Nkhotakota, MALAWI – Along the lakeshore of Nkhotakota lies Phikaphika Village, a community nestled among rolling hills and dense bushland. Despite its natural beauty, some parts of Phikaphika remain inaccessible, with footpaths being the only means of reaching them due to the rugged terrain.

This is home to Estere Nguluwe, 31, who has lived here with her husband for the past 15 years. Her parents also reside in the same village, having moved from another district in search of fertile land.

“My parents settled here because of the rich soil,” she shares. “The valley is good for farming, and that’s why we love it here.”

For many in Phikaphika, the promise of a good harvest outweighs the challenges of living in isolation. Over the years, the village has grown as more families have relocated to the area seeking better yields.

However, this remoteness comes at a price—especially when medical care is needed.

“The nearest health centre is by the main road, quite a distance from where we live,” says Estere. “It becomes particularly difficult when someone is seriously ill or when a woman is in labour.”

Estere knows this struggle all too well. In 2024, during her fourth pregnancy, she faced a life-threatening situation. With no transport available, she struggled to reach the health facility in time.

When she finally arrived, medical staff noticed that she had obstructed labour.

“The health centre couldn’t manage my case, so they referred me to the district hospital,” she recalls.

Doctors at the district hospital performed an emergency caesarean section to save her life. Tragically, her baby did not survive.

I was in such a bad state—I’m just grateful I made it out alive

Two days after the surgery, Estere noticed she was leaking urine uncontrollably. When she alerted the medical staff, they reassured her that it was a temporary side effect of the procedure and inserted a catheter. But after a week, the condition persisted, worsening each day.

“I had to sleep on a plastic sheet to avoid soiling the hospital bed,” she remembers.

Doctors eventually diagnosed her with obstetric fistula—a childbirth injury that creates an abnormal opening between the birth canal and the bladder, causing continuous leakage of urine. With no immediate solution at the district hospital, Estere decided to return home.

Back in Phikaphika, her life took a drastic turn. She withdrew from daily activities, confined to her house by shame and discomfort. As a farmer, her inability to work meant reduced food for the family.

“My husband was supportive, but I could see he was struggling to provide for us while also caring for me,” she reflects.

To make matters worse, a rumour spread in the village about another woman who had suffered from fistula for years and eventually passed away. Despite doctors assuring her that fistula was not life-threatening, fear and despair consumed her.

“I became depressed,” she admits. “I started believing the worst.”

A turning point came when a fellow church member heard a radio announcement about free fistula treatment at Bwaila Fistula Centre in Lilongwe. She immediately informed Estere’s husband, who wasted no time. The next day, the couple boarded a bus to Lilongwe, clinging to the hope of a cure.

“I had lost faith in treatment because my neighbour had lived with the condition for 15 years,” Estere says. “But when we heard that there was a solution, we didn’t hesitate.”

At Bwaila, doctors confirmed her diagnosis and scheduled her for surgery. Due to the high demand for treatment, she had to wait a week for her operation—but for the first time in months, she had hope.

“I didn’t mind waiting,” she says. “I just wanted my life back.”

Estere’s  surgery was supported by UNFPA through the Bridging Hope project funded by the  Government of Iceland.  When she was discharged, UNFPA also provided her with a solar power set. The solar set, which can charge phones and power small electrical devices, is part of a social reintegration program aimed at economically empowering fistula survivors.

“I had to avoid strenuous work for six months after the surgery,” she explains. “The solar set helped me generate income by charging phones. My husband also started a small barbershop at home, which provided additional support.”

Beyond business, the solar set brought another unexpected benefit—education for her children.

“They can now study at night,” she says. “Their grades have improved, and for that, I am truly grateful.”

Joseph Scott, Communications Specialist