How one woman turned pain into purpose to end Fistula in Kenya

Sarah Omega, a fistula survivor and founder of the Let's End Fistula Initiative (LEFI). [Courtesy] For 12 excruciating years, Sarah Omega lived in silence and isolation, battling a condition few dared to speak about: Obstetric Fistula. Today, she is not only healed but also a voice of hope-transforming her pain into a powerful movement that is reaching thousands of students in schools across nine counties. Omega, founder of the Let's End Fistula Initiative (LEFI), says she is working in nine counties to raise awareness and prevent new cases, particularly among teenage girls. Her campaign coincides with this year's International Day to End Obstetric Fistula, observed annually on May 23. "This year's theme, 'Her Health, Her Rights; Shaping a Future without Fistula', is deeply personal to me," said Omega, speaking during an awareness event in Mt Elgon, Bungoma County. Obstetric fistula is a devastating childbirth injury that occurs when prolonged, obstructed labour creates a hole between the birth canal and the bladder or rectum, resulting in incontinence. The condition causes uncontrollable leakage of urine or faeces. But beyond the physical damage, it often produces a persistent foul odour that drives many women into social exile. The World Health Organization (WHO) estimates that between 50,000 and 100,000 women are affected globally each year. Now in her 30s, Omega developed fistula at the age of 19 after a difficult labour ended in a stillbirth. Her baby, she says, weighed 4.8 kg-too large for her underdeveloped body to deliver safely. "I got pregnant at 19. The baby was too large, and my body was too young. I ended up with a stillbirth-and a fistula," Omega recounted. "I was in labour for hours. My organs weren't ready, and I sustained an injury that later became a fistula. The pain wasn't just physical. I was constantly wet, and the smell was unbearable. People wouldn't sit next to me. I was rejected by my community, my family-even myself. I isolated myself. I felt ashamed. I didn't think I could ever be part of society again," she said. Her physical pain was compounded by emotional trauma. For women like Omega, the stench associated with the condition becomes a cruel companion-inviting ridicule, disgust, and exclusion. In many cases, it forces survivors to live in isolation, afraid to attend church, go to the market, or use public transport. Sarah Omega joins fellow survivors in dance during an awareness event in Mt Elgon to mark the International Day to End Obstetric Fistula.. [Courtesy] Omega remained untreated and unmarried for 12 years, living in isolation and battling depression-until she underwent surgical repair at Moi Teaching and Referral Hospital (MTRH) in Eldoret. The operation changed her life-and set her on a mission. Through LEFI, Omega now works in Bungoma, West Pokot, Vihiga, Kakamega, Siaya, Migori, Trans Nzoia, Uasin Gishu, and Busia counties. These counties, she says, have been disproportionately affected by high rates of teenage pregnancy, sexual violence, and limited access to maternal healthcare-all contributing factors to fistula. Her outreach targets schools, healthcare facilities, and communities-particularly in areas where teenage pregnancies and sexual and gender-based violence are prevalent. "Teen pregnancies are a major risk factor for fistula, and Bungoma has some of the highest rates in Kenya," Omega said. Data from the 2022 Kenya Demographic and Health Survey (KDHS) shows that 19% of the country's teenage pregnancies occur in Bungoma, and 62% of women in the county have experienced either physical or sexual violence. Between 2016 and July 2023, 9,089 cases of gender-based violence involving girls aged 10-17 were recorded in Bungoma alone, compared to 18,510 nationally. "Early pregnancies and harmful practices like female genital mutilation make girls more vulnerable to fistula," said Dr Janet Chebet, Medical Superintendent at Cheptais Sub-County Hospital. Dr Chebet also warned against reliance on traditional birth attendants and emphasised the importance of antenatal care and skilled birth attendance to prevent complications during childbirth. "Most of the women who went through FGM suffer from fistula," she said, adding that prolonged labour is a common cause of the condition. In a bid to end fistula in the community, Dr Chebet stressed the need for pregnant women to attend antenatal care visits, deliver in the presence of skilled birth attendants, and present at a health facility in time to avoid prolonged obstructed labour. Omega's initiative takes a four-pronged approach: linking patients to treatment, promoting economic empowerment, supporting social reintegration, and encouraging survivors to become advocates. To date, she says, her organisation has helped more than 2,000 women access treatment. In Mt Elgon alone, advocacy has supported the recovery of over 200 women-many of whom were survivors of sexual violence during Kenya's 2007-2008 post-election crisis. "Mt Elgon remains a hotspot for fistula cases due to the violence women experienced during that period," Omega explained. Omega believes community-driven awareness is key. LEFI now trains former fistula patients to become "champions" in their own villages-encouraging women to seek antenatal care and deliver in health facilities. "These champions use their personal stories to break the silence around fistula. They show that healing is possible." While Omega applauds efforts by the government, she says more needs to be done to meet the global target of ending obstetric fistula by 2030. "We're falling short. Globally, five out of every 100 women still face this condition. I'm calling on our government to prioritise maternal health-invest more, and ensure that policies and insurance schemes cover fistula treatment," she said. She called on the Social Health Authority (SHA) to fully fund fistula surgeries. "There are countries where medical insurance covers fistula treatment. In Kenya, the SHA should take up this responsibility. I believe that if we reach that level as a nation, it will be a major milestone." "If we can make this treatment accessible and continue with education efforts, we can give thousands of women back their dignity." As music rose and survivors danced in Mt Elgon to celebrate healing and resilience, Omega stood tall-no longer a victim, but a beacon. "The scars will always be a part of me," she said. "But they are no longer a symbol of shame. They are a reminder of my mission-to end fistula, one girl, one school, one story at a time."

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