WAHA International and the National Midwives Association of Benin recently organized the first international midwives conference for midwife associations in West and Central Africa. The conference took place in Cotonou, Benin on May 18th and 19th. The goal of the conference was to explore the role of midwives in the prevention and treatment of obstetrical fistula. Please enjoy this guest blog post written by Dr. Fatouma Mabeye, the Medical Coordinator for WAHA International.
According to the World Health Organization, 2 million women with obstetric fistula are in need of treatment, with an additional 50,000 to 100,000 new cases occurring annually. Many of the women who make it to fistula programmes for surgery have been living with this condition for years and sometimes even decades. Yet across Africa, only a small proportion of women with obstetric fistula ever have access to a fistula surgeon. Less than 20,000 new and old obstetric fistula cases are operated on each year. While efforts for prevention and providing surgery must continue, we must also find new ways to increase the number of women treated in order to decrease the mounting backlog of cases and the number of women who suffer the social, economical and psychological consequences of obstetric fistula.
Until recently there had been limited data shared on the impact of Foley catheters in terms of curing new fistula cases. However unique data has been collected by the Nigeria National Fistula Programme under the direction of Dr. Kees Waaldijk. Out of a case series of 4424 patients with obstetric fistula who were treated within 75 days post partum, 37% (1579 patients) were cured completely with the use of a Foley catheter without the need of surgery. Dr. Waaldijk who is also president of the International Society of Obstetric Fistula Surgeons (ISOFS) estimates that a more systematic use of a Foley catheter could cure over 25% of all new fistula cases each year without the need of fistula surgeons.
As Dr. Kees Waaldijk explains: “The catheter is used as an immediate active management of any woman who starts leaking urine after childbirth. The earlier this is done the better the chance of spontaneous healing of the smaller fistulas. When it is successful, and that is in at least 25-30% of the patients, it will prevent the woman from being ostracized from her own family and community.”
So how does it work? To put it simply, the indwelling Foley catheter drains urine from the bladder. This decompresses the bladder wall so that the wounded edges come together and stay together giving it a greater chance of closing naturally, at least in the smaller fistulas.
These promising data could lead to a potential change in the role that midwives can play in the fight to eliminate obstetric fistula. If guidelines were developed such that midwives were trained and equipped to carry out this procedure, which costs a couple of US dollars compared to the 300 USD for a surgical intervention, then this could be a cost-efficient and highly effective way to reduce the incidence of fistula cases. This would also enable early identification of the other 75% of women who did not heal and who need a timely referral for surgical treatment in order to reduce the risk of being marginalized within their community.
These data were shared in thefirst international conference for midwife associations from French speaking Africa which was held on the 18th and 19th of May in Benin. Among the midwives who participated, very few felt sufficiently informed of the fistula eradication campaign or of the potential role that they could play in terms of diagnosis of suspected cases and referral to treatment centres. The midwives were very interested in playing a more involved role in preventing fistula—specifically through the use of Foley catheters, an approach which was also endorsed by many participants including gynaecologists, fistula surgeons, and representatives from the Ministry of health, WHO and UNFPA.
It is within this context that WAHA (Women and Health Alliance) International and Dr. Kees Waaldjik have launched a campaign to encourage a much wider adoption of the practice of using a Foley catheter by midwives.
“If applied all over the developing world this strategy will heal more new obstetric fistula cases than all cases being operated on at the moment by all fistula surgeons combined, for a fraction of the costs,” concludes Dr. Waaldijk in his report.
Of course, this campaign will need to address many issues if it is to become a success and a reality: midwives need to feel confident in knowing when and how to apply the catheter, equipment and material need to be available to ensure that it is done in appropriate and hygienic conditions, the patient has to be instructed and monitored very carefully and indications for referral need to be clear.
But as Ms. Monteiro, president of the National Midwife Association of Benin, said at the conference: “any initiative that can prevent, or increase the number of new cases that are successfully treated without surgery must be whole-heartedly embraced by the midwife community and others working in the field of maternal health”
Dr. Fatouma Mabeye is the Medical Coordinator for WAHA International. Fatouma originally trained as a midwife, and then as a medical doctor in Niger, where she subsequently practiced for several years before completing a Masters Degree in Public Health, and working on women’s health projects across Africa.
Pioneer in many innovative surgical techniques and protocols for treating fistula, Dr. Kees Waaldijk is launching, with WAHA International, an “immediate management of the obstetric fistula” campaign that incorporates the use of indwelling bladder catheters. The findings mentioned in this article are being prepared for publication.
To learn more about fistula, please visit the Fistula Care website, a project of EngenderHealth. Also, take a look at the Fistula Foundation website.
Let us know what you think about this blog post! Do you have experience working on fistula prevention and treatment? What do you know about the use of catheters? Join the conversation by sharing your comments in the comments section below.