The Action on Fistula programme aims to transform the lives of over 1,200 women in Kenya suffering due to obstetric fistula.
An obstetric fistula is a hole between the vagina and rectum or bladder that is caused by prolonged obstructed labour when emergency care is unavailable, causing incontinence.
women living with fistula
Around 1,000,000 women live with obstetric fistula in developing countries1
women’s lives transformed
The Action on Fistula programme aims to transform the lives of over 1,200 women in Kenya suffering due to obstetric fistula
new cases every year in Kenya
UNFPA estimates 3,000 new cases of obstetric fistula occur annually in Kenya, with approximately one to two fistulas for every 1,000 deliveries2
Recognising that many of the women with obstetric fistula live in isolation in rural communities, Action on Fistula will support the creation of a Fistula Treatment Network across Kenya and fund a major outreach programme with many Fistula ambassadors working in the field
Sufferers of obstetric fistula are often stigmatised and isolated from their families and communities. The damage often prevents further pregnancies
The Action on Fistula programme will free more women from this devastating condition and build capacity through surgical training so that more women can be treated in the future
While obstetric fistula cases can be repaired with reconstructive plastic surgery and straightforward cases have around 90% success rate, surgery and other costs such as nursing care and transport make treatment beyond the reach of the majority of the women affected3
Astellas will provide funding of over €1.5 million over a three year period between 2014-2017
Fistula surgery is complicated and requires experienced healthcare professionals. Kenya currently only has four who are members of the ISOFS, the International Society of Fistula Surgeons
The Action on Fistula programme will increase the number of fistula surgeons in Kenya by 100% through the FIGO (International Federation of Gynecology and Obstetrics) Competency Based Training Programme
Betty endured the trauma of losing her child at birth after a week of painful labour. Then, after she noticed the leaking of urine, doctors discovered she had an obstetric fistula. The condition left Betty feeling isolated and a burden to her mother. However, following corrective surgery provided by the Action on Fistula programme, Betty now feels hopeful that her dignity and quality of life can be restored.
In 2014 Betty became pregnant and experienced no complications until she began to suffer from what her family believed were false labour pains.
Betty endured a week of prolonged pain before reaching out for help.
“My mother assumed I was experiencing false labour, but I was in constant pain for one week. When we realised something was wrong we sought help, but it was too late. The doctors told me that my baby had died.”
The hospital performed a Caesarean section to remove the baby, but after the operation Betty immediately noticed she was leaking urine.
The doctors realised that Betty was suffering from an obstetric fistula. She was identified by the Action on Fistula outreach network and referred to Cherangany Nursing Home for corrective surgery provided by the Action on Fistula programme.
Betty expressed her relief: “Having this surgery has helped to restore my dignity and bring an end to a life of isolation. It has let me help my mother, and I no longer feel like a burden.”
Following a healthy pregnancy, Evelyn was left in labour for 24 hours before being referred to a unit for a Caesarean procedure. Sadly, Evelyn lost her baby and suffered an obstetric fistula, enduring three months of pain, shame and isolation, before finally being treated by the Action on Fistula programme.
At age 20, Evelyn was already a mother of two children when she became pregnant for a third time. Following a healthy pregnancy, Evelyn travelled to her nearest healthcare facility 20 kilometres away, where she was left in labour for 24 hours before being referred to a unit which could perform a Caesarean procedure.
After her prolonged labour and operation, she tragically lost her baby and suffered an obstetric fistula, leaving her in pain and causing her to leak urine. However, Evelyn was assured the fistula would heal on its own and that it was a normal complication of a Caesarean section.
In fact, this was the start of three months of pain, shame and isolation caused by her untreated fistula.
Evelyn explains: “It was so painful to leave the hospital with the few clothes I had bought for my baby. Painful to walk out of the gates without my baby, made worse by me leaking urine. I went from a life of dignity to a life of shame.”
Fortunately, Evelyn was subsequently treated successfully at Gynocare Fistula Centre, through Action on Fistula.
Evelyn credits treatment provided by the Action on Fistula programme for giving back her life.
“The three months I lived with fistula seemed like three decades. I will be forever grateful to Action on Fistula for the new life it has given me. I can now go back to my husband a woman again.”
