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PERU POSTABORTION PROGRAM

PERU POSTABORTION PROGRAM. Miguel Gutiérrez MD Project Coordinator Jhony Juárez MD Consultant. PERU POSTABORTION PROGRAM. GOAL : To improve the reproductive health status of poor women in Peru and contribute to the reduction of maternal deaths

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PERU POSTABORTION PROGRAM

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  1. PERU POSTABORTION PROGRAM Miguel Gutiérrez MD Project Coordinator Jhony Juárez MD Consultant

  2. PERU POSTABORTION PROGRAM • GOAL : To improve the reproductive health status of poor women in Peru and contribute to the reduction of maternal deaths • PURPOSE: To improve the quality and availability of treatment for the complications of incomplete abortion and postabortion family planning and counseling services

  3. PERU POSTABORTION PROGRAM OUTPUTS • Introduction of MVA technique in MOH hospitals • Improved integration achieved between postabortion care and family planning services • Development of appropiate IEC materials for postabortion patients • Increased awareness of health professionals of issues relating to abortion and the treatment of its consequences

  4. PERU POSTABORTION PROGRAM PROGRAM´S PHILOSOPHY • Humane care of incomplete abortion • Out-patient care of incomplete abortion when it is medically appropriate. • Use of MVA for the evacuation of ovular remainings. • Provision of information and contraceptive services inmediately after the abortion.

  5. PERU POSTABORTION PROGRAM PROGRAMS PHILOSOPHY • Diagnosis and treatment of sexually transmited diseases. • Early diagnosis of secondary infertility and referral in order to receive treatment. • Identifying problems related to sexual violence which could affect women’s reproductive health and the respective referral to receive treatment.

  6. PERU POSTABORTION PROGRAM ACTIVITIES • Hospitals assesments • Training • Monitoring and Follow-up • Advocacy

  7. PERU POSTABORTION PROGRAM PATHFINDER´S POSTABORTION CARE TRAINING MODEL Miguel Gutiérrez MD Jhony Juárez MD Elizabeth Aliaga MA

  8. PERU POSTABORTION PROGRAM MODULE TRAININGObjective • To develop skills among health providers to improve the quality of postabortion care throught the: • Sensitize about abortion • Use of MVA technique • Counseling for postabortion patients • Provision of postabortion family planning

  9. PERU POSTABORTION PROGRAM Specific Learning Objectives 1. Explain the impact of unsafe abortion on maternal mortality and morbidity. 2. Identify unwanted pregnancy as a major cause of unsafe abortion. 3. Demostrate sensitivity throughout the postabortion care process. 4. Explain counseling procedures, skills, and attitudes appropiate for MVA services.

  10. PERU POSTABORTION PROGRAM Specific Learning Objectives 5. Explain the steps needed to assess the condition of a woman presenting with symptoms of a septic or incomplete abortion. 6. Describe possible complications of incomplete or septic abortion and their appropiate management. 7. Evaluate the methods of uterine evacuation following incomplete abortion in the first trimester. 8. Demonstrate the preparation of MVA equipment.

  11. PERU POSTABORTION PROGRAM Specific Learning Objectives 9. Demonstrate infection prevention procedures for the provider. 10. Demonstrate how to process MVA instruments for reuse. 11. Summarize pain control procedures appropiate for MVA. 12. Demonstrate the PAC MVA procedure on an anatomical model. 13. Demostrate how to manage complications during the MVA procedure.

  12. PERU POSTABORTION PROGRAM MODULE TRAININGSimulated Skills Practice • Manual Vaccum aspiration (MVA) • Paracervical block. • Proper infection prevention procedures. • Counseling.

  13. PERU POSTABORTION PROGRAM Simulated Skills Practice Using the Five-Step Method of Demonstration and Return Demostration. 1. Overall Picture. 2. Trainer Demonstration. 3. Trainer/Participant Talk-Through. 4. Participant Talk-Trough. 5. Guided Practice.

  14. PERU POSTABORTION PROGRAM MODULE TRAININGClinical Practicum Objectives Trainees will demostrate the following: • History taking. • Physical examination. • Manual Vaccum Aspiration. • Paracervical Block. • Proper infection prevention procedures. • Counseling

  15. PERU POSTABORTION PROGRAM Training /Learning Methodology • Participants handouts. • Discussion. • Brainstorming. • Role play. • Demonstration/Return demonstration. • Trainer presentation/short lecture. • Case studies • Group exercises. • Simulation practice. • Clinical practicum.

