'Japielo, Jalayo’: The cruel names that defined my life until surgery gave me hope again
Lucy Achieng' Odhiambo during an interview at her home in Aluor village, Lambwe East, Homa Bay County, on May 19, 2025. She is a survivor of obstetric fistula.
What you need to know:
- After nine years of isolation, stigma, and pain, Lucy Achieng’s life changed through a free fistula surgery.
- She found healing through surgery and a stranger’s kindness, after being shunned by her community and abandoned by family.
“I had lost the feeling of a full bladder, so much that the night after correctional surgery, I imagined that the extreme lower abdominal pain I was experiencing that night was a result of post-surgery complications,” says Lucy Achieng’ Odhiambo, a 32-year-old resident of Ndhuru in Homa Bay County.
Two weeks earlier, as Lucy was wheeled into the Homa Bay County Teaching and Referral Hospital theatre for corrective surgery, she had only one hope, to leave the facility having regained full control over the call of nature. The surgery date, October 23, 2023, remains fresh in her mind like it happened yesterday. She hoped to leave a life of dignity, one she had yearned for nearly a decade. For more than nine years, she had endured stigma and shame, lived in isolation having lost touch with close family, friends and an entire community.
Lucy also had to temporarily stop her vegetable selling business and was no longer welcomed in public gatherings, thanks to obstetrics fistula.
Dr Evelyne Okello, an obstetrician-gynecologist at the Jaramogi Oginga Odinga Teaching and Referral Hospital, describes obstetric fistula as a connection between the birth canal and bladder and or rectum.
“Normally, the bladder and anus have a sphincter mechanism allowing one to pass urine or stool at one’s convenience. The medical condition, however, leaves a woman with a hole leading to leakage of urine, stool or both.”
Dr Okello says the condition arises from obstructed labour, an obstetric emergency that occurs during contractions when a baby’s head does not progress through the birth canal and ends up compressing the bladder. The body organ wears out, creating a hole between the bladder and vagina or anus, thus resulting in obstetric fistula. While the expert says age does not determine whether the condition affects a woman, being a first time mother or conceiving at a younger age increases the risk of the condition. “This is because they may be younger or have underdeveloped bones.”
As the world marks International Day to End Obstetric Fistula today, the World Health Organization estimates that every year, 50,000 to 100,000 women worldwide are affected. The global health agency's 2018 report reveals that two million young women live with untreated obstetric fistula in Asia and Sub-Saharan Africa.
In Kenya, a recent report by the Global Fistula Map says 24,000 women need corrective surgery, while only 2,000 accessed the services in 2021, creating a backlog. The condition is preventable. For Lucy, all had been well until June 2014 when she walked into a healthy facility suspecting labour. She was 36 weeks pregnant. A medical checkup revealed that her cervix was four centimetres dilated. The healthy worker in charge sent her home, saying she could not be induced because she would possibly go into premature labour.
While the pain persisted over the next couple of days, the doctor advised the expectant mother to get bed rest. A week later, Lucy noticed a continuous vaginal discharge and rushed to the same facility where she was immediately induced. “When my cervix was seven centimetres dilated, labour pain suddenly stopped. My cervix also stopped dilating and the doctors started preparing me for an emergency Caesarean section, saying my baby was distressed.”
While she was being wheeled to the theatre, she recalls experiencing a sudden urge to push the baby out. Lucy pushed for a few seconds but had to stop after her doctor announced that the baby was too big and had to be helped out. A medical equipment, ventouse, would then be inserted inside her cervix and within seconds, she had delivered her second born daughter. Later that night, as she lay in hospital bed with her baby, Lucy realised she was passing urine without control. She alerted the doctor in charge and after a medical examination, she was assured that all would be well.
Lucy was in hospital for the next two weeks. Each passing day, however, the hope of getting better kept fading away. The new mother felt the medical experts were no longer in control of whatever was happening. The more days she stayed, the fewer the doctors who would check up on her. She was eventually discharged, with the medics promising to get back, a promise that was never fulfilled. In the place of adult diapers, she was using old cloth pieces to manage the discharge of urine. Three days after discharge, she was woken up by a foul smell at night, only to realise a faecal matter on her bed. “I did not understand what was happening. I spent the entire morning crying asking questions I had no answers to.”
She proceeded to seek health attention in Migori Teaching and Referral Hospital and was diagnosed with obstetric fistula. While health experts said the condition could be reversed, Lucy was unable to receive timely care because of the high cost involved – about Sh300,000. The hospital had no health expert to attend to her at the time. This was the beginning of a painful nine-year journey.
