Problems medicine cannot solve


This evening I attended UCL’s Annual Lancet Lecture. This year’s theme was; Climate Change – The biggest global health threat of the 21st century? ….But no, climate change is not my topic for today. In making a point this years lecturer and one of Britain’s most senior scientists; Lord May, a former President of the Royal Society and Government chief scientist mad an astonishing empirical fact – that on average, girls that have had a primary education – have 1.5 children less than those that do not. Girls that have a secondary education have on average 3 children less!

Now…what does this have to do with anything?

Vesico vaginal fistulas (VVF) is one of those things very few of us talk about, even in the profession. I have hardly thought of this since leaving university. It is just not on the health agenda……What are VVFs some might wonder, especially if you have not worked in our neigbourhood. In simplest terms these are abnormal anatomical passages between the bladder and the vagina most often cause by obstructed labour in young (often very young) mothers. Another reason obviously is more access to appropriate antenatal care. It is a devastating condition as women become incontinent of urine.

Recently the Minister of Health announced during the foundation laying ceremony of National Vagina Fistula (VVF) Centre in Kwali area council, Abuja that Nigeria had the higest number of VVF cases in the world. Its is hardy a surprising statistic – although the source of any health data in Nigeria is always a worry.

To mark this, Thisday published an excellent piece analysing the VVF situation in the country. To start of ..they quote the number of 800,000 women affected. Its not quite clear where they get this number from or what time period it covers…but we can all agree that there are lot women affected.
Apparently there are five major centers in the northern part of the country where those with the condition are looked after. These include Katsina as the headquarters, Kano, Zaria, Sokoto and Kebbi. The National VVF Project  in these five centers in the north are managed by Dutch surgeon known as Dr Kees, who is the head of the whole project. He added that Krees trained all of them in these centers.
With population growth without a parallel increase in access to education and antenatal care by women, especially young women we will be needing the expertise of Dr Keets for a while to come.
Another thing that struck me was the very little space and prominence given to this launch. Okay the Miniter was there and so were  few others….Compare this to the launch of Madam First lady’s cancer centre in Abuja a few months ago!!! this surprising? Which of our elite will like to be associated with VVFs? This is one problem modern medicine cannot solve! We need a societal shift from the acceptance of this as a norm and then societal synergy to do something about it.
This is one problem medicine cannot solve! Not for us….

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

Discussion2 Comments

  1. thank you for blogging about this… I do not understand why women should still be sufferring from this disese ….so sad that the opening of the cancer centre was given more priority than this most pressing issue in northern nigeria..the most annoying part of it all is that vvf is soo utterly preventable…

  2. Hi there. Thank you for your post on fistula. Very interesting to hear about the situation in Nigeria. I recently finished my MPH in International Health and have focused on Maternal Health issues—and am particularly interested in fistula care and prevention. I started a blog just over a month ago ( tracks media coverage of the issue of maternal mortality and MDG5. Take a look if you get a chance. I have posted a few items about Nigeria recently. I will continue to visit your blog! Thanks!

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