Silent Struggles, Loud Victories: Judith’s triumph over Fistula

In 2017, as Judith walked into the hospital to give birth to her second child, she expected a smooth experience similar to her first pregnancy. Judith, a 30-year-old mother from Mjanaheri village in Kilifi County, Kenya, had a supportive husband and a vibrant community around her. Her first pregnancy had been straightforward, resulting in the birth of a healthy baby girl. 

However, this time was different. Judith faced obstructed labour, with each contraction bringing pain that consumed her entire being—the hours dragged on, filled with agony. Despite hearing screams from other rooms, no doctor was available at night. She had arrived at the hospital at 1 AM and only delivered at 8 AM. Seven hours of nothing but labour and pain. Yet, when she held her baby boy in her arms, the joy of a newborn washed away all the pain. 

“As I left the hospital, I realised I was having trouble controlling my urine and would leak drops here and there. When I raised the concern with the midwife, she assured me it was normal given the long hours of labour and that my bladder would regain elasticity after a few days. ‘Hiyo ni hali ya Uzazi (that’s a normal delivery process),’ she said,” Judith narrates. 

She did not know she had a fistula. 

Fistula, a childbirth injury often caused by prolonged obstructed labour, affects an estimated two million women globally, with 50,000 to 100,000 new cases each year in sub-Saharan Africa and Asia. Women like Judith, who lack access to timely medical intervention, are particularly at risk. This condition creates an abnormal opening between the birth canal and the bladder or rectum, leading to uncontrollable leakage of urine or faeces, or both. 

Judith went home, hoping the problem would resolve over time. It didn’t. Soon, she noticed that sexual intercourse with her husband was becoming painful. Determined to maintain intimacy and a sense of normalcy in her marriage, Judith chose to persevere through the discomfort. “I loved my husband and wanted to keep our connection strong,” she explains. “Even though it hurt, I didn’t want to push him away or let my condition affect our relationship.” 

Before long, she was pregnant again. Judith describes her third pregnancy as the straw that broke the camel’s back. After delivery, she could no longer control her urine or bowel movements. 

“I couldn’t make it to the toilet in time, and when I did, I would find lumps of faeces in my pants. This caused an odour all the time. I sought treatment at Malindi Hospital, but the cost was too high. They quoted Ksh 150,000, which my husband and I couldn’t afford,” Judith recalls. 

This led Judith to isolate herself from her community. She avoided social gatherings out of shame. “I was ashamed that people would notice the smell and ostracise me. I removed myself instead. This ordeal took a toll on my mental state as I kept comparing myself to other women. When I couldn’t take it anymore, I sought prayer assistance from a women’s group at church.” 

The church was a last resort for Judith because she had never heard of anyone else suffering from fistula and feared it might be witchcraft. “In our community, such conditions are often misunderstood. People think it’s a curse or witchcraft. I felt so alone.” 

 In 2022, she received a broadcast message informing her that Amref Health Africa and the Flying Doctors Society of Africa would be having a free medical camp at Kilifi General Hospital. The message included a toll-free number to call, and when she confirmed it was true, she decided to go. 

“I went to the hospital on 26 March 2022, where I was warmly received. The doctors explained the whole procedure to me with respect. I found other women at the hospital and realised I was not alone. I underwent surgery and was admitted for a few days post-operation as the doctors monitored my recovery.” 

Amref Health Africa, in partnership with the Flying Doctors Society of Africa, is implementing a Fistula Programme funded by the Mpesa Foundation in three counties: Kilifi, Bungoma, and Kiambu. The programme aims to reduce fistula cases in the country by 2030. 

Since 1992, Amref Health Africa has been instrumental in addressing maternal health issues in Africa, focusing on the prevention, treatment, and rehabilitation of fistula patients. The programme has been involved in large-scale surgical interventions targeting women and girls with obstetric fistula. The organisation has conducted numerous medical camps, providing free surgeries to women who otherwise couldn’t afford treatment, and has trained local healthcare providers to identify and manage fistula cases. The programme also trains doctors, nurses, and midwives in obstetric fistula awareness, prevention, surgical repair, and post-operative care. 

“All I can say is that fistula is curable. It is not witchcraft. I am a true testament that this condition can be cured. I am now a fistula champion in my community. I want to reach as many women as possible to create awareness about the condition and urge them to seek treatment. I am forever grateful to Amref Health Africa, Flying Doctors Society of Africa and the Mpesa Foundation. I am now a new woman. I feel like a girl again. I am also grateful to my husband for his support throughout my condition for five years. Not once did I feel shunned,” Judith concludes with a big smile. 

Judith Mangi speaking at a forum sharing the story of her triumph over fistula, Marafa, Kilifi County, Kenya. 

By sharing her story, Judith hopes to destigmatise fistula and encourage other women to seek help. Her journey reflects the broader struggle of many women across Africa and highlights the importance of accessible healthcare and community support in overcoming such challenges.   

Author: Nyambura Gitonga, Communications, Amref Health Africa in Kenya.