“Once you have VVF you’re isolated from the community,” said Unity Sylvester, the vesicovaginal fistula Nurse Supervisor for in the Médecins Sans Frontières run maternity department of the Jahun hospital. The hospital offers the combination of emergency obstetrics and newborn care.
Vesicovaginal fistula (VVF), is a devastating injury usually caused by obstructed labour. As the baby’s head presses against the birth canal, the surrounding tissue eventually dies, creating a hole between the vagina and the bladder or rectum, through which urine or stool leaks continuously. “You don’t go out. Nobody wants to associate with you. You’re just isolated in the house; your friends don’t visit you anymore. Your husband can even divorce you. There’s a big stigma we’re trying to fight,” Unity said. The fistula will never heal naturally and, more often than not, the baby will be stillborn, adding yet more suffering for the mother.
"Girls get married at 12, 13…it’s a risk factor for VVF. If they have complications they come in very bad"
In remote regions such as northern Nigeria, where obstetric care is scarce, any complications with childbirth can result in a woman being in labour for days. The prevalence of VVF is therefore extraordinarily high. “In this part of the country many of the women don’t go to antenatal clinics and in these northern parts—they’re mostly rural areas—they get married early. Girls get married at 12, 13…it’s a risk factor for VVF. If they have complications they come in very bad,” Unity said, referring to how at that age, the girls themselves are still growing and developing, their pelvis and birth canal too narrow to deliver a baby easily.
Unity has recently taken on the role of VVF Nurse Supervisor, the next step in a career with Médecins Sans Frontières that began several years ago when a former colleague notified her about a position. “He called me and told me that there was an opening for MSF. It was a malnutrition programme in Jigawa. I applied online and then I was called the next day! I travelled all the way from Lagos to Jigawa State just to interview and I was among the successful candidates so I started there as a Malnutrition Nurse in 2010,” Unity said. When the project closed in 2012, Unity moved to maternity at Jahun, eventually transferring to the OT where she quickly gained management experience. “When my supervisor was not around, I acted as the supervisor. When I saw the vacancy [in VVF] I thought I could really supervise a unit, so I applied and was successful,” she said.
The project sees more than 1,000 admissions every month such is the dire need in northern Nigeria. Furthermore, women travel from neighbouring states – and even neighbouring countries – to reach what is known as ‘Jahun Paradise’. “Most of them are not very much well-to-do,” Unity said, understating the poverty of the region. “Many who leave here give testimonies: ‘You can go there, they attend to you for free and you can get maximum care, more than you can get from other facilities in the country. So instead of going to nearby hospitals where they pay money and get less attention, they prefer to take transportation down here with the money they have. It’s free and you get quality care.”