23 May 2025 by Limpho Sello

Est. Read Time: 7m 5s

Listen to this article:

---

This story was produced with support from the United Nations Population Fund (UNFPA) Lesotho to mark the International Day to End Obstetric Fistula.

“I use cloths to pad myself and wrap in blankets whenever I need to go somewhere. Still, the urine leaks through. When I feel the wetness, I have to find a place to change. Sometimes I hear people whisper, ‘Ho nkha mosese mona’ (It smells like urine here), and I just keep quiet.”

With calm resolve, *Libuseng Lebeko (not her real name) recounts her daily reality. Twenty-five years ago, a prolonged labour caused her bladder to tear, leaving her with a lifelong condition known as Obstetric Fistula.

According to Fistula Foundation  an obstetric fistula occurs when a mother has prolonged, obstructed labor, but doesn’t have access to emergency medical care, such as a C-section. 

Because of her condition, Lebeko now lives with the shame of being called ‘mamokotla’—a name given to her because she always carries a school bag filled with cloths and spare trousers.

“I now have a name here—some people call me mamokotla,” a 51-year-old Ha-Mapale resident from Nazareth shared her story with Uncensored News on May 12, 2025.

Lebeko said she has lived with stigma and that her confidence has been shattered because of Obstetric Fistula—a condition that resulted after she endured excruciating labour for days and gave birth to her second stillborn child, leaving her with a torn bladder 25 years ago.

A painful beginning

Lebeko became pregnant with her second child in the late ’90s, though she cannot recall the exact year due to the trauma she endured.

“One Saturday afternoon, around 3pm, I started having contractions. I knew right then that it was time to go to a health facility to deliver my baby. Although I was attending antenatal care at Nazareth Health Centre, I decided to go to a private clinic at Ha-Ntsi.”

Upon arrival, the contractions worsened. The health provider was hopeful Lebeko would deliver soon, but even by the second day, Sunday, she was still in pain. 

“That night, she referred me to St. Joseph Hospital in Roma. When I got there, there was no vehicle to transport me away. Eventually, around 8pm, I was referred to Queen Elizabeth II Hospital.

From that moment, her memory becomes hazy. 

“I do not remember how I was assisted upon arrival until I gave birth. But I know I went into labour that same night. That is where I came across this fate of having a fractured bladder, and the saddest part is that I lost my baby. The nurses told me it was a stillbirth.” 

With more than 24 hours in labour and multiple delays in receiving emergency care, Lebeko’s case illustrates one of the leading causes of obstetric fistula.

The United Nations Population Fund identifies delays in accessing emergency care as a leading cause of obstetric fistula—one of the most serious and tragic childbirth injuries. Caused by prolonged, obstructed labour without timely, high-quality medical treatment, fistula results in a hole between the birth canal and the bladder and/or rectum.

“It leaves women and girls leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty. 

“Half a million women and girls in sub-Saharan Africa, Asia, the Arab States region and Latin America and the Caribbean are estimated to be living with fistula, with new cases developing every year. Yet fistula is almost entirely preventable,” UNFPA said.

While statistics highlight the scale of the crisis, Lebeko’s experience brings those numbers to life.

“When I finally found myself, I was bedridden and helpless. I couldn’t move from my bed. I received the sad news that my baby had passed away and that my bladder had torn. I was admitted there for so many months that I don’t remember how long it was,” Lebeko said. 

She added: “They had to put waterproofs on my bed, which they changed regularly because the urine was just coming out without warning. I couldn’t feel it coming out. What kept me long was the fact that I couldn’t walk.”

Lebeko had to relearn how to walk, moving like a baby taking their first steps. At one point, she was given a walker to help her regain mobility. 

Trying to convey just how long she had stayed in the hospital, Lebeko said, “When I was finally discharged, I couldn’t even remember the corners of the hospital. It felt like I was seeing it for the first time. I think if I had been alone, I would have gotten lost.”

After her discharge from Queen Elizabeth II Hospital, Lebeko was referred to Bloemfontein in South Africa on three separate occasions.

“All the times I’ve gone to Bloemfontein, they would just examine me and give me a new date. Sometimes they would make me drink a lot of water and examine the outcome, but afterward, I would be sent back to Lesotho with no treatment or surgery.”

