[Applause]
let me start by giving you a story of a
Miriam Miriam is a 28 year old housewife
mother of two who I met in 2016 when my
foundation was recruiting patients for a
vdf camp just a very sad woman very
withdrawn always had her head down and
could barely make eye contact the first
thing you notice however the most
striking thing you notice when you meet
Miriam is the stench of urine that
emanates from her a condition that
started a year previously during Pauline
our last delivery she had had two
previous deliveries at home successfully
and so when she got into labor in her
third pregnancy she thought business as
usual I will have this baby at home
unfortunately this was not the case
Miriam remained in labor for two days in
excruciating pain before it became clear
that this baby was not going to come and
then she was now taken to hospital what
had happened was she had developed a
complication of labor cold obstructed
labor obstructed labor occurs when
there’s an impediment to the movement of
the baby through the birth canal to the
outside world such that the baby becomes
trapped in the pelvis now with Miriam
her baby became trapped had suffocated
from lack of oxygen because it had been
there for too long
and so by the time she arrived in
hospital her baby had died doctors did
their best and she was discharged to him
a couple of days later after she had
delivered a stillborn baby boy now a few
days later Maryam noticed fluid just
draining down her legs and then she
suddenly realized it was actually urine
coming out of her vagina and that was
the start of Miriam’s nightmare
from then on she no longer had control
of her bladder she was constantly
leaking urine barely having enough rags
to cover herself and cover the smell
now this is a BBF you’ll be wondering
what exactly is a v DF v DF is short in
medical terms for vesikko vagina fistula
in simple terms it just means a hole
between the bladder and the vagina there
are different forms of fistula but 90%
of fistulas that are core or core as a
result of prolonged obstructed labor the
complication that Miriam had what
happens with obstructed labor is when
the head is trapped the bladder that
lies just behind the neutrals is trapped
between the baby’s head and the uterus
and so that head exerts pressure on the
bladder causes an asana injury now after
the delivery the pressure is released
but injury becomes the hole and it is
from that hole that urine goes through
out through the vagina and out outside
in honor in another scenario you can
have the same pressure of the baby’s
head on the rectum because they are all
in the same area costing the same kind
of injury but this time you have stool
coming out of that hole into the vagina
and outside so you have some women
having a combination of course leaking
urine and you construe emergence as she
was leaking urine so suddenly Mariam
finds herself a social outcast
she’s completely isolated her husband
soon abandons her divorces her and she
moves back home at the time I met her
she was living at home with her mother
she was so miserable because even her
mother had isolated herself from her
this is the typical picture of a vbf
patient typical abandoned no baby to
show for at the end of the problem and
isolated the World Health Organization
estimates that you have over 2 million
cases of vivia occurring every year in
the world
I think the best way we can describe the
plight of a PDF patient is by this quote
by Robertson one of the most frightful
conditions of the humankind frightful
afflictions of the humankind day and
night hour by hour the urine wet
excoriates and hurts the victim of this
condition social intercourse is no
longer existent a pariah is made and you
over two million women are living with
VBF in the world and 90% of this occur
in Africa of this case is eight hundred
thousand are living in Nigeria to make
things worse it is estimated that there
are about 12,000 cases occurring yearly
in Nigeria if you do the math you are
talking about two hundred and thirty
women weekly today is Saturday it means
this week two hundred and thirty women
in Nigeria have developed a VBF there
are many predisposing factors to this
problem but I’m going to highlight a few
of them if you are the important factors
the first one is for access to emergency
obstetric care many of the women who
develop this condition are those living
in hard-to-reach areas with limited or
poor access
to antenatal care and emergency of
strategy basically emergency foster care
means the kind of care a pregnant woman
gets in pregnancy as well as delivery in
Miriam story she had spent two days
before she finally got to the hospital
now when they do eventually get to the
hospital they meet clinics that are
ill-equipped and understaffed poverty
more often than not the women will be VF
at the poorest of the poor in society
usually uneducated no skillset and so
cannot afford to go to hospital in
Nigeria we all know that hospital if
medical services or healthcare is mostly
out-of-pocket so the 500 naira the 1000
RR that she would pay when she goes to a
primary health care center
she doesn’t have so she would rather
stay at home until it is clear she
cannot have this baby without going to
the hospital number three early marriage
teenage pregnancy teenagers have no
business getting pregnant simply because
at the time that teenagers their
pelvises are small not mature enough to
carry a pregnancy especially when you
add malnutrition to it which is what you
