When Jackeline Onderi was wheeled into the delivery ward in 2008, her mind was fixed on one thing- the bundle of joy that she would help usher into the world. All those memories borne out of the heartache she and her husband carried in search of another child seemed all too distant.
Finally, the Onderis would have another arrow in their quiver. A second child to bear their family name with pride. At the time, she did not know that the new life she was about to usher into the world would come at great personal sacrifice.
That night, as she pushed to bring a life into the world, a piece of her would die. Altering her existence in ways unimaginable.
Seventeen years later, she finds herself back on the operating table. This time, not to bring new life into the world but to reclaim one that was lost nearly two decades ago and perhaps have another stab at a life that almost slipped through her fingers.
“I just want to live a normal life,” she says, slowly adjusting her stripped green hospital gown
She walks to a window in the general ward at Kisii Teaching and Referral Levell 6 Hospital and looks outside towards the undulating hills. Her eyes are unblinking. Her gaze fixated on something only she could see.
“My family knows about this, and they have given me support,” she says. “But it had its challenges. Fistula is very intrusive. There are things many people take for granted. Things such as attending weddings. Attending funerals. Making love… Because even during intimacy, you get leakages,” she says, then pauses.
She looks downwards and starts making her way back to her sterile hospital bed from the window. She gets on the bed and lies face up. Her gaze now towards the heavens. She shuts her eyes and exhales loudly. For the next 20 minutes, the room is pin-drop silent.
Numbers Don’t Lie.
It is estimated that one million women worldwide live with untreated fistula.
Behind this staggering estimate are real lives—mothers, daughters, and sisters—enduring unimaginable pain and isolation. Fistula, a devastating childbirth injury, occurs when women in labor cannot access life-saving emergency care.
Trapped in prolonged, obstructed labor without medical help, they survive—but are left with a body that can no longer control urine or feces. The physical agony is only the beginning. The shame, loneliness, and crushing stigma that follow often steal their futures.
In Kenya, roughly 1% of women of reproductive age have experienced fistula-like symptoms, but exact numbers remain unknown. Many suffer in silence, hidden away by a world that misunderstands their condition.
Beyond the relentless leaking and infections, these women face stillbirths, chronic pain, infertility, and nerve damage.
Fistula preys on the most vulnerable among us—women already marginalized by poverty, with no voice in local, national, or global health discussions. Yet their suffering is not inevitable. With proper medical care, fistula is both preventable and treatable. Every woman living with this injury carries a story of resilience but also of systemic neglect. Their pain is not just physical—it’s the loss of dignity, love, and hope.
Searching for Redemption
Jackline’s journey to Kisii Teaching and Referral Level 6 started with a text from a family friend. The message was straightforward; there was a free medical camp whose objective was to address the challenges faced by women with fistula. The ask was even more succinct- would she like to be part of the camp?
“I did not think twice,” she says. “I wanted to do something. I wanted to see whether I could be healed.”
She applied for a few days off her work as a machine operator in Kajiado, and once approved, she got onto the next available night bus and made it to Kisii. Ready for whatever the world would throw her way.
“But before I got on the bus, I had to take some pills that help me hold everything inside,” she says.
A key characteristic of fistula patients is the inability to hold urine, feces, or both. The condition causes them to surrender control of their bowel movements, often resulting in embarrassing situations.
“This is what I have been doing for more than the past decade. Before I go to church…before I go to an event…before I go to a public place. This is what I have been doing,” she says.
Her overnight travel meant she was the first potential patient at the medical camp. After closely being examined, a nurse gave a name to what she had been living with for years- a rectovaginal fistula that causes the fecal matter to leak through her vagina.
Those without the luxury of understanding their condition and finding ways of coping are often surrounded by a constant odor that drives loved ones away—husbands abandon them, families withdraw, and communities shun them, believing the condition is a curse or punishment. The psychological toll is unbearable: depression and suicidal thoughts haunt those who once dreamed of raising children, working, and belonging.
To lessen the psychological toll of fistula to women living with the condition, the M-PESA Foundation, in collaboration with other partners such as the Ministry of Health, the Flying Doctors’ Society of Africa (FDSA), and Amref Health Africa, continues organize- since 2016- free fistula camps across the country. Here, women from all walks of life get diagnosed and, critically, access lifesaving surgeries at no cost.
These fistula camps are often the only way out for women like Jackline who suffer through the condition for years.
“This is our way of contributing to the United Nation’s goal of eradicating fistula by 2030,” Lynda Kasina, a trustee of Safaricom Foundation says.
