November 4, 2023, will forever be etched in the mind of Mary Nthenya Wambua. On this day, her husband of 25 years, Comas Wambua, officially married her in a church ceremony, fulfilling a desire she had longed for over decades.

Mary walked down the aisle at Mwaani Catholic Church in Makueni County, radiantly tying the knot with the love of her life. The flowing white wedding dress moved gracefully as she made her way down the aisle on that bright, sunny morning.

What made this memory even more joyous was that the wedding fulfilled a promise her husband had made when he first married her 26 years ago.

Mary was born with obstetric fistula, a condition she battled until undergoing successful surgery last year. Fistula is a devastating childbirth injury that creates a hole between the birth canal and bladder or rectum, causing uncontrollable leakage of urine or faeces.

Unlike most cases of obstetric fistula caused by obstructed and prolonged labour, Mary's condition was congenital, existing from birth. While often hereditary, congenital fistulas can also result from actions or exposures during pregnancy or childbirth.

When her husband initially married her, he vowed to stand by her and support her despite her condition, promising to honour her with a church wedding once she was healed.

When nation.africa visits their home in the rural village of Kyamsoi about 70 kilometres from Wote town, Mary vividly recounted the excitement of exchanging vows with her husband on that bright, sunny morning.

"This is what I had been praying for all my adult life. It was the happiest day. The man who married me in my youth, despite my shortcomings, wed me in church in broad daylight in front of God and man. I was so humbled by his love for me," she says, beaming with joy.

However, beneath her radiant smile lay a tough journey spanning nearly five decades as she battled with obstetric fistula. Mary opens up about the pain and challenges, citing stigma as one of the worst aspects. Her lowest moment came when she was unable to receive an education due to her condition.

"The condition made me drop out of school so early," Mary explains sombrely.

Read: "I couldn't control a fart", one woman's crusade to end fistula stigma

"When my parents took me, the teachers chased me away, fearing I would infect the other pupils. The embarrassment was unbearable."

She vividly recalls the taunts and ridicule she faced, as her incontinence led to accidents during her menstrual cycle.

"I was the laughing stock of the school. They nicknamed me 'Kinungi', meaning 'the woman who always smells'," she says, her eyes clouding with the memory.

Unable to cope with the stigma, Mary dropped out of primary school in Class Four. She attempted to continue her education at a local polytechnic, hoping for a more understanding environment. However, the same cruel fate awaited her there.

"My fellow students belittled and side-lined me. At lunchtime, I was always served food in isolation, as they claimed I smelled of urine. I had no friends and was always alone," she recalls, the pain still evident decades later.

At age 20, Mary's life took a turn when she moved to Nairobi to live with her supportive brother, the only person who truly understood and loved her unconditionally despite her condition. It was here that she met her future husband. Initially hesitant to pursue a relationship due to her fistula, she eventually accepted his marriage proposal after he assured her of his unconditional acceptance and love.

However, navigating married life with fistula was far from easy.

"The pregnancy periods were the most difficult," Mary confides.

"Carrying a child while battling fistula is an incredibly challenging experience, both physically and emotionally." As a result, after having two children, Mary made the difficult decision to never give birth again, undergoing a tubal ligation procedure.

For years, her parents had desperately sought a cure, consulting witchdoctors and performing rituals in the belief that her condition was caused by a generational curse or witchcraft. However, no traditional interventions provided relief. The persistent incontinence and stigma took a heavy toll, leaving Mary on the verge of a mental breakdown. 

Turning point

Her turning point finally came in March 2022, when she underwent successful fistula surgery at the Makueni County Referral Hospital.

Mary's triumphant story mirrors that of many others in the county, after the government introduced fistula care services in partnership with Jhpiego, a non-profit organisation affiliated with Johns Hopkins University.

"That surgery was life-changing," Mary says, her eyes shining with gratitude.

"After living with this condition for so long, I finally felt whole again. The weight of shame and stigma was lifted off my shoulders."

Post-surgery, Mary confidently returned to church and social settings she had avoided for most of her adult life while fighting stigma.

Read: Let’s be sensitive towards women with Obstetric Fistula

According to Dr Doris Mbithi, an obstetrician-gynaecologist and fistula surgeon heading the Makueni Fistula Care Unit, hundreds of women have been screened, and many have undergone fistula repair surgeries since the unit's inception in March 2022.

The United Nations Population Fund (UNFPA) Country Director, Anders Thomsen, emphasises the need for advocacy and awareness to prevent and treat this preventable condition.

"Fistula is a tragic but avoidable injury that robs women of their dignity and quality of life," he states. "We must continue raising awareness, dispelling stigma, and ensuring all women have access to quality maternal healthcare."

Thomsen calls on affected women to seek help and advocates for preventive care through timely hospital referrals and professional birth attendants.

"By empowering women with knowledge and resources, we can stop fistulas before they occur, and provide life-changing treatment for those already suffering," he adds.

Read: Fistula surgeries giving suffering women their lives back

The Makueni County government has made strides in addressing the issue, prioritising hospital deliveries to reduce the risk of obstetric fistulas. However, with only about 10 fistula surgeons available nationwide, access to fistula care remains limited across Kenya. Efforts are underway to train more surgeons and develop routine fistula management in all 47 counties by 2030.

"We have developed a comprehensive training package to equip more doctors with the skills needed to perform fistula repair surgeries," explains Dr Karen Aura, the fistula lead at the Reproductive and Maternal Health Division at the Ministry of Health.

"Our goal is to have fistula care integrated into routine maternal health services across the country."

While commending Makueni County's efforts, the head of the Reproductive and Maternal Health division, Edward Serem, challenges other counties to prioritise fistula prevention.

"The most sustainable way to address fistulas is to prevent them from happening in the first place," he states. "This requires developing the capacity of medical professionals, retaining them in their areas, and strengthening primary healthcare and referral systems."

As for Mary, her long-awaited church wedding marked the beginning of a new chapter, free from the shackles of fistula and stigma.

"That day, I felt like a true bride – beautiful, loved, and complete," she says, her radiant smile a testament to her resilience and the power of hope.

"My husband's unwavering love and support carried me through the darkest of times, and now, we can truly embrace the future together."

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