Doctors say Nigeria, the most populous country in Africa, has one of the world’s highest rates of fistulas - a condition common among women who give birth when they are too young, and too small to have children. In the Nigerian capital, Abuja cures for fistulas are hard to come by and overcoming the social stigma associated with the condition is even harder.
Vesicovaginal fistula, also known as VVF, or fistula, is a tear in the bladder that causes incontinence. It often happens to young women in childbirth, when they are too small to have children safely. It is also common among victims of rape in war zones.
Nigerian doctor Aminu Magashi says his country has one of the world’s highest rates of fistula. He says 20,000 new cases are reported each year, with only about 4,000 patients receiving treatment.
Doctors say most of the cases, like that of Zakkutta Tsinda, a young divorcee, are from Nigeria’s northern states - the poorest part of the country.
Tsinda says she was able to have her fistula repaired, but others in her village have not been so lucky.
Tsinda says she knows five women suffering from fistula who have not received treatment, making them incontinent. Women with fistulas often find themselves ostracized by their communities or divorced by their husbands. Tsinda says she is not sure whether she can recover from that.
Borno State Commissioner for Women Affairs and Social Development, Inna Galadima, says no one knows how many rural women suffer from fistulas. In many villages, girls are married as young as 14-years-old, and access to prenatal care is rare.
Galadima works with a Nigerian government and United Nations program that seeks out fistula patients, offers them medical treatment and trains them in job skills to help them return to their communities.
The two-week program teaches sewing and home economics, and graduates leave with a sewing machine or other business equipment. Galadima says many of the students have been abandoned by their husbands, and now need jobs to survive.
"We learnt that most of these women were divorced by their husbands because of their conditions. But now that they have their skills, they can be self-reliant and they can stand on their own," said Galadima.
Doctors say fistulas usually occur when a woman suffers prolonged labor in childbirth, without proper medical care. In some villages, traditional methods of speeding up difficult births at home can increase the size of the vagina, but can also tear the bladder.
But doctors say that lack of education is at the heart of the problem, making fistula prevention difficult.