A woman smiles for the camera

Justine’s Fresh Start

A simple surgery restores dignity and hope

A woman looks off-camera

After giving birth to her fifth child, Justine Nitele struggled to do basic chores. For three years, she couldn’t control her bowels. A long labor had left the 36-year-old mother with an embarrassing condition called fistula, a hole between the birth canal and internal organs that causes urine or feces to leak.

More than 2 million women in sub-Saharan Africa and Asia are estimated to be living with fistula. Many are ostracized by their community and abandoned by their husbands because of their condition.

“I feared being among people,” Justine says. “I felt disgusting and shameful.”

A woman sits outside on a rock wall, holding a young child
A woman works the soil outside a small brick house while two children play in the yard

Fortunately for Justine, who lives in Kalungu District in Uganda, her husband was understanding and helped her with chores like fetching water and collecting firewood.

When she delivered her sixth child, a midwife told Justine that there are doctors who help women suffering from fistula.

Men milk cattle at sunrise
A woman with a baby asleep on her back crouches on a floor, lighting a fire in a brick oven
A woman walks along a path carrying a water can

Fistula is curable and ― with access to timely and skilled medical care during labor and delivery and the ability to time and space pregnancies ― almost entirely preventable.

“I had believed there was no cure for fistula, because I’d had it for so many years,” Justine says.

A woman reads signs on a billboard about fistula
Two women walk on a covered walkway
A woman sits on a hospital bed

Justine underwent surgery at Kitovu Hospital, a Catholic health complex in the town of Masaka where USAID has worked to improve fistula care.

“Because of my treatment, I’m now fine,” Justine says. “I can now do everything with all my energy, without limitations.”

Entrance to Kitovu Hospital
A woman in hospital scrubs stands in front of a door with a sign that reads

Through a partnership with Kitovu hospital and the fistula program, a local organization provided Justine with four goats after her fistula repair to help her family get back on their feet.

“I am rearing the goats to cater for my family’s needs, like school fees, clothes, medical care, and other things,” she says.

A woman tends goats in an enclosure
A woman pours milk for two young children
A wife, husband, and three children pose for the camera
A woman speaks to a group of other women

Now welcomed back into her community, Justine is raising awareness of fistula and how to prevent it.

She encourages women to deliver in a health facility, not at home. She talks to women about voluntary family planning, to have children at the healthiest times to prevent fistula.

“At our women’s group, when I tell them about my ordeal and my treatment, I feel so humbled and grateful,” Justine says.

A smiling woman sits on a mat on the floor, holding a young child

In the five years since her repair, Justine had her seventh and final child via a caesarian section and then opted to use a permanent family planning method.

A woman stands among trees, smiling broadly

“Now that I’m free from fistula, I see a brighter future ahead of me,” Justine says.

About This Story

Since 2004, USAID has provided fistula services in sub-Saharan Africa and South Asia, enabling more than 54,000 fistula repair surgeries.

USAID’s fistula programs focus on the treatment of women with obstetric fistula, as well as prevention and social reintegration.

Through our fistula projects, USAID makes grants to health facilities and other providers that offer dedicated fistula repair services in high-burden countries.

Through this investment, USAID has provided more than 1.5 million family planning counseling sessions, improved 100 health facilities, and trained thousands of local medical personnel and volunteers, including more than 300 surgeons in fistula repair.

Through close partnerships with national governments, USAID advocates for increased health system investments in fistula prevention and repair, promoting host country ownership of fistula prevention and support for fistula survivors.

Photos by Carielle Doe for USAID / Video by Nyasha Kadandara for USAID