After fistula: How Mama Sarah got her groove back

At 19, Sarah Omega's life took a dark turn when she was raped, resulting in a pregnancy that led to a stillbirth. This left her with a devastating childbirth injury - fistula.

The condition is characterised by the formation of a hole between the bladder and vagina, or between the rectum and vagina due to prolonged obstructed labour. This leads to uncontrollable leakage of urine or stool.

For 12 agonising years, she suffered in silence, bearing the burden of stigma and shame of isolation that would eventually lead to depression. Unaware of the condition she was suffering from, Sarah did not even know where to turn for help.

"I became pregnant and gave birth at a tender age. Though I never saw the baby, I was told the baby weighed around 4.8 kg," Sarah says.

She learned about fistula treatment in 2007 while undergoing medication for depression at the Moi Teaching and Referral Hospital in Eldoret.

“It was during this period, around 2007, that I underwent a successful fistula surgery, and for once, I regained myself because I had lost myself in the process,” explains Sarah, who admits that she had lived in the shadow of herself the entire period.

The World Health Organisation (WHO) states that this condition affects between 50,000 to 100,000 women annually. It's also estimated that more than two million young women live with this untreated condition in Asia and Sub-Saharan Africa. In Kenya, two women get a fistula in every 100 births, resulting in 2,400 new cases annually.

The leading causes of fistula include obstructed labour. This is common in short-stature women with small pelvic bones (outlet) or normal-stature women who have large babies. Obstetric fistula can also occur from inadvertent injury to the bladder or rectum during the process of delivery by a health worker. This type of injury is more common at caesarean sections, but it can occur during vaginal birth too. In cases where instruments assist delivery (vacuum or forceps), they may injure the tissues.

Sarah says the treatment defined a moment of rebirth for her.

“The surgery was successful, and I was able to begin the healing process both physically and emotionally,” she recalls.

Read also: When childbirth leads to lifelong tears

Drawing on her journey of healing and transformation, she has become a beacon of hope for thousands of women facing similar challenges.

Sarah, popularly known as Mama Sarah, started the "Let's End Fistula Initiative (Lefi)" program in 2011, then serving as the Country Program Manager at One By One, a US-based organisation that supports women with fistula.

“Knowing that I was in the same situation as many others who wouldn't disclose or mention it and were suffering in silence, I purposed to use my experience to connect as many women as possible with the then-free fistula surgical care,” she explains.

Childbirth injury

Lefi has grown into a fully-fledged non-governmental organisation (NGO) where Sarah serves as the founder and executive director.

“We started by finding and connecting fistula patients with surgical care. Our mission is to contribute to ending fistula in Kenya and rebuilding the lives of women and girls who have suffered this childbirth injury, through community-based interventions,” says Sarah, whose organisation is based in Eldoret.

Lefi rolls out its programs through four strategic focus areas: Treatment, social reintegration, economic empowerment, and prevention.

Under the treatment component, Sarah says they have a network of fistula survivors referred to as regional representatives. They are trained and engage their communities through religious groups, social gatherings, and learning institutions. The group also links fistula patients to medical care.

“We pay for their round-trip transportation to medical facilities and surgical care. When they go home following surgical care, they are advised on many things, including abstaining from any sexual interaction for a minimum of three months to enhance recovery. Through our team on the ground, we follow up to ensure they adhere to this,” Sarah says.

Social reintegration, their second focus, provides the necessary support system for fistula survivors.

“After treatment, we bring them into solidarity groups where we give them an opportunity to continue sharing their experience. We started launching groups in 2017 with 12 groups serving as our pilot program. Here, they become support systems for each other. This is a critical support for their psychosocial needs.”

In economic empowerment, the third strategic focus area, they provide supportive structures and build the capacity of fistula survivors to start and run successful income-generating activities.

“We build their capacity around financial literacy and entrepreneurship. We train them on how to come up with an income-generating idea and grow it into a profitable enterprise. We also provide mentorship and, at some point, offer seed funds. We are proud when we see their lives completely transformed,” she says.

Under the prevention component, Lefi builds the capacity of survivors through the solidarity groups to serve as champions of safe childbirth.

