HEALTH-NIGER: Battle Against Fistula Moves Ahead

By Ousseini Issa Reprint | | Print |

Ousseini Issa

NIAMEY, Aug 26 2004 (IPS) - Zeinabou Baba had just about given up on the prospect of living a normal life by the time aid workers arrived in her village of Tera, west of Niger’s capital û Niamey.

Married at the age 16, Baba had experienced four pregnancies that resulted in stillbirths – and the development of a condition known as obstetric fistula.

This disability can occur if a woman’s pelvis is too small to allow for delivery of a child (or if the baby is badly positioned at the time of birth, or its head too big). This leads to obstructed labour that may continue for days, causing extensive damage to the woman’s birth canal that makes her become incontinent. Fistula typically affects poor, young women who do not have access to û or cannot afford û the caesarean procedure that would allow them to avoid this disability.

The unrestricted flow of urine and fecal matter create an odour that often lead to women with fistulas being socially ostracized. In Baba’s case, she was rejected by her husband û and had to return home to her parents. Fistula may also result in nerve damage to a woman’s legs that makes walking difficult.

Matters changed, however, when a team from the United Nations Population Fund (UNFPA) arrived in Baba’s village, offering assistance to women with fistulas. The team arranged for her to visit the National Hospital of Niamey, where she underwent surgery to treat the condition.

Baba eventually returned to her village in 2002, to start a small business with seed capital from the Support Fund Against Poverty (Fonds d’appui à la lutte contre la pauvreté, FALP) û which assists Niger officials and civil society in the fight against poverty.

According to official statistics, Niger has the highest fertility rate in sub-Saharan Africa: on average, women have eight children each. But, it’s unclear how many of them suffer from fistulas.

– There is no exact figure on the number of women with fistulas in Niger, but there must be many since all the factors which correlate with the appearance of fistulas are present,” Nathalie Maulet, a technical advisor on gender issues at the UNFPA office in Niamey, told IPS.

These factors include early marriage, which is very common in rural areas; the continuing practice of female genital mutilation û and a general lack of reproductive health care. Only 30 percent of women in Niger have access to prenatal care, and just 17 percent are assisted in childbirth. Four percent have access to caesareans in the event of complications during the birth.

Poverty and a 91 percent illiteracy rate amongst women also create an enabling environment for fistulas, says Maulet. According to the UN Development Programme’s Human Development Report for 2004, about 61 percent of Niger’s citizens live below the poverty line of a dollar a day.

In recent years, however, fistulas have received greater attention in Niger. Government has joined forces with private health groups to ensure that women who have this condition receive the surgery required to treat it.

ôThese operations are helping to ease congestion in the National Hospital of Niamey. (Previously) many women who needed treatment û some of whom had been waiting for a long time û had taken to living in the hospital,” Kassoum Sanoussi, a surgeon, told IPS.

Bibata Salou, a fistula sufferer from Karma, a village near Niamey, was one of those for whom the hospital became home.

ôI lived in the hospital in Niamey for five years. Only recently was I able to get treatment,” she told IPS.

Adds Salou’s mother, ôAt first, her sister would help her. But as the possibility of treatment lagged, her sister finally returned to her village, leaving Bibata alone in the hospital.”

ôTo us, it was an impossibility that she would ever get better; we were in total despair.”

A fistula eradication network made up of twelve organisations was created in October 2003. ôThis network, which is chaired by the Ministry of Health, aims to end the duplication of effort we’ve seen on the ground regarding operations,” Maulet says.

Reproductive Health for Motherhood Without Risk (DIMOL), a non- governmental organisation based in Niamey, is one of the groups that is involved in the campaign to care for women afflicted with fistulas. More than a hundred women have received medical and social treatment under the initiative.

ôThis operation was made possible by a donation of about 42 million CFA francs (almost 80,000 dollars) from the Canadian Embassy in Niger, through the Support Fund Against Poverty,” Hadiza Abdou, coordinator of the FALP project, told IPS.

According to Ali Amadou, DIMOL’s project manager, ôAmong the women who are cured, 97 have been reintegrated into their communities with 25,000 CFA francs (almost 50 dollars) each worth of seed moneyàThe purpose of the money is to help them start a small business.”

In addition, an appeal has been issued to foreign specialists to come to Niger periodically and perform fistula correction surgeries.

ôIn February 2004, we brought in Professor Kees Waaldijk, a specialist in vesico-vaginal fistulas, to the hospital in Katsina (Nigeria),” says Amadou.

ôHe’s operated on about thirty women, and taught his technique to about forty doctors, surgeons, obstetrician-gyneacologists and anesthetists û as well as students from Niger and Mali,” he adds.

The UNFPA plans to send more health workers for training with Waaldjik in Nigeria, which neighbors Niger.

ôWe hope, with help from the Ministry of Health, to send a complete team, composed of a physician, an anesthetist and two nurses for six weeks of training with Professor Waaldijk,” notes Maulet.

ôThe UNPF granted 40,000 dollars in financial support in 2003 to Niger, as part of the fistula eradication program. During the same year, the country also received a four-year grant for 300,000 dollars from the (United States-based) Bill and Melinda Gates Foundation through the UNFPA,” she adds.