  16. PERU POSTABORTION PROGRAM CONTINOUS TRAINING Through: • Formal courses of predermined length by experienced trainers • Replicas of formal courses developed by the personnel previously trained in formal courses • In service • Internships

  17. PERU POSTABORTION PROGRAM TRAINING METHODOLOGY(Materials) 1. Training Modules: • Clinical • Counseling 2. Pelvic model to perform practices of the MVA technique 3. Brochures

  18. PERU POSTABORTION PROGRAM MVA PROCEDUREPATHFINDER´S MODEL • The MVA procedure occurs in 2 distinct phases. • Phase 1: “Metal Phase” • When you will be using a speculum, cleaning the cervix and applying a tenaculum and performing a paracervical block, if necessary. • Phase 2: “Plastic Phase” • Is the part of the procedure during which you will be using the plastic MVA equipment (syringe and cannula)

  19. PERU POSTABORTION PROGRAM MVA PROCEDUREPATHFINDER´S MODEL • In order to practice the best infection prevention technique possible and decrease the risk of contamination, it is helpful to prepare the sterile instrument tray (a Mayo stand or table covered with a sterile drap or cloth) in two parts: • 1 part, approximately 60% of the table is absolutely “no touch”. • 2 part, approximately 40% of the table is the “gloved hand”.

  20. MVA PROCEDUREPrepare sterile instrument tray “No Touch” Area “Gloved hand” Area

  21. PERU POSTABORTION PROGRAM MVA PROCEDUREPATHFINDER´S MODEL • Phase 1: “Metal Phase” • Put the following material in the “no touch” space: • Ring forceps (except for the handles) • Put the following materials in the “gloved hand”space: • Speculum. • Forceps for cleaning the cervix. • Tenaculum (or vulsellum forceps). • Syringe (10cc with 1% lydocaine) and needle extender (for paracervical block) • Cotton or gauze balls

  22. MVA PROCEDUREPATHFINDER´S MODEL

  23. PERU POSTABORTION PROGRAM MVA PROCEDUREPATHFINDER´S MODEL • Phase 2: “Plastic Phase” • Put the following material in the “no touch” space: • Cannulae (except for adaptor ends) • Dilators ( if neccesary) • Put the following materials in the “gloved hand”space: • Adaptor ends of cannulae. • MVA syringe

  24. MVA PROCEDUREPATHFINDER´S MODEL

  25. PERU POSTABORTION PROGRAM COUNSELING • Is an important space where people can receive support and information when being in a critical situation. Counseling means not only to guide or to provide information, but also to strengthen personal self-esteem and to understand personal experiencies. • Is face to face, personal and confodential communication in which one person helps to another to make decisions and then to act on them

  26. PERU POSTABORTION PROGRAM COUNSELING MODEL Counseling is performed in three diferent care phases and has accurate obsjectives: • Before the procedure • During the procedure • After the procedure

  27. PERU POSTABORTION PROGRAM COUNSELING MODEL • Before the procedure • Identify the emotional situation of patient and help her to manage fears or anguishes • Inform on anatomical aspects of reproductive organs. • Inform on pain management/controlling. • Identify her reproductive intentions and the possibility to use postabortion contraception • During the procedure • help patient by maintaining an active communication. • Help her to control pain. • Be “the brigde” between physician-patient

  28. PERU POSTABORTION PROGRAM COUNSELING MODEL • After the procedure • Inform on postabortion family planning and other issues of reproductive health(STD/HIV, cervix or breast cancer detection, sexual violence, etc) • Inform on alarm signs. • Give the post-procedure indications. • Co-ordinate the control visit.

  29. PERU POSTABORTION PROGRAM PATHFINDER´S POST ABORTION CARE MODEL Patient Medical Evaluation Diagnosis MVA Procedure Recovery Counseling BeforeDuring Contraception After Discharge

  30. BOLIVIA Distribution of Hospitals where training courses were conducted 1997- 2001Sept. CHILE PUNO TACNA MADRE DE DIOS MOQUEGUA COLOMBIA BRASIL AREQUIPA CUZCO APURIMAC L O R E T O UCAYALI AYACUCHO JUNIN HUANCAVELICA ICA PASCO HUANUCO SAN MARTIN LIMA Hospitals Trained ANCASH AMAZONAS LA LIBERTAD CAJAMARCA ECUADOR OCEANO PACIFICO YEQUE LAMBA- PIURA TUMBES

  31. Physicians Midwives Nurses TOTAL: PERU POSTABORTION PROGRAM Number of professionals trained 421 215 249 885

  32. PERU POSTABORTION PROGRAM OUTLOOK TO 2001 1.Introduction of Peru Postabortion Program in : • 28 Hospitals (MOH) • 15 Health Centers (MOH) 2.To achieve a change of attitudes towards the women with incomplete abortion in health professionals 3.To offer postabortion counseling in 100% of patients

  33. PERU POSTABORTION PROGRAM OUTLOOK TO 2001 4.To increase postabortion contraception 5.To offer ambulatory treatment for postabortion uncomplicated patients and to use MVA in 60% of cases 6.To improve the quality of postabortion care in 43 MOH hospitals 7.Institutionalization of Postabortion Program

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