Betty first developed fistula while delivering her first child in February 2020. She had prolonged labour. Her water had broken, and she suffered labour pains for 2 days before she finally delivered the baby.  When labour began, Betty was in excruciating pain. She went to hospital as she thought her delivery time was close. When she got to the hospital, the doctor admitted her but told her to wait and left her unattended. Whenever she tried to inform the nurses of her pain, they ignored her. She then felt the urge to push the baby out and walked herself to the delivery room where she still did not receive any assistance. Without any support, Betty lay on the bench and pushed out the baby. The baby let out an ear-splitting cry that then attracted the students on training to run to her aid.

During the delivery, Betty had suffered tears which were stitched. However, after three days the stitches came apart. During these three days she also realized that she had uncontrolled flatulence through her vagina and had a foul smell. She went back to hospital, but they did nothing to assist her. The nurse who attended to her informed her that the stitches were poorly done and because it had already healed, there was nothing that could be done.

Her situation was quite embarrassing, and she was sinking into depression. She could not mingle freely and was confined to the routine of going to work and returning home. Her husband who she thought would be her strongest support system abandoned her. He worked in a different town and reduced the frequency of coming home. She tried to keep busy at work which helped her get her mind off her problems. She explained her situation to her employer, and they indulged her. Despite being able to attend work, she was still unable to freely mingle or have a social life.

Betty decided to get pregnant with hopes that during her second delivery, the problem would be corrected. This was however not the case. Betty delivered her second child in October 2021 via caesarean section which did not offer her a solution to her problem. The doctor who assisted in delivery informed her that the stitches were not professionally done but did not offer a solution. This was heart breaking for her.

One afternoon in May, Betty received a call from the matron at the district hospital informing her about the medical camp, and she purposed to attend. She came to the district hospital for screening and assessment and was identified as a good candidate for the surgery.

Betty says she is feeling better and is now comfortable to sit with others. She is extremely grateful and wishes God’s blessings upon M-PESA Foundation, Beyond Zero, UNFPA, Royal Media Services and Flying Doctors’ Society of Africa. She urges women to get help and not feel embarrassed to speak out about fistula because it does not choose its victim.

Juliet developed fistula in 1988 when delivering her last child. She underwent a caesarean section which resulted in her developing uncontrolled urine flow. Because of her lack of economic capability, Juliet could not seek medical attention and resigned to her fate and accepted her new normal. She did not seek any medical attention.

Juliet lived a life of solitude. She could not socialize with her friends and family neither could she participate in activities she enjoyed such as going to church. Her husband is deceased, and her children already married, and she therefore was on her own. Her children were not able to complete their education and do not have stable jobs. They are therefore only able to assist her with small things such as purchasing soap.

Because she was unable to hide her condition, the women in her community took it upon themselves to help her whenever they could. They mobilized each other to cook and fetch water for her whenever necessary. This kept her going and made life a little easier for her.

While sitting in her home, one of her community members visited her and informed her about the medical camp at Tharaka Nithi which she purposed to attend. Juliet went through successful corrective surgery on 25^th May. She is very happy with the results.

Juliet states that she will take it upon herself to empower women and advise them to seek medical treatment. She is grateful to Flying Doctors Society of Africa, Citizen and all other partners. She thanks them from the bottom of her heart and urges them to continue helping others.

Having successfully delivered two children, Stella did not anticipate developing any complications. Like any other mother, she was excited to meet her bundle of joy. At the time of delivery, Stella encountered some challenges. Her child was too large. The baby was four-kilograms heavy and caused her to suffer tears during delivery. The doctor attending to her was not thorough in stitching the wound causing her more problems than good. Because of the poor stitching, Stella was unable to pass stool neither could she control her urine flow.

Stella tried to seek medical assistance severally but kept getting turned away because the wound had already healed. She sought help at the District Hospital and the doctor who attended to her told her that he would transfer her to Eldoret Teaching and Referral Hospital. He however gave a caveat and stated that it would be costly. Due to her limited finances, going to Eldoret for treatment was not an option for Stella.

To manage her condition, Stella had to remain hydrated and to eat light foods. She was extremely embarrassed by this situation. She could not interact with others because she was afraid of soiling herself. Her self-esteem took a plunge and she sat in solitude most days. She did not feel like a complete woman.  Luckily, her husband was extremely supportive. At first, she did not share her problem with him, but he noticed that she was always sitting outside, and he tried to find out what the problem was. When she shared with him, he stood by her and assisted her to find solutions for her. He got her a bucket to use while in the house. He stood by her and encouraged her.

