HEALTH INTERACTIVE WITH DR AMINU MAGASHI

My Visit to Dambatta VVF Center

cphkano@yahoo.co.uk

 

When I wrote my price entitled ‘ Traditional Practices And Community Intervention that was published on this page of 6th April, 2004, my objective then was to critically examine the practices, why they are being perpetrated and recommended that the best approach to all the  preventable cases is nothing other  than community intervention. I dispassionately  discouraged the attitude of Reproductive Health NGOs and their donor partners sitting down in workshops in urban areas under flamboyant atmosphere in luxurious hotels to engage in reciting figures , reviewing statistics and also adopting a communiqué that is never meant to be implemented , while abandoning the vulnerable and impoverished women and youths  in villages and rural areas in a dilemma and despair  and regrettably  just a quarter of what is being spend in those workshops will be more than enough to address  , halt and reverse the complications of those traditional practices.

 

In line with that article, I received an E  : mail from a woman  leader , Dr ( Mrs. ) Rah mat Mohammad  who was at that time in United Kingdom for a course  also has an NGO in Nigeria that is doing something more or less similar to what was advocated in that article. Although the mail was brief but she urged me to visit  The Vesico-Vaginal- Fistula ( VVF ) center in  Dambatta LGA of Kano state, a center being  manage by an NGO by name Foundation For Women’s Health , Research And Development ( FORWARD ) Nigeria on which she is the Project Director.

 

One thing lead to another, I couldn’t made such visit until when she come back to Nigeria and informed me of her arrival, I regrettably told her of my inability to visit the center and jointly agreed to have the visitation together,  at least that would provide the enabling environment to ask all necessary questions , share information and if possible pass some recommendations  on areas to improve on.

 

On Saturday, 26th June, 04 around 4: 30 PM we arrived at the center in Dambatta, a city not far away from Kano metropolis. Ordinarily I could not have thought that, it is really an NGO that is managing that place.  The surrounding is spacious, and it accommodates two dormitories which reminded me of my Junior Secondary School’s Hostel with nostalgia, a class room, an administrative office, a small health outfit and another small place where I came across sewing and knitting  machines, a kitchen, bore hole, generator e/t/c. Behind the buildings , a large garden  is situated where by one can flock  fruits and cultivate Beans And Groundnuts, so  amazingly, is a poultry and rabbit houses  plus other domestic animals like goats, sheep and cattle. I was told that  the lives stocks  belong to the center for the project to sustain itself.

 

 VVF, an abnormal connection between vagina and the wall of the bladder is a complication or a sequlae of some traditional practices but however , over seventy percent of  all cases is due to prolonged /obstructed labour which could be due to small pelvis that cannot allow fetus to come out or a contractile pelvis due to  diseased bone  and deformity. As we are aware that the growth and development of pelvic bones   are proportional to  increase in age, hence the basis of finding VVF more among underage women. Other issues are to do with traditional delivery procedures  by  birth attendants where by in trying  to widen the birth canal , end of traumatizing the genital part and damaging the bladder wall to cause an abnormal connection with the vagina. Other more worrisome factors are Ignorance and Poverty which resulted in not attending antenatal care and in some cases even if there is an existing health post in the village, it is only a building with no human resources and facilities. From available information majority of VVF cases occur in northern part of Nigeria mostly due to low level of education and awareness. Young women marry, become pregnant without attending antenatal care, attempted labour at home for 2 to 3 days, have still birth and develop VVF, leaking urine, abandon and divorce by husbands and in coming  back to their parents  , are treated with disdain, rejected and confine to a remote part of their  homes. This is the typical scenario regarding the social sequlae of VVF. In some worse cases, could not even be accommodated at their homes but resort to roaming the streets as hapless beggars.

 

It was due to some of the social problems mentioned above and as a collective responsibility that the then Kano state government in 1984 built the center at Dambatta for rehabilitation of the patients, but unfortunately abandoned. When Dr Rahmat and her team under the flat form of FORWARD developed the concept of rehabilitation in 1998 and in 1999 the project took off with support from Department For International Development (DFID) And Community Fund UK . The center provides shelter and feeding to VVF patients, teaches them how to read and write and provides treatment in form of repair of the fistula and also teaches them skills on how to engage in business for economic emancipation. As part of reintegration in to  the society, after completion of eleven months rehabilitation, the center provides them with loan to engage in business on  returning  to their community. From available data, the center has graduated  VVF patients /students up to 156 ( 114 who stayed for that period while 42 were attended as out patients and among those that keep in touch with center after graduation, 13  got married and bore children.

 

For VVF patients whom the abnormal connection is repaired, although some school of taught discourage vaginal delivery but a caesarean section (CS). I am of the  opinion that from care full observation, those women who develop VVF are very young with small pelvis, but by the time the fistula got repair and are reintegrated in to the society, they are more matured with wider pelvis and improved on nutritional status and are empowered to be attending antenatal care, by that the earlier factors causing prolonged/obstructed labour  are removed , as such nothing stop them from trying vaginal delivery under supervision in a hospital and of course when one weigh the risks  attached to C.S ( trauma, infection and tissue damage  and with array of quack health personnel parading as experts ) it is better to allow the women to try labour vaginnaly.

 

In conclusion , although the initiative by Dr Rahmat and Forward Nigeria  and  other sincere NGOs else where  that are engaging in community projects is highly commendable but I urge and enjoy them to be more transparent and accountable not only to their donors but the community where the projects are cited  by involving the local people  from needs Assessment, Design, Implementation, Monitoring And Evaluation.

Lastly, as the saying goes, prevention is better than cure, apart from repair, rehabilitation and reintegration of VVF patients, I call on all stakeholders ( Governments , Civil Societies And Donors   ) to know that no society can fully develop without investing in Antenatal Care And Education (particularly Girl Child); the two interventions are  part and percel of the most important goals in the Famous Millennium Development Goals (MDG)  that was developed by heads of governments and member nations of U.N in year 2000

 

Dr Magashi Is The Executive Director Of Community Health and Research Initiative, Kano , Nigeria .