Faith developed a fistula when she was just 12 years old. In the nine years it took her to access surgery, her mother made the decision to leave the household, but her father stayed. Faith has now received life-changing reconstructive surgery through the Action on Fistula programme.
Faith suffered from an obstetric fistula for nine years. Speaking of their long journey together, Faith’s father, Isaac said: “It does not matter how long it takes. This is my daughter. We have come so far. We see the end of the road which will be the beginning. I hope to marry again one day, but only when Faith is totally healed.”
Isaac kept his promise. He is her strongest supporter and advocate, and he has been at her side at every doctor’s appointment along the way. Many women suffering from obstetric fistula are subject to severe social stigma and denied access to education and employment, leaving them in isolation. Faith feels lucky to have such support from her father.
Through Action on Fistula, Faith has now finally received surgery at Gynocare Fistula Centre. Her fistula was extremely complicated to repair, and it took several surgeries to heal completely, however Faith is now finally healed and her life has been completely transformed.
She was able to enrol in a reintegration and literacy programme offered to fistula patients at Gynocare. The Centre offers ways for women to learn valuable skills, such as sewing, to help them get back on their feet and earn a living.
Faith has also been able to go back to school. Her teacher said: “In a matter of one month, she went from being barely able to hold a pencil on her first day, to becoming one of the brightest students in her class.”
Access to free reconstructive surgery gave Faith back her health, happiness and a bright and promising future.
During her second pregnancy, Queen was left in labour for two days before being taken to a healthcare facility. The prolonged labour resulted in a stillborn baby, with Queen suffering an obstetric fistula and being left unable to walk. Incredibly, Queen endured double incontinence for 40 years, before finally being treated by the Action on Fistula programme.
In 1971, aged 17, Queen was forced into an arranged marriage. Sadly Queen’s first child was stillborn. With her second pregnancy Queen was in labour for two days before travelling to the nearest healthcare facility for help.
After a prolonged labour Queen lost her baby and suffered an obstetric fistula, leaving her doubly incontinent. She was also left unable to walk as a result of injuries sustained from her baby being forcibly removed. When she returned home, she was shunned by her husband and felt feelings of deep isolation and emptiness.
Queen explains: “When my husband saw my injuries, he began to verbally abuse me, calling me a cripple. I was always alone, and often starving.”
After a long period of abuse, Queen returned to her parents but after a few years they died and Queen again felt deeply alone. Fortunately, she was identified and subsequently referred to Gynocare Fistula Centre, where she received free surgery to repair her obstetric fistula, funded through the Action on Fistula programme. After years of isolation, Queen says she now feels valued, and looks forward to being treated with respect and dignity.
“I do not own anything, I don’t have a husband or child – my life is empty. But at Gynocare I am happy, I have found a family and will finally be clean again.”
Pregnant at the age of 13, Elizabeth laboured for two days before delivering a stillborn baby. She developed obstetric fistula, which led to two decades of shame and sadness. She suffered alone until learning that treatment was available through the Action on Fistula programme.
Elizabeth, aged 34, is from Siaya County in Kenya. At the age of 13, Elizabeth dropped out of school after discovering she was pregnant when her mother began to notice physical changes. She carried her pregnancy to full term without any difficulty.
Elizabeth experienced labour pains for two days, and when her labour had still not progressed, her family decided to take her to the hospital, where, tragically, she delivered a stillborn child. Three days later, she realised that she was unable to hold her urine. Nurses incorrectly assured her that the problem would heal on its own with time.
She explains: “Days, weeks, months and eventually years went by without any sign that things were to get back to normal again. I felt confused. My dreams of going back to school were shattered completely, and I felt left in darkness about my condition because I didn’t know what was happening.
“I could no longer go out and socialise. I became the talk of our village, I tried to marry but it never worked because immediately they learned about my condition. Then they left, and I never saw them again.”
When Elizabeth’s employer learned of her condition, she threw her out of her house with fear that she would infect her children with the disease. She later found a man who took her in as a wife, but after two miscarriages, he left her too.
“I had lost hope until I heard an announcement over the radio about fistula treatment,” Elizabeth said.
