As a trained midwife, Barnabus Mulenga acts as a mentor and counselor to pregnant women, helping them with family planning and deliveries.
What sets Barnabus apart from other midwifes, however, is that he’s also a fistula nurse, acting as a mentor to other nurses about the best ways to treat fistula patients.
“I love this work because I see the way these women suffer, starting from failing to provide for their families because they need to wash their cloths all the time,” he says. “I work hard so they are healed and they go back to their normal life.”
Barnabus currently worka at Mansas General Hospital, where he has been employed since 2004. He has been affiliated with the Fistula Foundation since 2017, and has helped with more than 200 fistula surgeries at Mansa General Hospital and 300 surgeries counting other surgical outreaches.
As a mentor to other nurses, he focuses on teaching them how to screen patients, among other things.
“Patients can be screened verbally if having urine incontinence,” he says. “Incontinence – it can be demonstrated. You can see the urine coming out.”
Another way to screen patients is to examine the vagina, where one can feel the defect or hole, he says. The other way to test for fistula that he teaches is by having the patient take part in a dye test with a catheter.
“It’s important to have specialized nursing care,” he says.
The nurse’s job also continues after the patient concludes surgery.
“They come with catheters from theater,” Barnabus says. “Catheters drain urine so we must make sure they aren’t blocked by giving them a lot of IV fluids, so the area is washed out.”
After surgery, it’s recommended that patients drink three to four liters of water within 24 hours.
“We educate them on the importance of drinking water, the genesis of this disease,” he says, later adding that once healed, they should continue to consume a lot of water and abstain from sex for three months. “We want them to heal nicely before they start having sex.”
Once ready for sex, he says, the patient should also be on family planning, so they don’t get pregnant too early. The recommendation is to wait a full year before another pregnancy, and then, the patient must go to the hospital in the eighth month and prepare for a cesarean birth.
Once healed, the women are reintegrated back into the community through the village headmen and Community Health Volunteers, he says.
“The CHV will share that she has been healed in the hospital,” he adds.
But one problem that remains for many of the women is how to earn an income once they are back in the community. Barnabus notes that most of the patients are poor and can’t afford a small business but they might be able to start a cooperative.
“That’s what we are advocating for,” he says.
Barnabus believes sensitization needs to continue through radio programs, sharing information with other women and discussing the injury openly at the hospital because there are still women in the communities with fistula who need help.
“Especially those women who are healed, they tell their friends they can be healed at the hospital,” he says. Otherwise, “ they waste a lot of money at the witch doctor’s.”