VVF: Scourge of Very Vulnerable Females
I first met Halima some fifteen years ago. It was our first day at elementary school and she could not have been more than four years, the age at which I was enrolled. For a girl of four, I thought then that Halima looked rather small for her age. As children, we all had dreams and it was during one of our rendezvous that Halima said she wanted to be a nurse. We became very close until one day in our elementary class four when Halima stopped coming to school.
The story was that, Halima’s parents divorced when Halima was only three months old. Halima went along to live with her maternal grandparents. But her father was against her being sent to school! Halima had nine brothers and she was the only child of her mother. In a society the male child is king, so Halima’s mother knew her days in the harem were numbered the day the senior wife told her during a quarrel, that she should be ashamed of bearing a girl-child. It was the same reason Halima’s father gave the day he threw out Halima’s mother.
To show his hatred for western education, one day Halima’s father visited her maternal grandfather, took away the young Halima and placed her under the care of the same senior wife who insulted Halima’s mother. Halima’s maternal grandfather could not protest especially after Halima’s father quoted religious texts to support his claim that it is sinful for a girl-child to experience her first menstrual cycle under her parent’s roof without having been married off!
My parents were among the few parents around who believe male and female children should acquire Islamic and western education. I was the eldest of three children, all girls. We attended school but also attended Qur’anic classes in the evening. My parents are devout Muslims and, even though they did not go beyond elementary school, they vowed not to deny their children what their own children the benefit of western education.
I was preparing for junior secondary school when news went round that Halima would soon get married. Halima was two months into her tenth birthday when she was eventually married off to an old farmer and local leader of the ruling party who had three other wives. I have heard stories of young brides but this was the first time I experienced it happen to a close friend. My mother who knew how close I was with Halima felt pity for the girl.
My friendship with Halima blossomed in the few years we were together at school and not even the decision by her father to withdraw her affected our relationship. After she got ‘married’, I thought of breaking off the relationship but my mother told me that was the time Halima would need me most. She was right because Halima looked forward to my regular visits.
In fact, it was during one of my visits that she went into labour. As is the common practice here, a local barber (wanzam in Hausa language) was summoned to ‘operate’ Halima to ease her delivery. It is painful that despite the dangers associated with these ‘surgeries’ that are carried out with unsterilized blades and without anaesthetics, people still engage in the practice. One hour later, Halima was rushed to the much-despised health centre after it became clear she would die in the hand of the local barber. She survived but lost her baby.
It soon became clear that Halima had been badly damaged and had come down with vesico-vaginal fistula (VVF). Known locally in Hausa language as ‘yankan gishiri”, VVF is mainly caused by obstructed labour, early marriage, poverty, illiteracy and women's limited control over the use of family resources. Women and girls with this disability are often abandoned by their husbands and isolated from the community due to the smell and associated shame of urine leakage.
Vesico-vaginal fistula (VVF) is a dehumanizing condition which was first reported around 2050 BC in the literary works of physicians in ancient Egypt. The condition is preventable but, till date it has continued to inflict high morbidity in child brides and young mothers in rural populations in developing countries, mainly in Africa south of the Sahara.
VVF is a major cause of social isolation, marital disruption, rejection and, eventual destitution among girls and young women. In year 2000, Professor Robert F Zacharin in his book “A History of Obstetric Vesico-Vaginal Fistula” painted a gloomy picture faced by VVF sufferers: “In an unequal world, woman with fistula are the most unequal among the unequal.”
Official statistics of VVF worldwide is unknown but the World Health Organization (WHO) estimates that up to 2 million women live with this condition, mainly in developing countries. Nigeria, my native country, has the highest prevalence of VVF in the world with a figure ranging between 800,000 and 1,000,000 women sufferers mainly in rural communities in the northern part of the country. The Federal Ministry of Health estimates that at least 10,000 women come down with the condition annually.
The regular cost of treatment (repair) is put at $250 (about N100,000 in local currency) and this does not include rehabilitation and other hidden cost. This is out of the reach of sufferers. Today, there are less than a dozen centres in Nigeria to cater for less than 4000 sufferers annually. The situation is not helped by federal budgetary allocations to combat VVF since 2012 whose release and disbursement are often shrouded in secrecy. Going by available facilities in Nigeria today, it will take up to 100 years to repair current sufferers even if there are no new cases.
The dire situation has been attested to by Nigeria’s 3rd Strategic Framework for the Elimination of Obstetrics (2019-2023). The document says: “At the current pace however, it is obvious that the country would not achieve its goal of eliminating obstetric fistula within a generation.” The situation has forced victims to look up to the magnanimity of international non-government organizations (NGO’s) that periodically bring surgeons into the country to repair selected victims.
Luck soon smiled on Halima! Four weeks after her near-death experience, a team of foreign plastic surgeons who came visiting at the invitation of a local nongovernmental organisation was at the VVF centre to repair some selected sufferers. Halima was listed among those to benefit from the free surgery. But her husband had earlier sent a handwritten divorce note to Halima on her sick bed. In these parts, ‘sickness’, such as fistula, is valid ground for divorce! It did not even prick the conscience of her husband that he was complicit in the ‘sickness’ that afflicted the poor young girl.
At a tender age when Halima should be in school, she was forced to join the long and growing list of young and divorced girls. Thankfully, the surgery was successful and Halima no longer carried the stench of her urine wherever she went. But stigmatization and rejection from family and community members continued to trail her. Desperate to be rid of her, Halima’s family members searched for a willing husband. It was a decision that essentially put Halima’s ambition of becoming a trained nurse in jeopardy. In a community where many still regard VVF as the handwork of evil spirits, Halima knew her life was not going to be the same again.
It has not been.
Zeenat Magaji is a student of Federal University of Technology, Minna