Elizabeth called for help immediately. She had spent more than two decades suffering because of her obstetric fistula. It was hard for her to believe that her nightmare would soon be over.
Elizabeth was treated at Gynocare Fistula Centre and today is full of hope. She looks forward to working hard and to one day buy a piece of land to fulfil her dream of farming.
Evelynne was encouraged to stay at home to deliver her second baby. She laboured for three days with the help of a traditional birth attendant, but despite giving birth to a lively baby boy, in the lengthy birthing process she developed a fistula. Evelynne has now received life changing reconstructive surgery through the Action on Fistula programme.
Evelynne lives far from any health facility, but when a mobile clinic came to her village she sought assistance for her fistula which had left her incontinent. Due to a lack of widespread understanding of obstetric fistula, she was told by the nurse that she couldn’t be helped, but was given a few tablets of medicine just in case. However, the urine continued leaking.
Her husband decided that he couldn’t tolerate the smell of Evelynne in the house, so he left her and moved to Uganda with their cattle. Her in-laws asked her to leave the house and so she was forced to return home to live with her mother.
Evelynne’s mother, however, had previously met Jen, a Community Health Volunteer with the outreach organization WADADIA. Jen went from house to house telling people about a condition called fistula. At the time, Evelynne’s mother did not realize that her daughter had this condition, but as soon as she returned home she thought of Jen and was able to make the connection.
Evelynne says she was treated very well at Cherangany Nursing Home where she received her fistula repair surgery through the Action on Fistula programme, and she was so relieved to be dry when she left the facility. When she returned home she was able to find Jen to inform her of the good news and thank her for the help she provided.
She is now living with her husband and two children again and is feeling healthy and happy.
Everlyn developed a fistula during her second pregnancy. Shunned and stigmatised by her own family, her husband stood by her until she received successful treatment through the Action on Fistula programme.
Everlyn, aged 30, from Vihiga County in Kenya, developed a fistula in July 2003 during the birth of her second child. She was in labour for a day and a half. The distance from her home to the nearest facility was only one kilometre away but, as she had already laboured at home for nine hours, her condition had deteriorated.
On reaching the health facility, she discovered that they were unable to help her because it was not equipped to manage her situation. She was referred to a hospital in the larger town of Kisumu, where she tragically delivered, through caesarean section, a stillborn baby.
Her story is somewhat different from the story of many other women because, in her case, instead of her family remaining close to her, they were the ones who stigmatised her. She only found solace in her husband, who even went as far as quitting employment to take care of her. Her family told her that she brought shame upon them, and that they wished her dead.
Her fistula was very complex and two attempts at repair were not successful. She finally underwent a successful diversion surgery, provided free of charge through the Action on Fistula programme. She is delighted that she can now regularly go out like other women; the last time she went to church was 11 years ago.
She now looks forward to contributing to her home and community by getting into business and raising her son.
Felistus developed a fistula at the age of 17, after delivering a stillborn baby via Caesarean section. Her husband left her because he could not cope with her condition. She suffered alone until receiving surgical treatment through the Action on Fistula programme.
Felistus is 17 years old and from the town of Bumala, Kenya. She was married at the age of 16 after becoming pregnant. Felistus went into labour at midnight and, due to the lack of available transport at this time of night, had to endure the pain until dawn. She was then rushed to the nearest healthcare facility and continued to labour for 12 more hours. At this juncture they realised that she needed to be referred to another facility that could deliver her baby through an emergency Caesarean section. Sadly, she delivered a stillborn baby boy.
Two days after her operation Felistus started leaking urine. At the beginning she thought that perhaps this was part of the delivery process. However, after some time had passed, she realised that something was wrong. She talked to her nurses about it, but they incorrectly assured her that with time, the fistula would heal. While still at that facility, she developed other complications and was then referred to a provincial hospital for surgery on these other issues.
Felistus lived with fistula for two and a half months; the most painful part of her life. In the beginning, her husband was very understanding and supportive. However, after receiving bad advice from friends, his attitude towards her changed drastically. He told her that he could not stand sleeping on a wet bed every night. Felistus couldn’t go back to her parents’ home because she had left both her family and school for her husband. Then, one day her husband left the home and never came back.
