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Last Updated: Friday, 18 August 2006, 23:55 GMT 00:55 UK
Nigeria's 'dead women walking'
By Jane Elliott
BBC News health reporter

Binta Ahmed
Binta leaked urine continually
When Binta Ahmed prepared to have her baby at home, she was not expecting any problems.

She had already given birth to five children, and the 28-year-old had no reason to expect this birth would be any different.

For seven days she laboured on the floor of her hut in Nigeria, but she was unable to give birth.

Her baby was eventually born dead. Her relatives were extremely worried as Binta had no energy to move.

Embarrassment

Then she started to leak urine and faeces.

She could not walk, but her family managed to bundle her to a local clinic.

Doctors there said she needed to get to hospital immediately and her family braced themselves for the two-day trip to Kano.

These women were dead women walking: physically, socially and psychologically
Dr Gloria Esegbona

Doctors diagnosed an obstetric fistula, an injury, where the pressures of childbirth leads to a hole - or fistula - between the bladder or rectum.

UK doctor Gloria Esegbona, a specialist in treating fistulas, said that by the time they saw Binta she was in extremely poor shape.

"It took her family a day or two to get her to hospital. The journey... had been agony for her as her injuries were so terrible.

"When she lifted her skirt up to show us, she had a huge pressure sore where she had been sitting. It was from the skin to the bone.

"Where she was sitting was all wet with urine and faeces."

She also had 'foot drop' in both legs - another pregnancy-related injury, where the muscles are left weakened and the toes droop downward impeding the normal walking motion.

Surgery

Binta was in too poor a condition for immediate extensive surgery so she was patched up and sent to a local rehabilitation centre to recuperate. She stayed there for months while awaiting surgery.

She was finally operated on three months later by Kees Waaldijk, a world expert in fistula repair who has helped more than 16,000 women.

It took her months after the operation to regain her full control of her continence.

Her other injuries such as foot drop have taken longer to resolve.

Many women with fistulas are ostracised by their community because of their incontinence, and a large number are divorced by their husbands and left with no means of supporting themselves.

'Ostracised from society'

Dr Rahmat Hassan Mohammad, who founded the Foundation for Women's Health, Research and Development (FORWARD), where Binta is recuperating, said they treat about 30 women a year.

Each of the women stays an average of 10 months at the centre in Dambatta, Kano.

When they are allowed home they are given a gift of either animals or materials to enable them to earn a living in their own community.

Dr Mohammad explained; "We give these women economic empowerment and get them back into their community where they have been ostracized from society."

Dr Esegbona explained that Nigeria has one of the highest fistula prevalence rates in Africa.

As many as 800,000 women have the condition and there are another 20,000 new cases each year.

In Nigeria, a woman has a one in 18 lifetime risk of dying from complication of childbirth - in Europe that figure is one in 2,400.

She was so horrified by the statistics in the country of her origin that she resolved to go back there, to work on reducing the numbers of women with the condition.

"I was shocked by how much suffering these women endured. They were so scarred and so damaged."

"These women were dead women walking: physically, socially and psychologically. Many of them lose their babies in childbirth and have no hope of having another. "

Education work

Dr Esegbona makes extensive trips back to Nigeria and funds them working as a locum doctor in the UK.

She explained that she and her colleagues not only work on repairing the fistulas where possible, but they also spent much time trying to educate the women and their families about how to avoid them happening in the first place.

She said much of the emphasis has been on the fact that many of the women marry early or are illiterate, but she stressed there also needed to be access to quality emergency obstetric care.

"There is no point empowering a women, for instance with education, if she is only going to die anyway because she has no care available to her."




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