*Y.C.* REINTEGRATION OF WOMEN WITH VESICO VAGINAL FISTULA AND RECTO VAGINAL FISTULA IN NIGERIA.

Maternal health problems especially Vesico Vaginal Fistula (VVF) and Recto Vaginal Fistula (RVF)which are mostly as a result of prolonged obstructed labour has been observed and reported by the United Nations Population Fund (UNFPA). Aproximately, one million women are with the condition, with 50,000 to 100,000 new cases documented each year. Most of these patients are from poor rural areas where access to health facility is low. They are often malnurished, low economic status, illiterates and lack formal education. Associated co-mobidities of these conditions include: the continous uncontrolled leakage of urine or feces as the case may be, results to footdrup, chronic skin irritation, and offensive odor. The sequelae of these are stigmatization, isolation and loss of social support. It sometimes leads to divorce or separation, worsened malnutrition, suffering and premature death. Existing international support could be harnessed to help the predicaments of these patients. It was formally associated to the Northern Nigeria. But of late, more cases are been recorded in southern part of the country where patients have leaved with the condition for almost 46 years.
Now, my organization has been carying out intervention programs with intermediate results on access to quality fistula care, Prevention through access to Family Planning and Community mobilization and sensitization, training and capacity building of doctors and nurses on fistula care, reintegration of clients to their communities, and the use data for decision making.
The International Labour Organization (ILO) had documented that 428 million women work in the agricultural sector around the world, compared to 608 million men. In Sub- Saharan Africa where Nigeria is a part, and in South Asia, 68% and 61% of women are employed in Agriculture. The fact that women contributed 65% success in the Agricultural sector is known (ILO, 2008).
Its known that most women with Vesico Vaginal Fistula (VVF) and Recto Vaginal Fistula (RVF) are from poor agrian family setting. Before now, the reintegration of women who undergo fistula repair involves rehabilitating them by way of teaching them a trade or a skill that could enhance their source of income without necesarily knowing their socioeconomic background such that when they leave the facility after they might have been repaired, they seldomly use the skills they acquired at the rehabilitation center. More to it, there are inadequate established systems for tracking this patients to see whether they have been using the skill profitably.
I want to establish a strong tracking system that is community base and can be reached anytime and can give account of the socioeconomic well being of the clients who have been repaired or whose fistula is irrepairable through traditional leaders and religious leaders which can be coordinated by Community Based Organizations (CBOs). Thus, fistula repaired or irrepaired patients who were farmers before now may be taught improved way of farming along side the kniting and tailoring skill they acquire at the rehabilitation center. Those who may have been divorced because their conditions are irrepairable, through gender equity advocacy to the traditional rulers we can procure lands for them. Those who are repaired and reintegrated into their families do not loss out in their contribution towards achieving food security for the family, or else we end up creating a gap while trying to bridge one.