Fortunately, following a visit to a health facility for a catheter change, Felistus learned about fistula treatment provided by Gynocare Fistula Centre, funded by the Action on Fistula programme. She couldn’t believe that she was able to access free surgery and that she wouldn’t have to wait for treatment.
Following successful fistula surgery, Felistus’ husband got back in touch and she is now looking forward to reuniting with him and living her new life.
Grace got married in 1994 and immediately felt pressure to give birth to as many children as possible, as quickly as possible, to earn respect and stability in her marriage. With her fourth child, she endured a traumatic labour and developed a fistula. Thanks to the Action on Fistula programme, she has now been successfully treated.
Grace became pregnant three months after her wedding and delivered a healthy baby at home with the help of a traditional birth attendant. She went on to deliver two more babies at home, and became pregnant with her fourth child in 2006. Grace explains: “By this time, I had become a champion of home delivery and was sure that all I needed was a few minutes to deliver my fourth baby.”
When she went into labour, the birth attendant came as usual but this time there was a problem; Grace’s labour was obstructed. Grace nearly died during labour due to excessive bleeding, and a few days later that she noticed she was leaking urine. Thankful to be alive, she assumed the leaking would stop and everything would go back to normal in a few weeks.
The leaking did not stop, however, and Grace’s life hasn’t been the same since. Her husband would beat her, sex became very painful, and she had to wash herself every few minutes of every day. She began to live a life of isolation, avoiding all social gatherings and occasions.
One evening, Grace was in her kitchen cooking supper when she heard a radio announcement about fistula and free surgical repair. Overjoyed, she decided to find out more at a local health clinic, where staff connected her with Daraja Mbili Vision Volunteers. This group is part of the Action on Fistula programme in Kenya and runs an outreach project. Through Daraja Mbili, Grace was able to access free surgery at Gynocare Fistula Centre and is finally healed.
When asked about her journey, Grace said, “I am very happy that the Daraja Mbili outreach programme has ensured that information about fistula treatment can reach the very remote parts of Kenya; were it not for them, I would be still living with fistula.”
Helen gave birth alone at home, without any assistance, when she was in labour with her second child. Sadly, she delivered a stillborn baby. During her traumatic labour, Helen also developed a fistula and began leaking urine immediately. She has now been successfully treated with surgery by the Action on Fistula programme.
After her traumatic labour and losing her child, Helen was afraid and alone in her home, having recently lost her husband just a few weeks before. She also had trouble walking because of the injury caused by the difficult childbirth, and felt that she was unable to be around other people because of the bad smell caused by her incontinence. She used to walk with other women to collect traditional herbs to sell at a nearby market as a small source of income. But once she developed the fistula she felt unable to go out, so she would hide in the bush and wait until they were gone before trying to collect a few herbs.
Helen confessed that she had never told anyone about her condition because she was afraid of what they would think or do. “They would just laugh at me. They wouldn’t be able to help me,” she said. So she lived in silence.
One day Helen heard the news from Pastor Raphael, a respected and trusted member of her community, that she had a condition that could be cured through surgery. Pastor Raphael had been trained by the organisation, WADADIA, to sensitise his community to the signs and symptoms of fistula, and reassure women living with the condition that help was available.
Although she trusted Pastor Raphael, Helen was still anxious about going to the hospital. She did not know what to expect. When she arrived at Cherangany Nursing Home, however, she met many other women in the same situation as her. She was comforted to see that she was not alone, yet she still doubted whether she could truly be healed.
Helen underwent a successful repair surgery and is now she is back home in her community. She is dry and happy, and is able to socialise and go out with people once again. She has the energy she was missing and is able to go out to the farm and help her children.
Helen says: “I feel like a complete woman again and I say God bless you for that.”
Hellen is 36 years old and from a very remote village in south west Kenya. Whilst in labour with her fourth child she experienced serious complications and, following a Caesarean section, developed a fistula. She has now been successfully treated with surgery by the Action on Fistula programme.
After a few months of marriage, Hellen became pregnant with her first child. She delivered her baby at home, with no medical assistance, and over the next few years she delivered two more children at home without complications.