Lucy, who was a second time mother, never imagined that giving a fourth new life would subject her to pain. After the diagnosis, her husband was only supportive for three months. By December the same year, he had remarried and moved in with a new wife. “I would clean and change at least five times a day. This, however, was only a remedy for a few minutes,” she says. “When walking, I kept checking myself in case of leakages or flies buzzing around me; it was a walk of shame.”
Japielo, jalayo
Lucy’s husband would assault her physically and verbally. He had joined other villagers, including children, in referring to her as japielo (Luo for one who passes stool) or jalayo (one who passes urine). Nobody would eat or drink from Lucy’s house, lest they fell ill. “I once hosted my co-wife's relative and since she slept on my bedsheets, the following day my husband threatened me, saying I would be answerable if the relative ‘also developed obstetric fistula.’”
Lucy, an orphan, went back to her late parents’ home, but she was no longer welcome. To her family, she was a threat to sanitation. When she returned to her house, the 21-year-old at the time resorted to waking up as early as six to clean her bedding. She avoided locals and would stay isolated in her house. “Whenever I attended a public gathering, those around would cover their noses while making funny sounds.”
Her business collapsed as no one was willing to buy from her. She became a farmhand to support her young family. Over time, however, she developed rushes in her inner thighs because of the continuous flow of urine. A year later, Lucy, then 22, walked out of her marriage and moved in with her maternal grandmother, but the stigma did not stop. Her two daughters were not spared either. Her firstborn, then five, had difficulties making friends in school. Since word had gone round the village about her mother’s condition, other children considered her ‘dirty’.
At times, the minor would express disinterest in school and leave home, only for her mother to find her seated isolated looking disturbed. “To date, my daughter has yet to fully accept school. I wish I could enrol her in guidance and counselling services to help her heal. Unfortunately, I am economically unstable.”
Remarriage
Lucy says one of her most challenging moments was when a relative said on social media that “the gods” had punished her for an evil deed she had committed. In late 2022, the frustrated mother sneaked into her grandmother's backyard with a rope, ready to die by suicide. She was, however, rescued by an elderly neighbour visiting her grandmother. For the first time in eight years, someone gave Lucy a listening ear. He later welcomed her to his home, where she stayed for seven months and introduced her to a male relative, who ended up marrying her.
In 2023, the old man, who was now family, came across a poster at the Homa Bay County Teaching and Referral Hospital advertising a free obstetric fistula medical camp. He relayed the message to Lucy, who visited the facility the following day at noon. After an examination, she was booked for surgery the following morning. On October 23, 2023, she was wheeled into the theatre for 45-minute surgery. She was at the facility for two weeks as doctors monitored her recovery. A catheter was connected to her urinary tract to expel urine.
A few days after discharge, she woke up in the middle of the night feeling extreme pain on her lower abdomen. Lucy also felt a strong urge to pass urine. She stepped out and for the first time in more than nine years, she passed urine easily. The next morning her clothes and bedding were all dry. “That was the time I believed I was healed. To date, the medical procedure remains my greatest miracle.”
Lucy says that for the past year, she has been in control of her waste removal system except for a handful of days when having a running stomach.
Dr Okello says psychological impact is one of the major challenges due to the condition. He says the fact that survivors involuntarily pass urine and stool subjects them to exclusion and stigma by society, with some survivors kicked out of their marriages.
“The leakages predispose the women to urinary tract infections, dermatosis, inflammation of skin and malnutrition,” she says, adding that obstructed labour also leaves survivors’ pelvic nerves compressed while others may present difficulties or inability to walk.
Her comments are echoed by Fistula Foundation programme adviser Habiba Mohamed, who says the condition affects a woman’s health, economic activities and social life. She says it affects the mental health of a survivor and her family. “Let us picture a child who is stigmatised because of what her mother is going through. Some husbands turn to alcoholism or flee marriage to evade stigma.”
Habiba says that even after treatment, some survivors choose not to remarry or conceive because of trauma while others end up in pain during sex. She explains that obstetric fistula treatment should go beyond corrective surgery. Besides physical, the survivors should also access psychological healing to help them reintegrate into society.
In a 2023 interview, the Ministry of Health Head of Reproductive Division revealed that Kenya has only 10 facilities offering obstetric fistula care.
Habiba says Kenya has made strides to increase obstetric fistula surgeons from 10 to 15, with the cost, however, remaining a headache to many. “It is painful to think there are women who wait for months or years to access the service in medical camps. No woman deserves this, considering the stigma and humiliation associated with the condition.”
Lucy, who has yet to regain economic stability, says obstetric fistula is one condition that forces women into poverty. Survivors are left battling with stigma while others end up in depression when unable to access medical care, she adds. “I can only imagine what life would be like had it not been for the medical camp. Prior to the corrective procedure, I had made peace with the fact that I would die a shameful death with the condition,” she says.