04Apr

Introspection on Obstetric Fistula

bashirFistulaSustainability

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

03Apr

One of out of Many — The Story of MURJA (International Day to End Obstetric Fistula)

bashirFistulaAdvocacy

Our Journey in the terrain of putting an end to Obstetric Fistula has exposed us to various cases of fistula patients, ranging from a woman that has been experiencing VVF for over 30 years to that of a 16-year-old teenager that had gone through every humiliating process of being given out to early marriage, experienced Fistula and being subjected to inhumane acts from the society and people that were supposed to protect her.

Some recurring factors come up in all these cases;

– Detrimental/Archaic Cultural Practices and Values

– Gender Inequality

– Bad Health Care System

– Lack of Education, amidst others.

Back to the subject matter which leads us to the brief story of Murja, a 29-year-old lady who had undergone 7 childbirth deliveries, from which only 2 were delivered successfully.

The 7th delivery was the most devasting which eventually led to Obstetric Fistula. Just like many of the cases we have seen, the aftermath mostly leads to the isolation, stigma, fear, depression amidst others. It didn’t take long before she was evicted out of her matrimonial home with 2 children, prior to which the post fistula effect has gone severe with her health. By the time a help call was placed across to us at Bashir Fistula Foundation, she was already under critical health condition.

Let’s take a pause there, Things could have been different for Murja if she grew up in saner climes of being busy acquiring degrees or paving some career path for herself, with accessible quality healthcare and most importantly a society that values/prioritize the growth and development of women.

Today, The International Day to End Obstetric Fistula shouldn’t just be a day of Hashtags but a day we all, as a society reaffirm our stand towards ensuring an environment that provides a better life for every woman in all ramifications: professionally, politically, healthcare-wise, growth and development. A wake-up call to us all.

Note: With the help of our donors and supporters, Bashir Fistula Foundation was able to support Murja, benefited in a surgical intervention done in collaboration with our partner hospital and she has since been a survivor.

08May

Reproductive Software

bashirFistulaRehabilitation

I’m sure the first thing that probably comes to your mind after seeing the phrase “reproductive software” is the iOS, Android OS or maybe Windows OS. You might be wondering if we came to this world with pre-installed software which you haven’t heard about until now. Relax your mind – even though they can be compared in terms of overall function, our reproductive software is completely different from the ones on your devices. 

Just as with your phone which has a hardware and software component, our reproductive system has the same. The hardware (vagina, womb, ovaries, penis and testis) is quite functionless without the accompanying software (hormones like testosterone, estrogen, and progesterone). 

 This article is a sequel to the write-up on reproductive hardware which you can find here. Over the next few paragraphs, we are going to look at how these two components work together, and what really happens when there’s a dysfunction in the hormonal system. 

Before going into the web of connectivity between the two components, let’s take a quick dive into how we all came to be – the process of inception! 

Firstly, for any form of pregnancy to occur, a woman must be ovulating. Ovulation involves the release of an ovum (egg), which then gets fertilized by a sperm cell – if the woman is sexually active. The product of this fertilization is what develops into a baby within the womb. After approximately 9 months, the baby is delivered, becoming the newest cute member of the family. 

Now for these processes mentioned above to occur sequentially and at the right time, the body must release certain hormones at certain times. A reduced or excessive amount of these hormones can lead to fertility problems such as issues with conception (inability to get pregnant), or carrying the pregnancy to term (having early miscarriages). 

Hormonal imbalance is a very common condition among women. Women with hormonal imbalances can have a variety of symptoms. While some might have issues with fertility, others might have problems with the regularity of their menstruation. You then keep wondering why everybody else gets visited monthly and you only get visited 2 or 3 times a year! There is an article that further explains the different types of menstrual disorders which you can find here. 

Just as with women, men are not spared when it comes to the devastating impact of dysfunctional reproductive software. When there is an imbalance of hormones, a man can also have reduced libido and even a reduction in fertility. If it happens at a younger age, they can experience poor sexual development. 

In all, our sexual and reproductive system is a very complex one. I however hope that this has helped to demystify it and that you are a bit more enlightened than you were when you started reading a few minutes ago.

12Apr

Reproductive Hardware

bashirFistulaWomen's health

Hey ladies! Come gather around as I gist you about one of the coolest things ever – the female body! I know all those scientific words can be confusing, so I’ll explain how our amazing anatomy works in a simple way.

First up “down there” are the outer and inner lips that surround the vaginal opening, kinda like bouncers protecting the VIP between them. In between those lips is the clitoris, a bundle of feel-good nerves that love a good party! 

