04May

I’ve been on my feet for so long that they were beginning to hurt. It was noisy in my head as I thought long and hard about the movie I watched with my wife last night. I willed myself to ignore the pain but it was getting to my knees and one of us -my will or my knees- would have to throw in the towel soon enough. The details of what was happening to my feet was the impaired blood supply (and oxygenation) and drainage from my feet as they were compressed against the cold hard floor.

They called it ischaemia which would result in death/necrosis of the affected tissue if not resolved in due time. Same thing happens during a sprint by a newbie or to a bed-ridden person. My thoughts drifted to my neighbor who had a very bad stroke recently and needed frequent turning to prevent prolonged compression of a part of his body against the mattress, the impaired blood supply/oxygenation and the bedsores that could result from it.

My head was beginning to hurt from flashes of scenes from the movie Dry which was painful to watch but I shuffled my feet subconsciously, feeling warm as active circulation returned to my limbs. I remembered snippets of the conversation with my wife as she explained the whole concept of fistulas in her mummy-non-doctor-to-baby monotone. Despite myself, I chuckled as I recalled my 3-year old daughter nodding vigorously although clueless while her mother explained. She described fistula as the abnormal connection between two epithelial surfaces (of two organs). Like a solid block which becomes separated by any means and each covered by a tape, if put together for any length of time will always be separated by that thin layer of tape. My lips would never become an entity, neither should my toes…that sort of thing

Similar to my pain and the ischemia-necrosis jargon, my wife mentioned that when a baby’s head tries to pass through a narrow birth canal (pelvis) in a condition known as cephalopelvic disproportion, CPD. This could be due to the baby’s head being too big, or the pelvis being atypical or too narrow; all could arise from a variety of causes including a first time and very young woman’s labour experience resulting in the “failure of labour to progress”. CPD causes compression of the vaginal wall against the pelvic bones with intervening muscles of the rectum or bladder/urethra or anything else. Sometimes, a traditional birth attendant gives Gishiri” cuts bringing the baby out at all costs-even dead sometimes. The ischemia-necrosis sequelae ensues if this is prolonged without timely obstetric intervention. The dead tissue falls off after a while creating a new channel connecting two totally different epithelial surfaces as seen in vesicovaginal fistula(bladder-vagina); urethrovaginal fistula(urethra-vagina); rectovaginal fistula(rectum-vagina) amongst others. This allows uncontrolled leakage of urine or faeces through the affected orifices. This will never heal itself unless there’s a surgical intervention.

To think that sometimes fistula can be created deliberately is beyond me! I hear it is even a life- saving procedure in some instances. An ArterioVenous fistula connecting an artery and a vein would be created by a competent surgeon if someone needs hemodialysis; an enterocutaneous fistula done by exteriorizing the bowel could save someone with multiple bowel perforations. So technically, a fistula can be a monster or an angel depending on how you look at it.

It is all very complex and no woman should have to go through this trying to bring forth a new life.I shuffled my feet again as I got closer to my destination, reaching out for the Gala a road-side vendor was shoving in another uninterested passenger’s face, scurrying along as the bus decelerated. I handed him a #100 note and took another sip of water. Stretching and squinting as I got off the bus, I made a mental note not to ever stand in a BRT for such distance again. I do not need a “feet-o-shoe” fistula if that is even a thing.

Dry — is a 2014 Nigerian drama film directed by Stephanie Linus based on child marriage and VVF.

Gishiri — Gishiri or gishiri cutting is a form of female genital mutilation performed commonly by the peoples of the Hausa and Fulani regions of northern Nigeria and southern Nigeria

BRT — Bus Rapid Transport, a bus-based public transport system in Lagos, Nigeria.

CPD — cephalopelvic disproportion

Image Credit: Kristi Ramey

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