Nigeria: Specialised care for obstetric complications

Transcript

"So in this photo we can see the room where we host about 50 patients, 50 women having to survive to fistula. So that's a very nice room, but it's also a room where they can speak about what happened to them."

ON SCREEN TEXT: Obstetric fistula is caused by prolonged, obstructed labour, when medical care comes too late, or not at all. 

"Also, I see in this picture many patients that are there for two to three months, so they start to bond, a special relationship grows between each other, and they feel that they are like neighbours to each other. They also have mental health care, of course, but they can also discuss the loss of their child together because fistula is mostly a consequence of a problem during the delivery."

ON SCREEN TEXT: Each year, 300 women are treated by MSF medical teams in Jahun fistula centre, Nigeria.

“A lot of them also are divorced because of that. So it's, yes, a room where you can see a lot of hope, but also they are trying as much as possible to survive their wounds, the loss of their child and the loss of their dignity. Sometimes they leave their younger children at home. It’s also difficult for them to be all alone for that amount of time, and also for them to be rehabilitated socially.

"On this picture we can see a midwife looking out for a baby's well-being. It's one of the signs that we look at during the monitoring of a delivery.

"A delivery normally is a few hours, one day max. And here, it can take up to five days sometimes. We don't see obstetrical fistula, for example in Europe or in developed countries, because we have access to C-sections, but also vacuum extraction and these kinds of things. When you don't have access to this, the baby's stuck. And it has a lot of impact on the pelvis. And then when the baby's out, usually asphyxiated or dead, the woman will bleed a lot and will have this necrosis, which will have an impact afterwards."

ON SCREEN TEXT: Women with obstetric fistulas continue to suffer from severe persistent urinary incontinence even after successful fistula closure.

"Mostly what we see is, even when they walk from here to the toilet, they are leaking urine. It's the same for the stools. They are at a very big risk of infection and infertility because of this infection, for stigma and social problems but also depression and psychological troubles because of this.

"So mostly we see women and girls who are very young, less than 18 years old sometimes even less than 15 years old. Their pelvis is not developed enough for a baby, which will be at term. It can be twin pregnancies, it can be malnutrition, it can be women who have had many children, but this one baby is in a position that is not suitable for delivery, and then it gets stuck."

ON SCREEN TEXT: 90% of babies born during obstructed labour leading to fistula are stillborn.

"Normally, when a midwife or any skilled birth attendant is present, we know it directly just by touching. But if there is nobody, then it can take days and days and then have this fistula as a consequence.

"The services that we provide in Jahun Fistula Centre is operation, because it's surgery that is needed. And sometimes it isn’t just one surgery, but it can be consecutive surgeries.

"What we can see on this picture is a lot of shoes from different colours. And it's really representing for me the different women that we host and the different women that are arriving to our doors. It shows well that there is no unique strategy to make [fistula] decrease so quickly.

"What we can say to prevent fistula from happening – it would be mostly to sensitise the communities about having safe deliveries and to access care quickly. So, to sensitise men, but also mothers-in-law and older women from the community. It can be traditional birth attendants, it can be religious leaders, etc. They can provide the necessary decision to seek care without any delay.

"The second thing is to try as much as possible to talk about it during antenatal consultation—to explain the importance of having someone skilled to be able to deliver safely. But also, to have the cost of transportation already saved somewhere in the house. That's more, and more what is done.

"And also, to have the necessary equipment and skilled people all around the Jigawa state."

ON SCREEN TEXT : Fistula is preventable with timely access to skilled birth attendants, emergency obstetric care, and safe transport. This requires political will, community engagement, and sustained investment in maternal health.

"For example, we have one doctor and one midwife who came from Somalia to be trained, and they will open, inshallah very soon, a project in Somalia. But we have also other people from Nigeria who need to be aware of what is happening and how they can be trained and how can they benefit these populations as well.

"So, it's a little bit of a community approach, but also a medicalised approach. It's really what is working well for us together to try to find the best solution for these women and girls."

ON SCREEN TEXT: Obstetric fistula is one of the major complications of unsafe childbirth. Women's and girls' access to trained health professionals and teams during pregnancy and childbirth is a key element in their prevention.

Obstetrician-gynaecologists and midwives, especially with sexual and gender-based violence expertise, continue to be in demand in MSF projects. Please explore more about these roles via the links.