This article originally appeared in the Biblical Recorder, the news journal of the North Carolina Baptists
JOS, NIGERIA - A program at ECWA Evangel Hospital specializes in the repair of vesicovaginal fistulae (VVF's), a debilitating condition that is rare in the Western world, but more common in underdeveloped countries. In layman's terms, VVF occurs when tissue damage leaves an opening, or fistula, between the bladder and the vagina, resulting in a continuous and uncontrollable leaking of urine. In undeveloped countries, according to an unpublished paper by Dr. Norman, a number of factors contribute to a higher incidence of VVF. Among the Fulani people, for example, parents typically arrange marriages for their daughters as soon as they reach puberty, usually receiving a bride price paid in cows or other animals. The young teenagers often become pregnant within a year or two of marriage, before their bodies have finished maturing and the pelvic opening is large enough to allow for the safe passage of an infant during childbirth. Poverty and malnourishment are complicating factors that can result in slower or stunted growth. And, the women tend to live in isolated villages or family compounds that would be hours away from medical care by automobile. In many cases there are no motor able roads leading to the village, and no one nearby who owns a vehicle. Women are given little help with birthing beyond the presence of an older woman (sometimes called a “Traditional Birth Attendant”) who has had some experience in assisting with deliveries. In women whose baby is too large for their pelvic opening, or who have other complications such as mal-presentations, labor may continue for several days, much of the time spent in a traditional squatting position. The resulting pressure, which may continue for two to five days, cuts off the blood supply to parts of the urogenital area. The lack of blood results in necrosis, or tissue death, that contributes to the tearing or erosion of the bladder and the upper vagina. More than 90 percent of babies born in these situations do not live, and the mother is often left with birth injuries that render her incontinent. Either outcome provides a sufficient excuse in Fulani culture for a husband to return the woman to her father and ask for a refund on the bride price. Without running water, hygiene is basic at best in the bush. The constant smell of urine makes the woman an embarrassment to family members, who commonly banish her to a separate hut and try to keep her condition hidden. If it became known that a man's daughter had both failed to deliver a living child and had become humiliatingly incontinent, the value of his other daughters would be diminished. In addition, the family might feel obligated to employ local herbalists or spiritualists to try and cure the condition, adding to the expense of keeping up a daughter who now regarded as defective or troublesome. The young woman's condition, in the African mindset, “Destroys the fame of the family.” In that context, a surgical repair brings healing is a true gift of restored life.