Approximately 4,000 – 5,000 new obstetric fistulas occur in East Africa annually. FDSA (Flying Doctors Society of Africa) estimates that in Kenya about 1,200 fistula operations are performed per year. This represents about 30% of women and girls in desperate need of surgery.
A few good men.
Through 2024, Dr. Daniel Oluoch performed more than 60 fistula-related surgeries across Kenya. He is just one of the 15 fistula surgeons in the African nation.
“We are a product of our history,” he says, trying to figure out the things that led him onto the path he is currently on.
“I never pictured myself as a doctor. I did not have very high ambitions. But growing up, I came face to face with the plight that women faced when giving birth,” he says.
Dr. Oluoch grew up with a grandmother who was a midwife.
“I would see how women suffered when they came to deliver in my grandmother’s homestead. When I got to medical school, I developed an interest in obstetrics and gynecology and went ahead to pursue that.”
He has been handling fistula cases since 2018.
“There are a few of us because it is less rewarding… the practice has little economic gain. It is for the good of humanity. That is why we have few fistula surgeons, but I am happy the few are giving their time to this selfless act,” he says.
Whenever he walks into any fistula-related surgical procedure, he has only one objective.
“We aim to restore the original anatomy of the patients. It is not an easy task because it requires great effort to reach these women and even greater effort to convince them to get help,” he says.
Stigma often stands between the women and medical intervention.
“These women are not afflicted by design. They did not choose it. Secondly, the condition is not contagious, so they should not be put aside. These are normal people who found themselves in this state. We should not seclude them. We should encourage them to get help,” he says.
Those who overcome the stigma face yet another hurdle- costs.
“Those affected are people of a low social status. These medical camps are the only resort for some of these women,” Dr. Oluoch says.
The surgeries are not cheap and are out of reach for most of the affected women.
“Our reward is in seeing the smiles on their face after they get the intervention. Some require multiple surgeries. We try as much to restore them. For those we cannot restore completely, we do something called ‘diversion’ so that they do not soil themselves.”
The success of the surgery often relies on the surgeon’s technique and the quality of post-operative care. This ensures that they are cured at the first attempt.
Kenya may not be where it needs to be in terms of addressing fistula cases. However, for those who’ve been in the game for a while, notable progress has been made.
A sister’s keeper.
Beatrice Ogutu, a fistula nurse at Kenya’s largest referral hospital, the Kenyatta National Hospital, has been handling fistula cases since 2008. She has seen the highs; she has seen the lows. Throughout her roller coaster ride as a nurse, she has lost hope, regained it, and lost it again. Today, she is regaining it once more.
“We are less than 20 fistula nurses in the country. Some train, but along the way, they fizzle out,” Beatrice says. “It is not an easy job. It is a calling. When we see our mothers leaving our facilities smiling, it gives us hope that we are doing good work.”
But beyond the smiles, there is an often-untold toll on nurses like Beatrice.
“You hear stories of mothers, and they put you down,” Beatrice says. “We always seek god’s guidance along the way and even when we are working. In the darkness that is the life of those living with fistula, it is up to us to find the light.”
For her, a guiding light is encouraging patients who have suffered from this condition to come forward for treatment and, critically, finding the right partners to ensure that the interventions work
“The surgery is not cheap. A simple procedure in a public hospital costs up to KSh. 60,000 Eventually, many end up spending around Ksh. 160,000 to Ksh. 180,000. Many of those afflicted cannot afford this,” Beatrice says. “Having free medical camps ensures these bills are met. My endearing message is that there is hope.”
Beginnings of a journey.
The pin-drop silence in Jackeline’s ward is interrupted by the entry of her assigned nurse for the day, Christine Muthengi. Nurse Muthengi slowly took her through the pre-operation procedures, carefully explaining what the surgery was set to correct.
Once this was done, Jackeline was wheeled into surgery, where a scrubbed Dr. Oluoch waited.
Thirty minutes later, Jackeline emerged from the theatre. A brand-new world lay in wait to be conquered—Sans the stigma and the ridicule but full of a re-established self-belief.
Her future dreams might sound a bit cliché. All Jacqueline wants is to attend weddings without taking a pill. She wants to go to the funerals of her loved ones without wondering if people can smell her. She wants to be invited into people’s houses. She wants to belong. She wants to be her. She wants a return to normalcy. She wants to smile again. She wants to laugh again. Simply put, she wants to be her.
The 30-minute procedure performed by Dr. Oluoch will provide her with all these benefits and more.