“After fistula survivors' lives have been rebuilt following a successful restorative program, they voluntarily desire to give back to their community. This is when we come in to train them on how to effectively share preventive messaging using their own experiences,” she says.

Additionally, through the NGO, Sarah has established youth-related preventive programs, including Young Champions Fistula Clubs and Young Adolescent Mothers Programs, to empower adolescent girls and boys to become agents of social transformation. The young mothers' programs offer supportive structures that help in turning their scars into stars. It also has a Tuwape Kesho component, meaning 'let's give them a future’, which addresses their menstrual hygiene challenges.

“We do menstrual hygiene training and produce reusable sanitary pads, a preventive strategy to curb teenage pregnancies that result from girls engaging in early sex in exchange for money to buy pads. We also do community education where we look out for gaps that exist in maternal healthcare, in partnership with departments of health in our counties of operation,” she explains.

Solidarity group

From 2011 to date, Sarah reveals that the organisation, which operates in 12 counties, has supported more than 2,000 women.

Similarly, under their social integration and economic empowerment, which happens through solidarity groups, they have supported 27 groups of 553 women, with a total net worth of Sh13.8 million courtesy of their funders Worldwide Fistula Fund (US-based), Every Mother Counts (US-based), and Global Development (Australia-based).

Jane Tata, the chairlady of the Cheptais Solidarity Group, lauds Sarah for introducing her group to economic empowerment projects following their recovery.

“I engage in poultry, livestock farming, and table banking. This has helped me transform my life. I have even bought a piece of land. I give all credit to Mama Sarah because, through my businesses, I can keep records. Today, I am a beacon of hope in my community,” Jane says.

Leah Chemosoto, another fistula survivor who battled the condition for 20 years, says she is today, among the network of fistula survivors in Cheptais, on the slopes of Mt. Elgon, Bungoma County, sensitizing the community about fistula.

“We encourage women to consider giving birth in hospitals to avoid falling victim to fistula complications,” Leah says.

On her part, Florence Chemolorenyu, another survivor and the regional supervisor of the Bungoma region, reveals that after healing and undergoing economic empowerment in Sarah's organisation, she now engages in agribusiness.

“I appreciate Mama Sarah because I now have money in my pocket. I am the brainchild behind various solidarity groups in Kenya and Uganda under her. I thank her for how far she has brought me. I am also the woman representative of the Chesiro Women's Cooperative Society. I have earned Sh230,000 this year alone through coffee farming,” Florence discloses.

Meanwhile, Sarah says the most rewarding thing to her is seeing the work these women do after recovering. “

“You can see the transformation of a woman who once appeared lost in her world, who had lost her self-worth, to an excited woman who now has her whole life back. And more so, after they have gone through social integration and economic empowerment, they have become influential leaders in their communities, which is so rewarding,” she says.

“Even when I am no longer there, I will be remembered. Even if these women will not remember me, their children will remember me. I have gained a lot; it has been the most enriching journey for me,” Sarah adds.

She started a family several years ago and is now married to Kennedy Otieno.

“He (Otieno) is a very supportive man who has brought out the best in me. God has blessed us with an eight-year-old daughter. I feel these are just the blessings of serving these women,” Sarah says.

In 2013, the United Nations recognised her for her dedication to serving women suffering from obstetric fistula. This is among the many accolades she has earned in her tour of duty.

“I am living a fulfilling life because I am bringing smiles to the faces of many women who had lost hope. Through this initiative, in the next five years or so, I want to build something that even when I am gone, they will say, there lived a woman,” adds Sarah, who seeks to establish an economic empowerment centre where all her work will be centralised.

“Soon, I want the communities to benefit from whatever we do.”

At the same time, Sarah reiterates that she is keen on male empowerment. “We believe that men play a critical role. They are still considered vital decision-makers in a family setup, so to win this battle, we must involve them,” she says.

As a woman, Sarah says she lives a much fulfilled life through her initiative.

“I count it a huge blessing that I have the opportunity to contribute to transforming another woman's life, and I am bringing hope where hope was lost. I am getting a reunion where marriage has failed. A woman should live, laugh, and live again,” concludes Sarah.

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