get with most of the women in our rural
areas the purposes are small and so the
height the likelihood of them having
obstructed labor is there then you add
pops that she care it’s a V V F waiting
to happen
early marriage predisposes to touching
each pregnancy and that vdf Miriam’s
case is different in the sense that she
already had two babies before she had
this the problem in her own case it was
simply because she could she didn’t have
access to emergence of such a care
majority of patients with VBF habit in
their first pregnancy and you can
imagine losing your baby in the first
pregnancy having this problem without
any sports
or idea that you can be cured from it
must be a living hell harmful
traditional practices I would give an
example of one female genital cutting I
don’t know whether we’ve heard of that
female genital cutting or female genital
mutilation it’s a common tradition it’s
a it’s not too common here in Nigeria
but we do have it quite significantly
and it’s a practice where the external
genitalia of a girl is cut off parts of
it or all of it and then sewn together
so if she comes to have a baby and
nothing is still there she ends up
having complications like obstruction a
bow and a DVF Kanako but I think one of
the most important factors that are
associated with any maternal health
problem including v VF is lack of
education studies have shown that women
who are educated the most likely wants
to be empowered and are the one that can
take the good decisions they require to
have a very good safe pregnancy and safe
delivery and that at the same time have
very healthy children many of those
women would be VF uneducated
now this is one message that I would
like everybody to go home with the
sun’ll must not rise and set on a woman
in labor more than once
the Sun must not rise and set in a woman
in labor because that means that there
is if a woman is in labor for more than
12 hours and she hasn’t had her baby
there’s a problem there something needs
to be done now we’re all depressed I’m
sure by now I’m even depressed talking
about it to be honest but there is good
news and what is this good news DBF
sounds horrible is curable treatment is
by surgery once you are able to get the
fistula surgically corrected leakage
stops she becomes dry she goes about her
normal activities in fact
she can go ahead and have another
pregnancy and a delivery that is the
wonderful news about it in the last
three years or two years actually my
foundation in collaboration with other
foundations have actually operated well
we’ve updated the records now is almost
200 women now we’ve treated their DVF
and we’ve also rehabilitated them
because you see what happens is they’re
isolated they don’t have any skills they
are poor so even if you treat them you
need to get them back within their
communities and so we have to always
give them some kind of skill set before
we discharge them fully now you may be
wondering why is this man telling me
this
I’m not a doctor I’m not a surgeon what
can I do there is a lot that you can do
firstly you can support organizations
that work with vdf patients there as
there’s a lot surrounding how you manage
bvf patients apart from the surgery
before from the rehabilitation so people
organizations that work with these
people need they need a lot of support
and so that is something that you could
do secondly if you are involved in
empowerment programs enterpreneurship
programs please consider putting the VSP
women we have patients within your
structure so that you can train them
because that is one of the most
important things that they need the
media has a huge role to play for public
enlightenment and the sensitization
messages about this problem and how it
can be prevented because DVF is
preventable and how do we prevent it
even a girl who has been married early
or a teenager who is pregnant as long as
that woman or girl has proper access to
antenatal care and delivery being
attended by a skilled birth attendant
you will not develop that vdf so we need
that public message out there well if
you were to ask me the single most
important factor that can help our men
prevent vbf and other maternal health
issue is to educate the girl child we
have a girl child intervention program
in my foundation we mentor girls we try
to encourage retention of girls
enrollment and retention of girls in
school we need to emphasize on that I
think what we could do as an as
individuals is to form pressure groups
to ensure that the education of our
girls is made paramount so that every
girl who is educated is empowered and is
unlikely to have a problem in her
pregnancy and her delivery if there’s
one single message I want out there is
we need to work to see how we can get
that message out on the importance of
girl child education
lastly I’m sure you are wondering what
this picture was taken in our skill
acquisition center in Mena this is a
baby dress they were taught to make
ready-made clothes for babies and this
is one of the dresses that they make
maryam is back in her village and you
know what she’s back with her husband
want to flog the man so please look in
your environment where of Miriam’s there
are you know even in your backyard
forget about the villages there are
Miriam’s there are other Aisha’s there
are other Larabars there are other
people that are saddled with this
problem would be heid because of the
stigma attached what can you do to find
those people and put a smile on their
face like Maryam thank you [Applause]
let me start by giving you a story of a