While performing her household chores, Stella heard about the Flying Doctors Society of Africa’s medical camp on Innoro FM. She was determined to attend and not miss out on the opportunity. She travelled from Eldoret and successfully got surgery on 24^th May 2022. She couldn’t be happier with the results. She feels confident and has an improved self-esteem. Stella says that she now feels like a complete woman.

Stella is excited at the possibilities the future holds. She is grateful to the Flying Doctors Society of Africa. She also encourages women suffering fistula to be bold and come out to seek help.

Jessica first suffered fistula in September 2015 during the delivery of her second child. Despite being in hospital during delivery, Jessica had prolonged labour which resulted in suffering rectovaginal fistula. She passed stool through her vagina instead of through the rectum.

When she sought medical treatment from the hospital, her doctor informed her that there was treatment for the condition, however, it was very expensive. Jessica was greatly discouraged and lost hope of living a normal life. She resigned to her fate and tried to make the most of her new normal.

To navigate her daily routine and to lead a normal life, Jessica wore sanitary pads daily to avoid making a mess. She was constantly uncomfortable and uneasy especially in front of others because she could not only control her stool flow but neither could she control her flatulence. Jessica’s social life took a nosedive, because of her condition, Jessica could not mingle with friends and family, she avoided social gatherings because she was afraid of embarrassing herself.

Lucky for her, she had a great support system both at work and at home. Her husband was very supportive and stood by her during the time. He did not frustrate her or make their home life difficult because of her condition. Her employer was understanding and allowed her to continue working.

A week before the medical camp, while watching TV, Jessica saw the advertisement about the medical camp on Citizen TV and purposed to attend. Jessica proceeded to Kajiado Hospital where on 25^th April, she successfully received the corrective surgery.

Jessica is elated by the results. She says that she now feels like a woman. She is grateful to the M-PESA Foundation and urges them to keep up the great work and spread it to all counties in the country as there are many women suffering in silence. She also encourages women suffering from fistula to be bold and come out to seek help.

When a baby comes into the world, it is a joyous occasion. There is often jubilation to welcome the newest member of the family. This was however not the case for Taabu when she delivered her baby in 2015. Taabu was expecting twins. Before the birth of the children, she was excited to receive her two bundles of joy. The joy was however short lived as her labour was marred with misfortune.

During labour, Taabu delivered the first child normally but unfortunately the child was still born. As if that was not enough, the second baby was not properly positioned to be delivered through natural birth forcing Taabu to undergo an emergency Caesarean section. During the procedure, there was a mistake and she developed vaginal fistula.

Unfortunately, Taabu has lived with this condition for 17 years. Because she had no proper understanding of her condition, she went on with her life and tried to accommodate the medical condition. She went on with her job as a casual labourer and tried to maintain her life as normal as possible. While her husband may have not abandoned her, he was not too concerned with her because he did not understand the condition.

Taabu was alive to the fact that she could not simply wish away the condition and tried to seek for medical help from different medical facilities, but nothing changed her situation. All she received were bags of medication which she took religiously but they offered her no permanent solution.

When the medical help bore no fruit, Taabu sought spiritual help and went for prayers to correct her condition. She still saw no change. She asked her friends and other women but none of them had a solution for her.

A week before the medical camp, while listening to the radio as she was going about her day, Taabu heard about the medical camp. She purposed to attend. 28^th March 2022 will be a memorable day for Taabu as it is the day, she receives normalcy in her life. Her corrective surgery was successful.

Taabu is excited at the possibilities the future holds. She is grateful to the Flying Doctors Society of Africa. She also encourages women suffering from fistula to be bold and come out to seek help. She states that she will take it upon herself to empower women about fistula and encourage them to come forward.

Hers is a special story. Jasmila lived a normal, fulfilling life until 2017 when she went to deliver her baby. She was enveloped by the joy of being a new mother. She had great prospects for her growing family. Unfortunately, her joy was short-lived. Jasmila had to undergo a caesarean section and delivered a still-born child. To add salt to injury, she suffered a bladder injury which resulted in fistula. Jasmila was unable to control her urine flow.

She sought medical assistance and was given some medication. She was also asked to exercise to strengthen her pelvic muscles. These helped with the urine flow; however, her menstrual blood would flow out of the urethra instead of the vagina. This experience was not only uncomfortable but also traumatic especially because the flow was unmanageable. She went for several medical examinations but nothing solved or eased her condition.

Her condition severely affected her family and social life. She could no longer relate with her husband which strained their marriage. Further, she could not mingle with family and friends. Her movement and relations were constrained.

She reached out to friends and family for assistance but the reception was not the best. Some told her that she was cursed and needed to seek spiritual intervention. Some even recommended that she should reach out to native doctors for assistance. This only added to her misery and frustrations.

