Nigeria's Minister of Health Professor Isaac Adewole took his Ministry’s efforts to rid Nigeria of untreated obstetric fistula into his own hands by “scrubbing in” at a recent free surgical repair clinic for fistula patients at an Osun State hospital.

The Minister led a team of Nigeria’s top obstetric surgeons who participate in a free USAID supported benefit, which marked the commencement of a joint initiative to expand access to fistula repair treatments to more residents of Osun and Oyo states as part of a general push to improve access to the much needed and largely neglected services across the country.

“We still have too large a backlog of women living with fistula in the country,” Minister Adewole said after completing successful surgery on Sarah Famakinwa, a 37 year old mother of four who has needed the surgery for four years. “There is need to close the gap, which is why we intend to open up more fistula centers across the country.”

The clinic took place at the Wesley Guild a Federal Medical Center in Ilesha, the first of a series of hospitals nationwide to boost its fistula treatment capacity under a new Ministry initiative supported by USAID to establish a network of “centers of excellence” for fistula intervention in thirteen of Nigeria's 36 states.

USAID has supported thirteen state governments to reduce incidences of fistula through providing materials, training and logistical support to new and existing medical centers. In Osun State, the Ministry partnered with the hospital’s management staff to incorporate fistula surgeries, urethral catheterization and rehabilitation into medical doctors’ residency training. Officials are encouraged by the successes they have seen in other participating states, where more than 47,000 patients have received treatment in the last decade.

Still, further progress is needed. More than 400,000 women suffer from the painful and debilitating condition – half the cases in the world, according to the National Strategic Framework for Fistula Prevention and Control. With up to 12,000 new cases each year, the backlog for surgical interventions is at more than 200,000, attributable to high medical costs and a dearth of surgeons qualified to perform the repairs.

“Far too many women in Nigeria needlessly suffer through life with fistula after having given birth,” said USAID Mission Director Stephen M. Haykin. “This initiative, in partnership with the Ministry of Health, will free thousands of women from this burden and allow them to once again lead healthy and productive lives.”

Obstetric fistula is the result of prolonged labor without prompt medical intervention, and is most common among women living in impoverished households. The condition leads to the formation of a hole in a woman’s birth canal, which causes pain, chronic incontinence and threatens the health of the baby.

Yet few who suffer from fistula ever receive treatment. In rural areas, women may be unaware of their condition, and those who are seldom acknowledge it, fearing social marginalization. Women with fistula are often abandoned by their husbands and shunned by the members of their village.

For Sarah Famakinwa, an unsuccessful repair resulted in a four year wait due to lack of funds for the $750 procedure. Finally able to make the payment, Sarah and her husband were surprised to find out treatment was free that day. “We are grateful for the care and happy Sarah is free of fistula,” said husband said after the surgery. “It has been a long and difficult ordeal.”

The USAID initiative, known as Fistula Care Plus, also rolled out a set of awareness building activities to educate women about options on diagnosis and treatment of the condition. Implemented by Engender Health, Fistula Care Plus supports prevention and treatment of obstetric fistula through surgeries and urethral catheterization, and rehabilitation of obstetric fistula clients in 13 states across Nigeria.