Pregnancy disease in Nigeria

The article Natalie Imbruglia Campaigns Against Pregnancy Disease (June 30) makes for interesting reading. The existence of incontinence in women caused by the urinary bladder emptying into the vagina after prolonged and difficult labour in Nigeria is very real. Ms Imbruglia's campaign is very commendable and she ought to be congratulated for her concern and interest in a condition which is so degrading and embarrassing to so many young women.

I worked in Nigeria as a doctor during the 1950s and 1960s and it would appear that conditions have not changed much. In my surgery list, which was invariably two or three times a week, repair of vesico-vaginal fistula featured very prominently. Very often, however, this "simple surgery", which the author indicates, could not be performed for the simple reason that the hole was so extensive that there was not enough tissue in the area to do the repair with.

In those cases, the only remedy open to us at the time was to transplant the ureters draining the kidneys from the bladder or what was left of it into the rectum. This of course involved major surgery and operating under primitive conditions was not easy. However, in this way, the women were relieved of the misery and humiliation of having urine constantly draining down their legs and this operation changed radically their social life.