The Movie DRY produced in 2014 narrates the story of a thirteen-year-old girl, Halima, whose poor uneducated parents married her off to Sani, a 60-year-old man, who constantly rapes her. Halima gets pregnant and suffers Obstetric fistula after child delivery; she’s consequently abandoned by her husband and discriminated against in the society. Zara, a medical doctor who also suffered a horrific childhood meets Halima; who later turned out to be her daughter, she tried to help her get through her situation and also save other young women under such circumstance. At the end of the day, it turned out the same woe befell the daughter. While, the mother had a somewhat happy ending, Halima didn’t live to tell the story.
This is the tale of most young girls. 3% of every 1000 young under-aged Nigerian girl goes through the phase. This has become common practice in Northern Nigeria.
Obstetric fistula (OF) is a medical condition in which a hole develops between either the rectum and vagina, a ureter and the vagina, or between the bladder and vagina after difficulties in childbirth. It can result in incontinence of urine or faeces.
It is more common and evolves into something worse when adequate medical care is not available. It is considered a disease of poverty or ignorance.
Literally, the United Nations Population Fund (UNFPA) says obstetric fistula is simply-
“A childbirth injury that has been largely neglected, despite the devastating impact it has on the lives of affected girls and women. It is usually caused by prolonged, obstructed labour, without timely medical intervention, say an emergency Caesarean section. During unassisted, prolonged, obstructed labour, the sustained pressure of the baby’s head on the mother’s pelvic bone damages soft tissues, creating a hole, also called fistula between the vagina and the bladder and/or rectum. The pressure deprives blood flow to the tissue, leading to necrosis. Eventually, the dead tissue comes away, leaving a fistula/hole, which causes a constant leaking of urine and/or faeces through the vagina.”
The Signs and symptoms of this disease includes:
Fecal incontinence or Lack of control over defecation, leading to involuntary loss of bowel contents such as flatus (gas), liquid stool elements and mucus, or solid faeces. This usually happens at night or may be continual.
- Foul-smelling vaginal discharge
- Repeated vaginal or urinary tract infections
- Irritation or pain in the vagina or surrounding areas
- Pain during sexual activity
Obstetric fistula have far-reaching physical, social, economic, and psychological consequences on the women affected.
Mostly the tail end of young under-aged marriages for girls between the ages of 9-15, and according to UNFPA, “Due to the prolonged obstructed labour (during child birth after the much older men would have forcibly had their way with the girls and they become pregnant) , the baby almost inevitably dies, and the woman is left with chronic incontinence. That is, she becomes unable to control the flow of urine or faeces, or both, she may be abandoned by her husband and family and ostracized by her community. Without treatment, her prospects for work and family life are virtually non-existent.”
The implication of Obstetric Fistula can be in three forms
- Physical
- Societal
- Psychological
Physical Implication
The most direct consequence of an obstetric fistula is the constant leaking of urine, faeces, and blood as a result of a hole that forms between the vagina and bladder or rectum. This leaking has both physical and societal penalties. The acid in the urine, faeces, and blood causes severe burn wounds on the legs from the continuous dripping.
Nerve damage that can result from the leaking can cause women to struggle with walking and eventually lose mobility.
In an attempt to avoid the dripping, women limit their intake of water and liquid which can ultimately lead to dangerous cases of dehydration. Ulceration and infections can persist, as well as kidney disease and kidney failure, which can each lead to death. Some women, due to obstetric fistulae and other complications from childbirth, do not survive.
Social Implication
Physical consequences of obstetric fistula leads to severe sociocultural stigmatization for various reasons. For example, in the Movie DRY, Halima’s friends, family and supposed in-laws probably due to illiteracy or ignorance did not consider obstetric fistula a medical condition, but a divine punishment or a curse for disloyalty, infidelity, disrespectful behaviour or even witchcraft.
Pain resulting from Fistula makes the woman unable to perform household chores and childrearing as a wife and as a mother, thus devaluing her especially in a society like ours where it is solely considered a woman’s duty to do chores. As a result, many girls who were forced/coerced into early marriages are divorced or abandoned by their husbands and partners, disowned by family, ridiculed by friends and immediate society.
Just like Halima who became a marginalized member of the village, she was made to live in the bush far from friends and loved ones, she was isolated in a hut. Though she her mother and co-wife showered her some love, yet it wasn’t enough. She was humiliated and felt so alone. She later passed on due to an infection in the birth canal. She was thrown out of her husband’s home due to the constant leakage and unavoidable offensive odour.
Psychological Implication
This range from the saddening effect of the loss of a child, the rejection and humiliation they face from their supposed loved ones, the marginalization from the smell, societal embarrassment and inability to perform wifely/motherly roles. This is enough to run one mental/ suicidal.
In treating fistula, the nature and size of the injury should be considered. This varies depending on the size and location of the fistula, so a surgeon with experience is needed to improvise on the spot. Before the patient undergoes surgery, treatment and evaluation are needed for conditions including anemia, malnutrition, and malaria. Treatment for this is available through reconstructive surgery. Primary fistula repair has a 91% success rate. Successful surgery enables women to live normal lives and have more children, but it is recommended to have a cesarean section to prevent the fistula from recurring.
Mental health treatment is needed to rehabilitate fistula patients, who experience psychological trauma from being ostracized by the community.
Also, professional and medical birth attendance at all births is required to prevent this illness. In doing this, emergency obstetric care for women who develop complications during delivery would keep fistula at bay.
One major challenge hindering the treatment of fistula is information. Most women have no idea that treatment is available. Because this is a condition of shame and embarrassment, these women hide themselves and their condition and suffer in silence.
Early marriages lead to early childbirth; which increases the risk of obstructed labour. If this practice of marrying off young under-aged girls to much older men, illiteracy and traditional home birth can be stop then 90% of Obstetric Fistula will be prevented. Then our girls can go to school, live their dreams, become a force to reckon with and make the nation proud.
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