The next stop is the vagina which is basically a super stretchy hallway that connects to the uterus, also called your womb. It can stretch from ‘sexy times’ to pushing out a whole baby during delivery! At the top of the vagina is the cervix, the gatekeeper to the womb. It decides what goes in and out. During your period, it opens just a little, like a door slightly ajar, for blood to pass through, and its sealed shut during pregnancy to protect the bun in the oven.

Further in is the womb, your personal baby-making factory. Shaped like a pear, it expands as the baby develops. When it’s time for the baby to be born, the muscular walls of the womb contract and push the baby out through the vagina. Crazy right? The womb lining also thickens each month getting ready in case a baby is made, then sheds off if you don’t get pregnant. That’s where your period comes from.

On each side of the womb are the ovaries, which hold thousands of tiny eggs. One gets released each month into special tubes called fallopian tubes which have finger-like extensions that guide the egg, like an usher showing you to your seat. This is where an egg meets a sperm, and a baby can start growing! The ovaries also make hormones that control your cycles and moods.

So you see, everything works together in an amazing way! From your first period to sexual pleasure and to being able to have babies someday, your body is goal! Make sure to take care of it and appreciate all it does for you!

17Jan
BFFWH Contraceptive

Contraceptives

bashirFistulaWomen's health

What are Contraceptives?

Contraceptives are things that prevent pregnancy. They are also called ‘family planning’ or ‘birth control’. There are lots of options from pills to IUDs to condoms.

Types of Contraceptives

There are different types of contraceptives, and they work in different ways. Some like condoms work by preventing the sperm from meeting the egg, others like the birth control pill or injections or implants work by releasing hormones that stop ovulation (the release of an egg from the ovaries). Without an egg, pregnancy can’t happen. And there are some natural methods like tracking your ovulation.

Should I be on contraceptives?

It’s something to think about if you’re sexually active. For women who don’t want kids right now, using some type of birth control can be a good idea.

And most importantly...which one should I even start with?!

Everybody is unique, so what works very well for your friend or sister may not work for you o. Let your doctor or nurse know your full health history and lifestyle to discuss the ups and downs of every method. Feel free to ask any questions you have. Then you can weigh the various options and choose the one that’d work for you.

When I want to have a baby, would contraceptives make it difficult?

No! They do their job while you use them, whether that’s 3-5 years for the implant or longer for Your fertility to come right back afterwards—some IUDs.

Ugh, Am I going to gain weight?!

To be honest, you may gain some water weight or bloating at first while you adjust to the hormones. But don’t stress – for most methods, you can assume your body weight will stay the same. If you notice that the ‘fatness’ is getting too much after 3-6 months, chat with your doctor to switch it!

Would it make me moody?

Mood stuff can be complicated and differ from person to person. But plenty of people use birth control with no problem at all. Pay attention to how you feel and if it’s really affecting you, don’t just suffer in silence – get it checked out by your doc right away so you can find the best option for YOU.

Would it make my periods irregular?

Everyone is so different on this! Lots of contraceptives make your periods lighter or you might not even get them at all, which many people love. For others, periods can get more irregular and weirder at first while things stabilize. Keep track of your flow and let your doctor know if things stay scattered for more than three months. There are always more options to try.

Does it cause cancer?

Yes and No. Using birth control pills for years may slightly raise the risk of breast cancer but the good thing is that it also lowers the risks for other cancers like cancer of the ovaries and the womb.

Is it Painful?

Not really. Most types like the implant, patch or pill are not painful to use at all. IUD insertion has some temporary pain however.

Does it affect libido?

Most types do not affect sex drive, but some impacts are possible. Discuss any changes with your doctor.

Does it protect me from HIV?

Only condoms properly prevent the spread of infections like HIV and Hepatitis. Other contraceptives do not.

Where can I get contraceptives?

From doctors, health clinics, pharmacies, or family planning centres.

How long does it last?

Some like IUDs and implants last for as long as 3-12 years. Others like the pill or injections must be taken daily, weekly, monthly or every three months depending on type.

Do they still prevent pregnancy if I use them after I have sex?

Only emergency contraceptives like the ‘’morning after pill’’ which helps prevent pregnancy when taken shortly after sex. Not the regular birth control methods.

Can I still get pregnant even if I am on contraceptives?

There is always a small chance of pregnancy on any birth control method.

What’s the best contraceptive?

There is no universal “best” option. Discuss your needs and preferences with a doctor to choose what fits your body and lifestyle.

Do men have pills?

Not yet. At the moment, condoms are the easiest reversible option for men. Researchers are studying male hormonal and non-hormonal options though.

By Dr Mutmainah Sanni