Miriam Miriam is a 28 year old housewife
mother of two who I met in 2016 when my
foundation was recruiting patients for a
vdf camp just a very sad woman very
withdrawn always had her head down and
could barely make eye contact the first
thing you notice however the most
striking thing you notice when you meet
Miriam is the stench of urine that
emanates from her a condition that
started a year previously during Pauline
our last delivery she had had two
previous deliveries at home successfully
and so when she got into labor in her
third pregnancy she thought business as
usual I will have this baby at home
unfortunately this was not the case
Miriam remained in labor for two days in
excruciating pain before it became clear
that this baby was not going to come and
then she was now taken to hospital what
had happened was she had developed a
complication of labor cold obstructed
labor obstructed labor occurs when
there’s an impediment to the movement of
the baby through the birth canal to the
outside world such that the baby becomes
trapped in the pelvis now with Miriam
her baby became trapped had suffocated
from lack of oxygen because it had been
there for too long
and so by the time she arrived in
hospital her baby had died doctors did
their best and she was discharged to him
a couple of days later after she had
delivered a stillborn baby boy now a few
days later Maryam noticed fluid just
draining down her legs and then she
suddenly realized it was actually urine
coming out of her vagina and that was
the start of Miriam’s nightmare
from then on she no longer had control
of her bladder she was constantly
leaking urine barely having enough rags
to cover herself and cover the smell
now this is a BBF you’ll be wondering
what exactly is a v DF v DF is short in
medical terms for vesikko vagina fistula
in simple terms it just means a hole
between the bladder and the vagina there
are different forms of fistula but 90%
of fistulas that are core or core as a
result of prolonged obstructed labor the
complication that Miriam had what
happens with obstructed labor is when
the head is trapped the bladder that
lies just behind the neutrals is trapped
between the baby’s head and the uterus
and so that head exerts pressure on the
bladder causes an asana injury now after
the delivery the pressure is released
but injury becomes the hole and it is
from that hole that urine goes through
out through the vagina and out outside
in honor in another scenario you can
have the same pressure of the baby’s
head on the rectum because they are all
in the same area costing the same kind
of injury but this time you have stool
coming out of that hole into the vagina
and outside so you have some women
having a combination of course leaking
urine and you construe emergence as she
was leaking urine so suddenly Mariam
finds herself a social outcast
she’s completely isolated her husband
soon abandons her divorces her and she
moves back home at the time I met her
she was living at home with her mother
she was so miserable because even her
mother had isolated herself from her
this is the typical picture of a vbf
patient typical abandoned no baby to
show for at the end of the problem and
isolated the World Health Organization
estimates that you have over 2 million
cases of vivia occurring every year in
the world
I think the best way we can describe the
plight of a PDF patient is by this quote
by Robertson one of the most frightful
conditions of the humankind frightful
afflictions of the humankind day and
night hour by hour the urine wet
excoriates and hurts the victim of this
condition social intercourse is no
longer existent a pariah is made and you
over two million women are living with
VBF in the world and 90% of this occur
in Africa of this case is eight hundred
thousand are living in Nigeria to make
things worse it is estimated that there
are about 12,000 cases occurring yearly
in Nigeria if you do the math you are
talking about two hundred and thirty
women weekly today is Saturday it means
this week two hundred and thirty women
in Nigeria have developed a VBF there
are many predisposing factors to this
problem but I’m going to highlight a few
of them if you are the important factors
the first one is for access to emergency
obstetric care many of the women who
develop this condition are those living
in hard-to-reach areas with limited or
poor access
to antenatal care and emergency of
strategy basically emergency foster care
means the kind of care a pregnant woman
gets in pregnancy as well as delivery in
Miriam story she had spent two days
before she finally got to the hospital
now when they do eventually get to the
hospital they meet clinics that are
ill-equipped and understaffed poverty
more often than not the women will be VF
at the poorest of the poor in society
usually uneducated no skillset and so
cannot afford to go to hospital in
Nigeria we all know that hospital if
medical services or healthcare is mostly
out-of-pocket so the 500 naira the 1000
RR that she would pay when she goes to a
primary health care center
she doesn’t have so she would rather
stay at home until it is clear she
cannot have this baby without going to
the hospital number three early marriage
teenage pregnancy teenagers have no
business getting pregnant simply because
at the time that teenagers their
pelvises are small not mature enough to
carry a pregnancy especially when you
add malnutrition to it which is what you
get with most of the women in our rural