Luckily, Jasmila caught wind of the medical camp hosted by the Flying Doctors Society of Africa and presented herself at the clinic for help. She was assessed and scheduled for corrective surgery. On 28^th March, Jasmila underwent the corrective surgery and is currently recovering.

Jasmila feels as though she has been given a new lease of life. She has high hopes for herself and her family. She promises to demystify the myths and change perceptions around fistula and empower women within her community.  She is extremely grateful to the M-pesa Foundation and Flying Doctors Society of Africa for coming to her rescue.

May 23 is the United Nations’ (UN) International Day to End Female Genital Fistula. This is a day which promotes action towards treating and preventing Female Genital Fistula. This year’s theme is “Women’s rights are human rights! End fistula now!” To mark this year’s celebrations, Flying Doctors Society of Africa in partnership with the Ministry of Health, UNFPA, KNH, Amref Health Africa, Beyond Zero Campaign, and Safaricom Foundation amongst other stakeholders are launching free fistula treatment at the Kenyatta National Hospital.

Simply defined, Female Genital Fistula is a birth injury caused by prolonged and obstructed labour without access to timely, quality medical treatment. The obstruction causes a hole between the birth canal and bladder and/or rectum leaving women with incontinence problems.

Female Genital Fistula is a maternal health concern that needs to be prioritized as an element of reproductive health services. Fistula is likely to be prevalent in informal settlements as the costs of emergency obstetric complications treatment are too high and often unavailable at local health facilities. Harmful cultural practices such as Female Genital Mutilation (FGM) and teenage pregnancies also increase the susceptibility of suffering fistula. Failure to offer medical services to prevent and/or correct fistula is a violation of women’s reproductive health rights as enshrined in the Constitution of Kenya 2010.

Statistics by the World Health Organization indicate that two women get Female Genital Fistula per 100 births resulting in approximately 3,000 new cases annually. Of the new cases, only 7.5% of the patients have access to medical and surgical treatment. This leaves a majority living with the medical, psychosocial, and economic effects of the illness. This year, the numbers are likely to increase due to a large number of women unable to access proper reproductive medical care during birth.

With the ongoing coronavirus pandemic, many women and girls are likely to suffer from the injury. Following the high number of teenage pregnancies recorded during the pandemic, an increase in fistula cases is anticipated. This is because adolescent mothers face a higher risk of obstructed labour as their bodies are not developed enough to undergo labour safely.

The curfew and frequent lockdowns are likely to dissuade women in labour from seeking medical assistance especially at night. This puts them at risk of suffering fistula injuries. The lack of awareness within the community further dissuades women with fistula injuries from seeking medical help.

Further, overburdened healthcare systems will also put more women and girls at risk of Female Genital Fistula. Fistula repairs have widely been suspended as they are not deemed as emergencies, and hospitals have diverted resources to care for patients with COVID-19. It is therefore paramount that new strategies will be required in the post-COVID-19 recovery period to address the expected backlog of cases.

Female Genital Fistula patients are often unable to lead regular lives due to stigma within the community if corrective treatment is not sought. Further, the impact on their quality of life is severely affected. Fistula patients are often unable to actively participate in family and community life. Majority are left living with the medical, psychosocial, and economic effects of the illness.

In fulfilling its obligation of providing quality reproductive health services, the Government must be deliberate in its actions to end Female Genital Fistula. While private stakeholders such as NGOs and corporate organisations make efforts in creating awareness on fistula and providing free medical services, the Government needs to intensify actions towards ending Female Genital Fistula.

Financial investment in maternal health; capacity building of health care providers; development and implementation of maternal health policies are ways in which the government can work towards ending Female Genital Fistula. Domestication of international guides on Female Genital Fistula and other maternal health standards will also go a long way in ending the occurrence of the injury.

Further, enhancing partnerships and collaboration with NGOs will ensure that the government effectively addresses fistula. Dr. Ademola Olajide, the UNFPA Representative in Kenya states that, obstetric fistula is a sensitive indicator of the quality of sexual and reproductive health services and a severe assault on quality of life of those unfortunate to live with a fistula.  He further states that UNFPA remains committed to supporting the Government of Kenya in all efforts to eliminate obstetric fistula and other maternal morbidities.

In so doing, not only will Kenya eradicate Female Genital Fistula, but she will have made an important step towards achieving the Sustainable Development Goals and realizing the promise of the Beijing Declaration and Platform for Action as well as the Programme of Action of the International Conference on Population and Development. Both policies are focused on fighting for women’s rights, including sexual and reproductive health.

Beverly Mumbo, is an advocate of the High Court and a reproductive rights and gender based violence advocacy expert.