often work alone, eat alone, and are not allowed to cook for

anyone. They sleep in separate huts and often end up on the streets, begging for

survival”.

The discrediting effect VVF is a stigma and this is a brutal punch to the

psychological well-being of its victims. A stigmatized individual does not live a

successful and happy life; this is the case of a woman living with VVF!

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Overlooking the vast psycho-social consequences of VVF on its victims is not so

easy to achieve unless social researchers observe her in her own social setting,

thus World Health Organisation (2006) reports “the proper care of fistula victims

requires a holistic approach that pays as much attention to healing the psychosocial

wounds inflicted on these women as it does to curing their physical

injuries.

1.2 AIM

Against the background of the preceding exposition, the aim of my thesis is to

unravel the several factors responsible for the incidence of VVF and to look into

the impact of this disease on the psychological well-being of its victims in Nigeria.

With this, I intend to create an understanding and awareness of the socio-cultural

consequences of the VVF condition among its victims in Nigeria.

1.3 RESEARCH QUESTIONS

The following shall constitute the foci of my study:

- What are those factors responsible for the incidence of VVF in Nigeria?

- What are the psycho-social conditions faced by the victims of VVF?

and

- What are the coping and survival strategies of victims living with VVF?

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1.4 CHOICE AND MOTIVATION FOR THE STUDY

This study represents a part of my overall knowledge in the programme leading

to a Master in Health and Society. And the purpose is to demonstrate my

knowledge and a good understanding of the interaction between health and its

people.

While DJP Barker’s research work on “Mothers, Babies and health in Later Life”

places emphasises on the importance of good health care delivery to women at

both pre and post natal stage as being imperative in preventing some of the

human diseases, such as coronary heart diseases and so on in later life (Barker,

1998:136), my own study, though not primarily about preventing diseases among

women, focuses on the impact of diseases on the quality of life of women, vis a

vis their psychological stability. Thus, my research interest lies in the quality of life

of the vulnerable gender group in Nigerian society, i.e., the women whose

diseased condition has both medical and psycho-social consequences.

VVF victims have traditionally been neglected in reproductive health. The victims

are not getting the attention of programmes, research and donors, often in the

context of interventions to reduce maternal mortality and disability. Sadik (2001)

comments that “so much remains to be done for woman’s health …the frustration

is that the area of maternal mortality and morbidity is a subject about which we

know in the clinical sense, but so little in the social and cultural sense.”

In a lot of literature on the prevalence of VVF, it becomes so obvious that the

explanation and understanding of the phenomenon focus primarily on the

epidemiological (quantitative) perspective; figures and data are mostly used to

explain the prevalence. Maternal mortality and reproductive health are thus

considered and diagnosed quantitatively. The focus on VVF is mostly on its

medical consequences; hence, its social consequences on the victims are

neglected. Against this background, my own interest lies on the psycho-social

consequences of VVF on its victims.

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Since the subject usually stems from the perspective of the so-called “objective”

and hegemonic physicians, the voice and the “real” pains of the victims are

unheard, and when heard, they are usually underestimated with figures.

My choice of research is thus to have a qualitative and phenomenological view of

the patients as they present their everyday life.

This present investigation is motivated and justified in terms of the following:

There is an interest in victims of vesico vagina fistula which places them

more and more in the focus of attention. Due to the dearth of research that

principally explores the impact of the disease on the psychological wellbeing

of its victims, this study is seen as an attempt to respond to this

need.

Most of the research studies concerning vesico vagina fistula have been

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