areas the purposes are small and so the
height the likelihood of them having
obstructed labor is there then you add
pops that she care it’s a V V F waiting
to happen
early marriage predisposes to touching
each pregnancy and that vdf Miriam’s
case is different in the sense that she
already had two babies before she had
this the problem in her own case it was
simply because she could she didn’t have
access to emergence of such a care
majority of patients with VBF habit in
their first pregnancy and you can
imagine losing your baby in the first
pregnancy having this problem without
any sports
or idea that you can be cured from it
must be a living hell harmful
traditional practices I would give an
example of one female genital cutting I
don’t know whether we’ve heard of that
female genital cutting or female genital
mutilation it’s a common tradition it’s
a it’s not too common here in Nigeria
but we do have it quite significantly
and it’s a practice where the external
genitalia of a girl is cut off parts of
it or all of it and then sewn together
so if she comes to have a baby and
nothing is still there she ends up
having complications like obstruction a
bow and a DVF Kanako but I think one of
the most important factors that are
associated with any maternal health
problem including v VF is lack of
education studies have shown that women
who are educated the most likely wants
to be empowered and are the one that can
take the good decisions they require to
have a very good safe pregnancy and safe
delivery and that at the same time have
very healthy children many of those
women would be VF uneducated
now this is one message that I would
like everybody to go home with the
sun’ll must not rise and set on a woman
in labor more than once
the Sun must not rise and set in a woman
in labor because that means that there
is if a woman is in labor for more than
12 hours and she hasn’t had her baby
there’s a problem there something needs
to be done now we’re all depressed I’m
sure by now I’m even depressed talking
about it to be honest but there is good
news and what is this good news DBF
sounds horrible is curable treatment is
by surgery once you are able to get the
fistula surgically corrected leakage
stops she becomes dry she goes about her
normal activities in fact
she can go ahead and have another
pregnancy and a delivery that is the
wonderful news about it in the last
three years or two years actually my
foundation in collaboration with other
foundations have actually operated well
we’ve updated the records now is almost
200 women now we’ve treated their DVF
and we’ve also rehabilitated them
because you see what happens is they’re
isolated they don’t have any skills they
are poor so even if you treat them you
need to get them back within their
communities and so we have to always
give them some kind of skill set before
we discharge them fully now you may be
wondering why is this man telling me
this
I’m not a doctor I’m not a surgeon what
can I do there is a lot that you can do
firstly you can support organizations
that work with vdf patients there as
there’s a lot surrounding how you manage
bvf patients apart from the surgery
before from the rehabilitation so people
organizations that work with these
people need they need a lot of support
and so that is something that you could
do secondly if you are involved in
empowerment programs enterpreneurship
programs please consider putting the VSP
women we have patients within your
structure so that you can train them
because that is one of the most
important things that they need the
media has a huge role to play for public
enlightenment and the sensitization
messages about this problem and how it
can be prevented because DVF is
preventable and how do we prevent it
even a girl who has been married early
or a teenager who is pregnant as long as
that woman or girl has proper access to
antenatal care and delivery being
attended by a skilled birth attendant
you will not develop that vdf so we need
that public message out there well if
you were to ask me the single most
important factor that can help our men
prevent vbf and other maternal health
issue is to educate the girl child we
have a girl child intervention program
in my foundation we mentor girls we try
to encourage retention of girls
enrollment and retention of girls in
school we need to emphasize on that I
think what we could do as an as
individuals is to form pressure groups
to ensure that the education of our
girls is made paramount so that every
girl who is educated is empowered and is
unlikely to have a problem in her
pregnancy and her delivery if there’s
one single message I want out there is
we need to work to see how we can get
that message out on the importance of
girl child education
lastly I’m sure you are wondering what
this picture was taken in our skill
acquisition center in Mena this is a
baby dress they were taught to make
ready-made clothes for babies and this
is one of the dresses that they make
maryam is back in her village and you
know what she’s back with her husband
want to flog the man so please look in
your environment where of Miriam’s there
are you know even in your backyard
forget about the villages there are
Miriam’s there are other Aisha’s there
are other Larabars there are other
people that are saddled with this
problem would be heid because of the
stigma attached what can you do to find
those people and put a smile on their
face like Maryam thank you [Applause]
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