Why aren’t women like Lebeko getting life-changing surgeries?

Dr. Lucy Mapota is the Director of Clinical Services at the Ministry of Health. On May 22, 2025, Dr. Mapota told Uncensored News challenges in providing obstetrics and gynecology services in Lesotho include a shortage of medical specialists. 

"Firstly, we know that we do not have specialists in the country. The few we have are often from other countries, and at times their investment in patient care can be limited, as they are here mainly to improve their own lives," Dr. Mapota said.

She added: “On the other hand, although we have an agreement with our neighboring country, their health system prioritises their own citizens. As a result, referrals from Lesotho can be compromised.” 

Dr. Mapota said obstetric fistula is a condition that requires highly skilled and dedicated specialists to perform corrective surgeries.

 “Efforts are ongoing to ensure we have doctors in place. In the absence of a local medical school, arrangements have been made with Zambia’s Copperbelt University to admit our doctors,” she said, adding “it is a long-term plan, but it is essential to address the current challenges faced by patients.”

She also emphasised that socio-economic challenges among patients further impact their treatment. 

“Even when all necessary arrangements are made for patients to receive care, the lack of funds to travel back and forth until their treatment is completed becomes a major barrier,” she said.

She feels there is a pressing need for the government to invest in medical specialties and establish a medical school. Doing so, she noted, would help the country retain its doctors and train specialists in critical areas.

“The government must also prioritise improving doctors’ remuneration, as their role in saving lives ultimately benefits the entire country.”

Meanwhile, medical experts say that while surgery is the ultimate solution, providing interim support and counseling can significantly improve the quality of life for women like Lebeko.

Dr Azhar Alam explained that although fistulas rarely heal completely without surgery, non-surgical treatments can help control symptoms and prevent worsening, especially in mild cases or as a temporary measure before surgery.

He cautioned that such treatments must be done under strict medical supervision and advised women like Lebeko to use antibiotics to help clear infections and reduce discharge and swelling.

“However, they don’t address the fistula tract itself. For some, a non-surgical procedure called seton placement keeps the fistula tract open to drain, preventing abscess recurrence. While not a cure, it can manage symptoms until surgery is feasible,” Dr Alam said.

Waiting for help amidst hardship 

Yet, for many women like Lebeko, managing symptoms is only part of a much larger daily struggle. Lebeko said the condition has changed her life completely. She said she used to work as a domestic worker but had to stop, mainly due to the stigma surrounding her condition.

“I currently survive by selling packed snacks just to get something to eat or cater for my needs. I live alone in my hut, but in this yard we stay together with my sister’s children.”

She added, “Sometimes when I am around people, it becomes a struggle to stand up because I fear I might be wet. But when there is no other alternative, I just stand up and leave. I know there are people who speak nasty things about me, although some do not say it directly to me.” 

Lebeko manages her condition by padding herself with cloths and wrapping blankets around her whenever she goes out. Occasionally, she buys baby diapers from a local shop, but they often leak because of their size and quality.

“When I have a few rands, I sometimes buy loose baby diapers from the shop, but they don’t last long.”

She explained the physical toll this coping method has on her. 

“When I walk for long periods, the friction causes blisters and rashes. When that happens, I’m forced to stay indoors, remove my underwear, and keep my legs wide open to get some air, which I believe helps the healing. To heal the wounds I use methylated spirit and madubula (Jeyes Fluid) on the affected areas of my private part —they help me heal well.”

When asked how her challenges could be eased while she waits for life-changing surgery, she said she wishes she could afford adult diapers or a portable catheter, like she has seen others use.

“Also some relatives have advised me to go to Queen ‘Mamohato Memorial Hospital (QMMH), but I haven’t been able to because I don’t have transport money from Nazareth to Maseru.”

She has also requested assistance from the local council, including the provision of adult diapers, which they have promised to help arrange through the Ministry of Social Development in Maseru.

“They promised to submit my request to the Ministry of Social Development in Maseru. I followed up more than once. The person I spoke to said he hadn’t done it yet because of delays. He told me that if I couldn’t wait, I could take the documents myself to Maseru. So now I’m still waiting.”