In 2010, Hellen became pregnant with her fourth child. She was in labour at home for two days before seeking medical attention. It took six hours on a motorbike to reach the nearest health centre, and upon arrival the centre lacked even the most basic medical supplies, such as aspirin and gloves. It then took another four hours for Hellen to reach the district hospital, where a Caesarean section was finally performed.
Following the procedure, Hellen was in excruciating pain and discovered that she had developed a fistula. Her husband soon left her because he wanted a wife who could bear him more children. Hellen lived a lonely life before receiving treatment, feeling used and rejected by her friends and family.
Thankfully, Hellen heard about the Action on Fistula programme through a relative. She was linked with the programme’s outreach partner, Disciples of Mercy, who referred her for treatment at Gynocare Fistula Centre. Her surgery was successful and she is in recovery. Hellen looks forward to putting her life back together when she returns home.
Jacklyn is 29 years old and lives in Kisii County in western Kenya. Following two days of labour with her first child, Jacklyn tragically lost her baby and developed a fistula in the process. She lived with this devastating condition for 17 years until finally being successfully treated with surgery by the Action on Fistula programme.
At 17, Jacklyn was raped and forced into marriage. Jacklyn felt like she had no other choice, so she stayed. She became pregnant in 1998 and had a healthy pregnancy. When the time came to deliver, she went to the local health clinic and was then referred to a district hospital. After two days of labour, Jacklyn was finally taken to the operating room where she had a Caesarean section. Sadly, her baby was stillborn.
Her husband abandoned her at the hospital, where she had to stay for two months due to complications. Her older sister came to visit from time to time. One of those complications was obstetric fistula. The hospital, unable to heal Jacklyn, finally discharged her.
Jacklyn returned home with her sister. She felt like she was once again a burden to her older sister, and was unable to work due to the constant leaking of urine. She lost all her friends and was stigmatised in her community.
Jacklyn lived with fistula for 17 years until hearing about Action on Fistula through community outreach workers from Daraja Mbili Vision Volunteers. Through Daraja Mbili, Jacklyn was able to access free treatment at Gynocare Fistula Centre and is finally healed.
During her recovery, Jacklyn said: “I am so happy that after all the cruelty in life, I have been able to receive some kindness in getting treated.”
Mildred developed a fistula after a prolonged, obstructed labour with her second child. She endured two difficult months living with her condition before receiving life changing treatment through the Action on Fistula programme.
Mildred is 20 years old, and from the town of Mumias, Kenya. In 2011, she successfully delivered her first child with the help of her mother-in-law at home. In 2014, when Mildred went into labour with her second baby, she hoped to have another smooth home delivery. However, she was in labour for two days. As her labour progressed, she experienced complications and was rushed to a health care facility. Fortunately, she was able to successfully deliver her baby by Caesarean section.
Four days after her Caesarean section, Mildred began to notice the uncontrollable leaking of urine. In the time before being rushed to the hospital, constant pressure of the foetus had caused tissue to die, creating a fistula.
She lived with her fistula for two months, the most difficult time of her life, in isolation. Her husband was the only person who remained close to her, washing the urine-soaked rags she used to absorb her leaking urine every ten minutes.
Action on Fistula’s outreach partner WADADIA identified Mildred and referred her for surgery at Cherangany Nursing Home, where she received free treatment through the programme.
Mildred is delighted that WADADIA and Action on Fistula came to her rescue when she was unsure that she could ever be treated. She looks forward to living a happy, fistula-free life.
See the impact the Action on Fistula programme team is making.
Habiba Corodhia Mohamed is the Outreach Manager for Fistula Foundation’s Action on Fistula programme in Kenya. In this role, Habiba trains and manages teams of outreach partner organizations working at the local level to educate communities about fistula and help identify and refer women for treatment. In the first two years of her work on this programme, she developed the Obstetric Fistula Community Assesment Tool (OF-COMBAT) a verbal screening tool that has helped improve the rate of successful fistula diagnosis at the community level.
Prior to joining Fistula Foundation, Habiba worked on fistula for nearly a decade. In this time, she was able to publish a research paper on the psychosocial consequences of fistula to young mothers in western Kenya, and developed Habibathananga, a fistula reintegration model currently under pilot in western Kenya. Ms. Mohamed is also the founder of Women and Development Against Distress in Africa (WADADIA), a community based organization working in the western region of Kenya to provide women in need with psycho-social support, as well as information on reproductive health and economic empowerment.
