Dr. Joseph K. Ruminjo Offers Additional Insight on the Use of Catheters to Treat New Fistula Cases

Earlier today I posted a guest blog post from Dr. Fatouma Mabeye on a recent meeting in Benin of midwives from West and Central Africa. The goal of the meeting was to explore the role of midwives in preventing and treating fistula—and to discuss the use of Foley catheters to treat new fistula cases. Dr. Joseph K. Ruminjo, Maternal Health Task Force Editorial Committee member, is an obstetrician-gynecologist and the clinical director for the Fistula Care project, managed by EngenderHealth and supported by USAID. I asked Joseph to share his thoughts on the post. Here is what he had to say:

Immediate catheterization for select fresh fistula is one of the four key prevention interventions for fistula. The other three are family planning, use of partograph, and appropriate Cesarean section. Together, these four interventions make up the key prevention interventions of EngenderHealth’s Fistula Care Project. Building on the work done by Dr. Kees Waaldijk, when it comes to catheterization, the following are important considerations:

– What is the process for selecting appropriate cases or those that are most likely to succeed?

– What is the actual percentage of that selection that will then go on to heal spontaneously? A sub-group of these do not heal completely, but the fistula becomes small enough for quicker and simpler repair.

– What does all of this translate to in terms of cost-effectiveness and safety? For instance, you might need to have the catheter in-dwelling for many weeks; in most but not all facilities, this translates into the woman being an in-patient for all those weeks.

– With regard to training midwives or any other health personnel to do the actual catheterization (rather than the case selection) there is no great mystery to the procedure; indeed, most midwives will already know how to do a safe, clean, urethral catheterization for women from their midwifery training.

– Foley’s catheter was mentioned in today’s blog post, but the catheter need not specifically be Foley’s. Dr. Mabeye’s post was very useful and informative. It provides a good analysis of the important role catheterization can play in treating new fistula cases.