For five years, Lilian Moraa, 35, endured the pain of isolation, shame, and an unseen wound.  

A difficult childbirth in 2019 left her with a severe medical condition known as obstetric fistula, causing uncontrollable leakage of urine.  

On top of her physical suffering, she faced the heartbreak of being abandoned by the man she once called her husband.

The World Health Organisation (WHO) defines obstetric fistula as an abnormal opening between a woman’s genital tract and her urinary tract or rectum.  

It is estimated that between 50,000 and 100,000 women worldwide are affected by obstetric fistula, which is one of the leading causes of maternal mortality due to prolonged, obstructed labour without timely medical intervention.

Furthermore, the global health agency estimates that more than 2 million young women in Sub-Saharan Africa and Asia live with untreated obstetric fistula.

Women suffering from this condition experience constant incontinence, shame, social isolation, and various health-related complications.

Childbirth that changed everything  

The night Moraa went into labour in Kisii County, there was no skilled birth attendant nearby. Hours of pain turned into a full day of agonising labour at home.  

“I knew something was wrong when I could no longer feel the baby’s movement,” Moraa recalls. “But we had no way to get to the hospital.”  

Eventually, she made it to a local health facility and gave birth to a baby. However, joy quickly turned to confusion when she woke up soaked in urine.  

“At first, I thought I was bleeding. Then I realised I could not stop the urine; I was leaking, and I didn’t understand why,” she says.  

Her husband stayed for a week but began to withdraw, sleeping in a different room, avoiding her gaze, and complaining about the smell.  

“One day, he just left without a word,” Moraa says, her voice breaking as she goes into a deep thought.

“He said I was no longer a wife and that I had become disgusting.”  

Her in-laws soon followed his lead, accusing her of bringing shame to the family. Alone and grieving the loss of her marriage and dignity, Moraa sank into silence.

Hiding in the shadows

The next two years were marked by isolation and inadequate hygiene.

“I wrapped pieces of cloth between my legs and changed them several times a day. I avoided church, family gatherings—everything.”

Local myths only worsened her situation. Some whispered that she was cursed, while others claimed she had been unfaithful.

“I prayed every night to die in my sleep,” she confesses.  

Everything changed when she overheard a radio broadcast about a free surgical camp for women living with fistula, organised by a health NGO.

“I felt like God had finally remembered me.”  

It took immense courage for her to travel from her village to the camp in Kisii County.

There, she was examined and referred first to Kisii Teaching and Referral Hospital and then to Moi Teaching and Referral Hospital in Eldoret.  

After multiple surgeries, Moraa was finally dry.

“For the first time in years, I slept without wetness,” she says, her eyes lighting up.

However, the healing journey was not just physical; it was emotional, too.

Sewing her life back together  

Through counselling and peer support, Moraa found her voice again. She learnt tailoring—a skill she had always admired but never had the chance to pursue.

Back home, she started a small business with a donated sewing machine, making school uniforms and dresses. She now speaks to women’s groups, using her story to inspire and educate.  

“Fistula took away my husband, but it gave me a purpose. I don’t want another woman to suffer in silence like I did,” Moraa adds.  

In 2024, Kisii Teaching and Referral Hospital treated 428 women suffering from obstetric fistula.

While these numbers reflect successful treatment outcomes, they also highlight a deeper crisis in maternal health that continues to affect women in silence.

During a recent medical camp, the hospital recorded over 50 new cases requiring surgery, a clear indicator that the condition remains prevalent, particularly in rural areas where access to skilled birth attendance is limited.  

“That number alone tells us this condition remains a serious concern in our community,” says Dr Matiko Giabe, Director of Medical Services, Kisii County. “Yet fistula is both preventable and treatable—no woman should have to endure it, not now and not in the future.”

Dr Giabe emphasises that the Kisii County government is enhancing its efforts to eliminate obstetric fistula through a comprehensive maternal health strategy.

This strategy includes expanding maternal and newborn services across all public health facilities and training and deploying skilled birth attendants, particularly in rural and hard-to-reach areas.  

However, Dr Giabe believes that the journey does not end with a successful surgery.  

“Treatment alone is not enough. We must go further; survivors need to be fully reintegrated back into society, with dignity and renewed hope,” he states.

“This includes psychological support, trauma counselling, and economic empowerment.”  

The silent wound  

Beyond its physical toll, obstetric fistula leaves deep emotional scars. Many women endure years of rejection, isolation, and shame before seeking help.

“Obstetric fistula is not just a physical condition; it’s deeply traumatic,” explains Joyce Daniel, the Head of Clinical Services at KTRH.

“We see women suffering from depression, anxiety, and post-traumatic stress. Some become completely withdrawn or even suicidal.”

She highlights that survivors often lose their sense of self-worth, particularly if they have been abandoned by their spouses or ostracised by their communities due to the persistent leakage of urine or faeces, which are classic symptoms of the condition.  

Despite ongoing efforts, stigma remains a significant challenge. Dr Giabe stresses the importance of involving faith-based and community leaders in campaigns to eliminate shame and promote acceptance.

“Community support is crucial. No woman should feel ashamed for something that could happen to anyone in her position,” he notes.  

A national crisis

According to the UNFPA, between 3,000 to 3,500 new fistula cases occur in Kenya annually; however, fewer than half of those affected receive timely treatment.

Many live with the condition for years due to stigma, misinformation, and lack of access to services.  

Colin Nelson Musa of the Fistula Foundation reports that efforts are underway to change this trend.

Currently, Kenya has 11 treatment centres spread across 23 per cent of its counties, supported by the Ministry of Health, UNFPA, AMREF, the Flying Doctors Society, and other partners.  

These centres offer free surgical repairs, transportation, and follow-up care.

In the last five years alone, over 5,000 inpatient surgeries have been conducted. Community sensitisation campaigns are also boosting stigma reduction and encouraging early health-seeking behaviour among women.  

“We believe that once a woman is identified with a fistula, she shouldn’t have to wait,” says Musa.

“We cover transport, treatment costs, and post-operative care. There should be no reason for her to stay in pain.”  

Despite these advancements, challenges persist. Kenya lacks comprehensive data on fistula prevalence and distribution, complicating efforts to allocate resources effectively. Moraa now lives alone with her two children.

She has no husband and still longs for companionship, but she holds no bitterness.  

“I have learnt to love myself again. The pain is part of my story, but it’s not where my story ends,” she says in conclusion.