VESICO-VAGINAL FISTULA AND PSYCHO-SOCIAL WELL-BEING OF WOMEN IN NIGERIA

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

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 well-being 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”.

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!

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 psycho-social 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?

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.

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 well-being 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 conducted quantitatively by practitioners in the medical field. This study is thus considered necessary in that it is being conducted by a qualitative researcher

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