After a caesarean section damaged her bladder and sadly led to the loss of her child, 27-year-old Ruth lived with fistula for over a year. Fistula is an abnormal opening between a woman’s genital tract and her urinary tract or rectum, affecting between 50,000 to 100,000 women worldwide each year.
Fistula causes incontinence, alongside other health issues, and those living with the condition are often shamed and isolated in their communities. Despite seeking care from multiple health facilities and paying for treatment, Ruth received no help. It appeared that health workers either did not understand her condition or took advantage of her situation.
Ruth lost her livelihood, her children dropped out of school, and she reached a point of considering suicide. After confiding in friends, she learned about fistula repair services at Kitovu hospital in Uganda through radio campaigns, supported by Sanyu Centre for Arts and Rights (SARI)’s partnership with a local radio station. Ruth sought treatment and recovered after three months.
I know many women in my community are suffering with fistula silently. I really believe empowering village health teams in our community is key to ensuring that women get information on fistula treatment, but also on prevention. Moreover, health workers need more education on fistula. When I was suffering, they never told me what condition I had, maybe because they didn’t know.
Ruth’s story is sadly not uncommon. The Ministry of Health estimates that at least 200,000 women in Uganda are living with fistula, with 1,900 new cases occurring each year. But with organisations like SARI working to end the stigma of fistula and increase access to information and care, recovery can happen.
Breaking through stigma and shame
SARI is a creative and cultural arts organisation that empowers young people in creative arts and digital skills for better incomes, health, education and prevention of violence in Uganda. Through their AmplifyChange project, SARI is working in Wakiso district, located in the central region of Uganda, to increase access to sexual and reproductive health and rights (SRHR), including fistula repairs, family planning, and menstrual health for girls and young women with fistula.
Fistula in Uganda mostly affects young and vulnerable women with little education and limited access to quality healthcare. Young women are affected by gender-driven structural and systemic gaps that contribute to the root causes of fistula, including early marriage and poor access to voluntary family planning and emergency obstetric care. Young women whose bodies have not matured face increased complications in childbirth.
Understanding this challenge, SARI launched their Fistula-Free Girls and Young Women programme. The project aims to reduce the backlog of women awaiting life-changing fistula repair, ensuring that they receive timely and quality care from trained providers at Wakiso district health centre and Kitovu hospital.
SARI are approaching this issue from multiple angles:
- Advocacy for increased resource allocation and strengthening the capacity of village health teams to provide referrals and follow-up care for fistula patients. A total of 142 village health team members across four communities were trained in fistula prevention, treatment, and SRHR.
- Collaboration with the district health department, Ministry of Health, Wakiso district hospital, media, partner organisations, and schools to create connections across sectors to address the issue of fistula knowledge and treatment.
- Strengthening and supporting community-level health committees and volunteers in promoting maternal health, encouraging health-seeking behaviours, and improving access to family planning.
Central to their project, SARI advocates for district mobile camps to treat girls and young women with fistula. In 2025, camps were held in January, February, May and June, and in 2026, a six-week camp was held in January. These camps reached a total of 135 women and girls for treatment. Village health teams played a crucial role in raising awareness and supporting women and girls to access treatment.
Post-treatment, girls and young women are supported to reintegrate into their communities through connections to community groups for emotional and social recovery, while also becoming peer educators and ambassadors. SARI works with schoolgirls to increase awareness of SRHR, improve menstrual health knowledge, and prevent early and unintended pregnancies to reduce the likelihood of fistula.
Using arts and media to drive change
Additionally, SARI use visual media and performing arts, including forum theatre, radio dramas, and film screenings, to raise awareness and foster community dialogue on fistula prevention, SRHR, and issues affecting girls’ and women’s reproductive health. These creative spaces have brought together men, women, youth, local leaders, and community health workers, fostering collective support for girls’ and women’s SRHR and dignity.
Storytelling and humour through audiovisual media and live conversations have played a key role in shifting community mindsets and challenging harmful attitudes that contribute to SRHR violations. As a result, women who previously feared speaking out began sharing their experiences to support others. These approaches have opened space for conversations on sensitive health issues that might have otherwise remained unspoken. Stories shared by fistula survivors have served as powerful reminders of the importance of women’s health in community development.
Through in-person theatre and film screenings, SARI reached over 200 people, and through online content, reached more than 500 people. In addition, school awareness campaigns reached over 300 girls and led to the creation of six health clubs across seven schools, focusing on menstrual health, SRHR, and informed decision-making.
Community, sustainability, and growth
Despite delays in organising community events due to seasonal factors and misunderstandings particularly among men regarding the advocacy agenda, SARI have successfully engaged women, girls and the wider community to address the issue of fistula as an issue of health and human dignity. Empowering community members in advocacy has fostered a strong sense of ownership and sustainability.
SARI aims to build on its partnerships with NGOs, community-based organisations, and schools to expand outreach, engage media for increased awareness, and promote male inclusion to address gender norms contributing to fistula. The organisation also plans to work with women leaders to strengthen follow-up on village health team referrals and continue collaboration with Kitovu hospital and Wakiso district health centre.
SARI is developing a recovery programme for fistula survivors, focused on rebuilding their lives through art, community engagement, livelihood training, and storytelling. Survivors will be empowered to become advocates for dignified SRHR and maternal health.
Hope for the future
Today, Ruth is a village health team member and an advocate for maternal health. She encourages pregnant women and new mothers to seek antenatal care and speak up about reproductive health issues, including family planning and gender-related stigma and violence.
Through home visits and quarterly village meetings, she raises awareness and reaches approximately 70 people every quarter, in addition to weekly engagement with expectant and new mothers. Ruth’s experience shows the importance of the work that SARI and their partners are leading.
Before, I didn’t know about fistula and could not support my community. Through my outreach in 2025, I helped a 35-year-old woman, Josephine, access fistula treatment after four years of silent suffering. A single mother of three, she had lost her livelihood and hope. Today, she is fully recovered and employed full-time at Psalms, a confectionery company near her home. Wakiso district health centre now provides fistula repairs at least once a year. In my words, no woman deserves to go through fistula when it can be prevented and treated.