Kate Grant joined the Foundation as its first Chief Executive in 2005 and leads the Board and staff team, expanding the Foundation from supporting one institution in one country, Ethiopia, to its current global reach in more than 20 countries.
Kate leads the Action on Fistula programme, overseeing delivery on the ground in Kenya, including training of fistula surgeons and a major outreach programme.
“The need for fistula treatment in Kenya is great and we can’t face this challenge alone. We’re honoured to be working with Astellas to end the suffering caused by fistula for women across the country.”
“Our programme with Astellas helps provide the vital treatment these women need and deserve to live happy, fulfilled lives. This generous support also helps us train more surgeons to deliver high quality treatment, enabling many more women to be treated in the future.”
“We look forward to working together with Astellas to help transform many more lives of women affected by fistula.”
Dr. Hillary Mabeya is the founder and lead surgeon at Gynocare Fistula Center, a nongovernmental organisation in Western Kenya that provides reproductive health services to women. Since becoming the first specialised fistula surgeon in the region in 2003, Dr. Mabeya has performed thousands of surgeries that have transformed the lives of women suffering from obstetric fistula.
He previously served as the Chairman for the Division of Reproductive Health at Moi Teaching and Referral Hospital, as the District Medical Officer of Health, West Pokot District, Kenya, and the District Obstetrician/Gynecologist, Kajiado District, Kenya. He also served at the Hamlin Fistula Hospital in Addis Ababa, Ethiopia, and as a fistula surgeon for Africa Medical Research Foundation (AMREF). His professional memberships include the Kenya Medical Association (KMA), the Kenya Medical Practitioners and Dentists Board (KMPDB), Kenya Obstetrics and Gynecological Society (KOGS), and the East, Central Southern Africa Obstetric and Gynecological Society (ECSAOGS). Dr. Mabeya has provided numerous presentations on obstetric fistula in rural hospitals, HIV infected pregnant women, the social, economic, and cultural determinants of obstetric fistula, and surgical outcomes for obstetric fistula. He is also a lecturer and an obstetrician gynaecologist at Moi University School of Medicine in Eldoret, Kenya.
Dr. Mabeya holds a MBChB in Medicine and Surgery and a MMED in Obstetrics and Gynecology from the University of Nairobi. He is also certified in reproductive research by the World Health Organization and served as a Fellow of HIV in Women at Brown University.
“The backlog of patients waiting for treatment is tremendous. Some women have waited for over 70 years to get surgery! Action on Fistula will ease this backlog on a scale never before seen in Kenya.”
Lindsey Pollaczek directs Fistula Foundation’s work in Kenya. As part of the Action on Fistula programme, Lindsay coordinates delivery of the fistula surgery training programme and manages the development of a Fistula Treatment Network and outreach programme in Kenya. Prior to joining Fistula Foundation, Lindsey was with Direct Relief, overseeing the organisation’s Maternal and Child Health initiatives and partnerships in Sub-Saharan Africa.
“Action on Fistula is the first programme of its kind to approach fistula on such a comprehensive scale. Pairing the knowledge and efforts of partners on the ground throughout Kenya with the expertise of globally focused organisations like Fistula Foundation and the International Federation of Gynecology and Obstetrics in this way is not only smart, but respectful of the work that is already underway in Kenya to heal women who are suffering from obstetric fistula.”
If you want to find out about ways of getting involved, or have any questions about the Action on Fistula programme, please contact the Fistula Foundation
1 Adler, A. J., et al. "Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis." BMC pregnancy and childbirth 13.1 (2013): 1.
2 Roka, Zeinab Gura et al. "Factors Associated with Obstetric Fistulae Occurrence among Patients Attending Selected Hospitals in Kenya, 2010: A Case Control Study." BMC Pregnancy and Childbirth 13 (2013): 56. PMC.
3 Lewis, Gwyneth, and Luc De Bernis. Obstetric fistula: guiding principles for clinical management and programme development. World Health Organization, 2006
All photography © Georgina Goodwin