NAIROBI, 18 May 2010 (IRIN) - Every Tuesday and Friday, a bus leaves Langata suburb, 5km south of Nairobi city centre, to pick up women from various points in the city and take them to Jamaa mission hospital in the eastern Buruburu suburbs.

The bus belongs to the charity, Freedom From Fistula Foundation (FFFF), and all the woman are obstetric fistula patients. At the hospital, they receive free surgical services.

"Fistula is really about not being able to get a caesarian section," Lucy Mwangi, FFFF's Kenya director, told IRIN. "This could be due to delays in accessing the hospital at the village, delays in referrals. You can also be in a hospital but develop fistula because of a delay in diagnosis."

Obstetric fistula is a hole in the birth canal caused by prolonged and obstructed labour, leading to urinary incontinence.

Some of the women travelled hundreds of kilometres from their rural homes after contacting FFFF via a mobile hotline regularly advertised on radio stations.

"Whoever gets the number calls, flashes [beeps], or texts and we call them back and ask a couple of questions to establish if they are fistula patients. When in doubt there are incontinence issues," Mwangi added.

"Trust is such a big issue for a woman who has never in her wildest dreams thought of travelling to Nairobi. The women are sometimes also doubtful as they have gone to hospitals and been told they can live with fistula yet repair is possible."

Sometimes, FFFF facilitates the women's travel to Nairobi by sending cash via M-Pesa, a mobile phone money transfer service.

According to experts, Kenya records at least 1,000 new fistula cases annually, with thousands of cases pending surgery. Globally, fistula affects at least two million women and girls in developing countries, with 100,000 new cases each year.

source http://www.irinnews.org