PERU POSTABORTION PROGRAM

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PERU POSTABORTION PROGRAM

• Miguel Gutiérrez MD
• Project Coordinator
• Jhony Juárez MD
• Consultant

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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

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OUTPUTS
PERU POSTABORTION PROGRAM

• 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

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PROGRAMS PHILOSOPHY
PERU POSTABORTION PROGRAM

• 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.

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PROGRAMS PHILOSOPHY
PERU POSTABORTION PROGRAM

• 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 womens reproductive health
  and the respective referral to receive treatment.

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ACTIVITIES
PERU POSTABORTION PROGRAM

• Hospitals assesments
• Training
• Monitoring and Follow-up
• Advocacy

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PERU POSTABORTION PROGRAM

PATHFINDERS POSTABORTION CARE TRAINING
MODEL Miguel Gutiérrez MD Jhony Juárez
MD Elizabeth Aliaga MA
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MODULE TRAININGObjective
PERU POSTABORTION PROGRAM

• 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

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Specific Learning Objectives
PERU POSTABORTION PROGRAM

• 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.

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Specific Learning Objectives
PERU POSTABORTION PROGRAM

• 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.

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Specific Learning Objectives
PERU POSTABORTION PROGRAM

• 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.

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MODULE TRAININGSimulated Skills Practice
PERU POSTABORTION PROGRAM

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

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Simulated Skills Practice
PERU POSTABORTION PROGRAM

• 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.

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MODULE TRAININGClinical Practicum Objectives
PERU POSTABORTION PROGRAM

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

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Training /Learning Methodology
PERU POSTABORTION PROGRAM

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

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CONTINOUS TRAINING
PERU POSTABORTION PROGRAM

• 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

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TRAINING METHODOLOGY (Materials)
PERU POSTABORTION PROGRAM

• 1. Training Modules
• Clinical
• Counseling
• 2. Pelvic model to perform practices of the MVA
  technique
• 3. Brochures

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MVA PROCEDUREPATHFINDERS MODEL
PERU POSTABORTION PROGRAM

• 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)

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MVA PROCEDUREPATHFINDERS MODEL
PERU POSTABORTION PROGRAM

• 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.

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MVA PROCEDUREPrepare sterile instrument tray
No Touch Area
Gloved hand Area
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MVA PROCEDUREPATHFINDERS MODEL
PERU POSTABORTION PROGRAM

• 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
  handspace
• 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

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MVA PROCEDURE PATHFINDERS MODEL
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MVA PROCEDUREPATHFINDERS MODEL
PERU POSTABORTION PROGRAM

• 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
  handspace
• Adaptor ends of cannulae.
• MVA syringe

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MVA PROCEDURE PATHFINDERS MODEL
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COUNSELING
PERU POSTABORTION PROGRAM

• 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

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COUNSELING MODEL
PERU POSTABORTION PROGRAM

• Counseling is performed in three diferent care
  phases and has accurate obsjectives
• Before the procedure
• During the procedure
• After the procedure

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COUNSELING MODEL
PERU POSTABORTION PROGRAM

• 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

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COUNSELING MODEL
PERU POSTABORTION PROGRAM

• 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.

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PATHFINDERS POST ABORTION CARE MODEL
PERU POSTABORTION PROGRAM
Patient Medical Evaluation Diagnosis MVA
Procedure Recovery
Counseling
BeforeDuring
After
Contraception
Discharge
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Distribution of Hospitals where training courses
were conducted 1997- 2001Sept.
BOLIVIA
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
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PERU POSTABORTION PROGRAM
Number of professionals trained

421 215 249 885

• Physicians
• Midwives
• Nurses
• TOTAL

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OUTLOOK TO 2001
PERU POSTABORTION PROGRAM

• 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

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OUTLOOK TO 2001
PERU POSTABORTION PROGRAM

• 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