peru postabortion program

PERU POSTABORTION PROGRAM

Miguel Gutiérrez MDProject Coordinator

Jhony Juárez MDConsultant

PERU POSTABORTION PROGRAMPERU 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

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

PERU POSTABORTION PROGRAMPERU 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.


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.


ACTIVITIES

Hospitals assesments Training Monitoring and Follow-up Advocacy


PERU POSTABORTION PROGRAM

PATHFINDER´S POSTABORTION CARE

TRAINING MODEL

Miguel Gutiérrez MDJhony Juárez MD

Elizabeth Aliaga MA

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


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.



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.



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.


MODULE TRAININGSimulated Skills Practice

Manual Vaccum aspiration (MVA) Paracervical block. Proper infection prevention procedures. Counseling.


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.


MODULE TRAININGClinical Practicum Objectives

Trainees will demostrate the following: History taking. Physical examination. Manual Vaccum Aspiration. Paracervical Block. Proper infection prevention procedures. Counseling


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


CONTINOUS TRAININGThrough:

Formal courses of predermined length by experienced trainers

Replicas of formal courses developed by the personnel previously trained in formal courses

In service

Internships


TRAINING METHODOLOGY (Materials)

1. Training Modules: Clinical Counseling

2. Pelvic model to perform practices of the MVA technique

3. Brochures


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)



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”.


MVA PROCEDUREPrepare sterile instrument tray

““No Touch” AreaNo Touch” Area

““Gloved hand” Area Gloved hand” Area


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


MVA PROCEDURE PATHFINDER´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


MVA PROCEDURE PATHFINDER´S MODEL

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


COUNSELING MODEL

Counseling is performed in three diferent care phases and has accurate obsjectives:

Before the procedure During the procedure After the procedure


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


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.


PATHFINDER´S POST ABORTION CARE MODEL

PatientPatient

Medical EvaluationMedical Evaluation

DiagnosisDiagnosis

MVA ProcedureMVA Procedure

RecoveryRecovery

DischargeDischarge

BeforeBeforeDuringDuring

AfterAfterContraceptionContraception

CCoouunnsseelliinngg


ECU

AD

OR

ECU

AD

OR

AMAZONAS AMAZONAS

TUM

BES

TUM

BES

PIU

RA

PIU

RA

CAJAMARCA CAJAMARCA

LAM

BA

-LA

MB

A-

YEQ

UE

YEQ

UE

LA L

IBER

TAD

LA L

IBER

TADSA

N M

AR

TIN

SAN

MA

RTI

N

AN

CA

SHA

NC

ASH

HU

AN

UC

OH

UA

NU

CO

PASC

OPA

SCO

UC

AYA

LIU

CA

YALI

JUN

INJU

NIN

HUANCAVELICA

HUANCAVELICA

CU

ZCO

CU

ZCO

MA

DR

E D

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IOS

MA

DR

E D

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IOS

APU

RIM

AC

APU

RIM

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AYA

CU

CH

OA

YAC

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HO

ICA

ICA

PUN

OPU

NO

LIM

ALI

MA

AR

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IPA

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MOQUEGUA

MOQUEGUA

TAC

NA

TAC

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Hos

pita

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Tra

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OC

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CIF

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CH

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CH

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BOLIVIABOLIVIA

L O

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T O

L O

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T O

CO

LOM

BIA

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LOM

BIA

BR

ASI

LB

RA

SIL

Dist

ribut

ion

of H

ospi

tals

wher

e tra

inin

g co

urse

s wer

e co

nduc

ted

1997

- 200

1Sep

t.

421

215

249

885

Number of professionals trained PhysiciansPhysicians

MidwivesMidwives

NursesNurses

TOTAL:TOTAL:


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


OUTLOOK TO 20014. To increase postabortion contraception5. 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


peru postabortion program

Documents

postabortion care process

mva services

septic abortion

mva instruments

impact of unsafe abortion

pac mva procedure

preparation of mva equipment

counseling procedures