Vesico-vaginal fistula in Eastern Nigeria

Our objective was to examine the epidemiological determinants of vesico-vaginal fistula in Eastern Nigeria, and maternal characteristics and sociocultural factors predisposing to vesico-vaginal fistula. The case-records of 74 patients with vesico-vaginal fistula were reviewed. The mean age of the patients was 34.1 years and the mean age at occurrence of fistula was 30.1 years. A total of 24 women (32.4%) presented within 6 months of fistula formation. They were mainly multipara, housewives, subsistence farmers and still living with their husbands. A total of 68 (91.9%) developed a fistula following prolonged obstructed labour. Juxta-cervical fistula was the most common, 33 (44.6%) followed by juxta-urethral 11 (14.9%). The other associated morbidity included chronic vulval excoriation, cervical damage and amenorrhoea. Fetal wastage was high with 53 (77.9%) stillbirths and four (5.9%) early neonatal deaths. Vesico-vaginal fistula is still a major problem in the developing countries and a reflection of standard of obstetric care currently available to our women.

Ethical issues in vesico-vaginal fistula care and research

The plight of women in poor nonindustrialized countries who have incurred catastrophic childbirth injuries, such as vesico-vaginal and recto-vaginal fistulas, from prolonged obstructed labor is receiving increased attention from the world medical community. While the good intentions that have prompted this greater concern are not in doubt, intentions by themselves are insufficient guarantees of ethical conduct in programs developed to repair these injuries. Clinical proposals put forward to deal with the problem of fistula must undergo critical analysis to insure that basic ethical requirements are met. This article emphasizes the vulnerability to exploitation of women with obstetric fistulas and reviews the basic principles of medical ethics relevant to fistula care.

Did J. Marion Sims deliberately addict his first fistula patients to opium?

American surgeon J. Marion Sims (1813-83) is regarded by many modern authors as a controversial figure because he carried out a series of experimental surgeries on enslaved African American women between 1846 and 1849 in an attempt to cure them of vesicovaginal fistulas, which they had all developed as a result of prolonged obstructed labor. He operated on one woman, Anarcha Westcott, thirty times before he successfully closed her fistula. Sims performed these fistula repair operations without benefit of anesthesia but gave these women substantial doses of opium afterwards. Several modern writers have alleged that Sims did this in order to addict them to the drug and thereby to enhance his control over them. This article examines the controversy surrounding Sims' use of postoperative opium in these enslaved surgical patients. The evidence suggests that although these women were probably tolerant to the doses of opium that he used, there is no evidence that he deliberately tried to addict them to this drug. Sims' use of postoperative opium appears to have been well supported by the therapeutic practices of his day, and the regimen that he used was enthusiastically supported by many contemporary surgeons.

A Nurse’s Journey to Treat Obstetric Fistulae in Niger

Obstetric fistula is a devastating condition that results from prolonged or unassisted labor. It produces debilitating physical and emotional consequences caused by constant leaking of urine and/or feces. Because high-quality medical care is available throughout the developed world, unrepaired obstetric fistulae are virtually nonexistent in developed nations. However, the condition is rampant in many developing countries, including Niger, a nation in West Africa. This article explains what obstetric fistula is, why it is such a problem, and what nurses and other health care professionals can do to help improve the situation worldwide. It also tells the story of one nurse who went on a volunteer mission to treat obstetric fistulae in Niger, where she met a courtyard full of women she will never forget.

Characteristics of VVF patients as seen at the specialist hospital Sokoto, Nigeria

This paper is a preliminary report of a longitudinal study of VVF patients seen at the specialist hospital Sokoto, Nigeria. Thirty-one (31) patients admitted into the VVF ward during the period, May 1996 to April 1997 were studied. The patients were mainly Hausa/Fulani Muslims (100%), short-statured (mean height, 149 cm), full-time house wives (100%) and were married at the mean age of 13 years. Only 6% of the patients could read or write in English while 81% had Quranic school education only. 60% of the women live in rural communities which lacked, or remotely located to appropriate health care services. Most of the cases developed the disease at the mean age of 15 years. Majority of the cases (77%) did not receive antenatal care while the mean duration of labour for all the patients was 4 days. 84% of the patients were eventually referred to hospital for delivery. Pregnancy wastage rate was 87%. Averagely, twenty-six, (84%) of the patients have had 3 surgical repairs done. Divorce rate following the occurrence of the disease was 55%. Our recommendations include: the integration of maternal and child health (MCH) education in the curriculum of Quranic schools, and advocacy for free antenatal care and delivery services at the primary and secondary levels of health care, special health education programs on maternal health for religious leaders, training of more personnel, and bringing MCH services closer to the grassroots.