Esther Mwikali Ndii endured decades of shame and isolation due to an untreated obstetric fistula sustained during childbirth at age 20. The condition caused chronic incontinence, leading to social stigma and a reclusive life. In May 2024, Esther received successful treatment through Jhpiego’s Obstetric Fistula Project in Kenya, restoring her health and dignity. Today, Esther serves as a symbol of hope, with her story highlighting the importance of accessible maternal health care.
For more than six decades, Esther Mwikali Ndii of Makueni County, Kenya, lived in quiet torment—trapped by a condition all too common among mothers in low- and middle-income countries.
Esther suffered from obstetric fistula, a devastating childbirth injury resulting from the difficult birth of her firstborn when she was 20. Prolonged obstructed labor is often the cause of obstetric fistula, an abnormal opening between a woman’s birth canal and her bladder and/or rectum causing urinary and/or fecal incontinence or both.
“According to the Ministry of Health, 3,000 Kenyan women develop obstetric fistula annually,” said Dr. Daisy Ruto, Jhpiego’s Obstetric Fistula Project Director. “Yet, treatment remains out of reach for many due to limited resources, with only 12 trained surgeons in the country specializing in its repair.”
Childbirth, meant to be a joyful moment, instead left Esther’s body broken. The fistula caused her to lose control of her bladder and bowels and her incontinence brought her immense shame. A once devout churchgoer, she avoided social gatherings and mostly stayed indoors due to the pervasive smell of urine.
Esther made sacrifices to try to accommodate her condition. She ate less, hoping to reduce trips to the bathroom. But hunger did not bring her peace.
“We bring in nutritionists because most women with fistula are malnourished,” said Dr. Ruto. “They need to be optimized before surgery since some don’t eat well or drink enough fluids to avoid leaking urine and stool.”
A 60-year ordeal ends with hope
Despite her debilitating condition, Esther had three more children (pregnancy after developing a fistula can lead to major complications). Yet stigma followed her like a shadow—affecting her husband and children. “It was very difficult for us as a family. We were ashamed and heartbroken when our mother was openly rejected,” said her youngest son, David Kyalo, now 45.
Over the years, hope flickered and then dimmed. Several visits to hospitals for a diagnosis yielded nothing. The family resigned themselves to the feeling of shame and silence for 60 years.
“We chose to make her comfortable and live her life as best as possible. The family accepted the situation and built a thick skin, though there were moments when it felt utterly unbearable,” David explained, his voice heavy with resignation.
On May 21, 2024, a new chapter began for Esther—one of hope, dignity, and triumph.
That morning, David received a text about a program offering treatment for women with leakage of urine, stool, or both. Jhpiego, through the Obstetric Fistula Project, funded by Johnson & Johnson, was conducting an awareness campaign via SMS messages. The message informed David that there were free fistula screenings at Kilungu Sub-County Hospital, one of 10 fistula screening facilities in Makueni County. Although he didn’t think his mother could be treated because of her age, David convinced her to attend the screening. He said: “I wanted to try since my only wish was for my mother to regain her dignity and live without shame.”
That same day, Esther was admitted to the Makueni Mother and Child Hospital, one of the health facilities equipped to conduct fistula repair. Her long ordeal was finally about to end.
Comprehensive obstetric fistula services replace shame with joy
Through the combined efforts of Jhpiego, Johnson & Johnson, and the team at Makueni Mother and Child Hospital, Esther received the care and treatment she needed. Successful surgery restored her health and her dignity.
Jhpiego is implementing the three-year Obstetric Fistula Project in Makueni County to prevent obstetric fistula; raise awareness and provide education on obstetric fistula services; reduce the surgical backlog; find hidden cases; manage obstetric fistula cases; and support rehabilitation and reintegration. Since the project’s beginning, 146 women have received constructive surgeries at the Makueni Mother and Child Hospital.
Esther has become a beacon of hope in her community. She now attends church and other social events with her head held high and a broad smile fueled by a healed body. She can eat well without having to worry about soiling herself. David also smiles often. His mother’s perseverance and courage fill his heart with hope. The shame that bound their family has dissolved—gratitude and joy have replaced it.
This story was reviewed by Mary Muthengi, a Technical Officer in Jhpiego’s Kenya office.
Kevin Omollo was a communications intern for Jhpiego’s Kenya office.