Nightmare for African Women: Birthing Injury and Little Help
Published: September 28, 2005
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Nearly 600 women showed up, some arriving in busloads, when international and Nigerian officials staged a 14-day treatment campaign at Babbar Ruga and three other hospitals in February. Three hospitals ran out of beds. The youngest patient was 12.
Michael Kamber for The New York Times
Dr. Kees Waaldijk speaking with Faima Mamman, a patient at Babbar Ruga Hospital, after operating on her to repair a fistula.The oldest, more than 70, had been incontinent for a half-century.
"The health care system is not coping with it," Dr. Waaldijk said. "You go to a hospital and they have no working facilities. You say, 'You need this, this, this and this.' You go back. No water! No water in the whole hospital! You go back again, no lights!
"So where do you start?"
Dr. Waaldijk started here at Babbar Ruga Hospital 22 years ago, after a misspent youth followed by a lucrative surgical practice in Europe mixed with public health stints. Only when he came to this dusty town of open sewers and fickle electricity did he find his life's calling, he said.
With help from government and private donors, he slowly built Babbar Ruga into one of Africa's two biggest fistula centers, a small city of yellow concrete wards and hostels that typically houses 200 patients.
Those recovering from his surgery walk awkwardly about the grounds, catheters emptying between their legs into plastic buckets in girlish colors of pink and purple. Relatives camp by the dozens under the trees amid cooking pots, straw mats and tea kettles.
Dr. Waaldijk still hauls sutures, needles and anesthetics in big black suitcases from Holland to be certain of a reliable supply. He operates partly by the sun, wheeling his surgery table across the room to catch the best light, and personally logs his results on a laptop protected by a backup generator.
More than a third of his patients are 15 or younger; another 30 percent are between 15 and 20. His records indicate that most were married at 11 or 12, before menstruation. Nearly all bring with them tales of hardship, suffering and rejection.
Safiya, 23, was in the post-op ward after living for a year in the hut of a traditional healer who tried to cure her by stuffing potions into her vagina. Daso, 23, said she had leaked urine and feces for five years. Her husband divorced her.
Rumasau, 16, unluckily began labor on a Saturday, when her local hospital had no physician for her. She had to wait until the following Tuesday for an emergency Caesarean section - not an uncommon delay here, Dr. Waaldijk said.
For the few who get help, fistula surgery is life-changing. Zainabu Ado, 19, said she had leaked urine and feces for a year before coming to Babbar Ruga.
"People ran from me, even members of my own family," she said during an interview in Sululu, a tiny village hidden on a barely passable dirt road across the border in Niger. "My husband abandoned me. Nobody talked to me. Nobody visited me. For that whole year I stayed indoors."
At an impromptu gathering this month, Ms. Ado arrived resplendent with beaded jewelry, and her neighbors made room for her on straw mats in the sand.
Problems linger, she said. Her husband never bothered to divorce her, leaving her unable to remarry. She suffers a slight limp from lingering nerve damage. But compared with a fistula, such troubles are nits. "I am completely healed," she said, flashing a smile.
Her village is too small to appear on any map. Yet she is neither Sululu's first nor last fistula patient. She heard of Babbar Ruga Hospital from a neighbor who had undergone fistula surgery there. Ms. Ado, in turn, told Gide Gero.
Four feet 10 and nut-brown, Gide arrived at the hospital in September and spread her mat in the corridor outside the operating room. Her eyes were lively, her smile gap-toothed. She looked perhaps 12, but said she was 16.
Isolation and the traditions of her Fulani tribe governed her upbringing. She never went to school. Once she reached puberty, each suitor was allowed to specify that a decorative design be carved in her face as a sign of his interest.
She said she had fallen in love with one, but her grandfather had insisted that she marry her much older cousin, whom she did not meet till her wedding day. At 13, her grandparents decided, it was high time that she settle down. "Two reasons," her grandmother said in an interview. "She had started menstruating. And she had developed breasts."
Early this July, she started labor on a bed of bound sticks covered with a straw mat. For two days she struggled. Finally it took five hours for two cows to pull her family's wooden cart to the nearest hospital, 10 miles away.
There Gide labored for two more days before managing to expel a dead baby boy. When she discovered the next day that she could not control her urine, she said, she was dumbfounded. As a solution, she learned to wait as long as eight hours before allowing herself a sip of water.
Her fistula, it turned out, was a small one. Twenty minutes after she climbed atop Dr. Waaldijk's operating table, she was stretched out in the first bed in the recovery room, her grandmother by her side.
"She will be fine," Dr. Waaldijk predicted. Fine, that is, unless her next labor begins in the same village, far from medical treatment, as is all too likely. In which case, he said, her affliction will simply repeat itself.
"To be a woman in Africa," Dr. Waaldijk said as he stitched her last sutures, "is truly a terrible thing."
