VASECTOMY IN SOLOMON ISLANDS – reaching urban and rural areas
Dr Jack Siwainao Obstetrician Gynaecologist Na onal Referral Hospital
05 60 R1 3/6/03 11:07 PM Page 7
Instruments 2 and Supplies
The no-scalpel technique requires two instruments specially designed by Dr. Li Shunqiang. 1. The extracutaneous ringed forceps is a type of clamp used to fix the vas deferens (Fig. 1).For the sake of clarity, the term ringed clamp will be used throughout this manual. Throughout the operation, the surgeon uses the ringed tip of this instrument to encircle and to grasp the vas, without injuring the skin. The clamp grasps the vas both extracutaneously05 60 R1 3/6/03 11:07 PM Page 8 and directly. This instrument comes in three ring sizes: 3.0 mm, 3.5 mm, and 4.0 mm. These different diameters accommodate different thicknesses of vasa and scrotal skin. DR LI. SHUNQUIANG
FIGURE• Ringed clamp 1. Ringed clamp FIGURE• Dissec ng 2. Dissecting forcepsforceps
Inside dimensions of clamp: 3.0 mm, 3.5 mm, or 4.0 mm forceps
2. The dissecting forceps (Fig. 2) is similar to a curved mosquito hemostat, except that the tips are sharply pointed. It is used to puncture the scrotal skin, EngenderHealth 7 to spread the tissues, to dissect the sheath, and to deliver the vas deferens. The dissecting forceps can also be used to grasp the vas while a ligature or cautery is applied for occlusion. Because the instrument is a modified hemostat, it can be used to control bleeding. Throughout this manual, the term dissecting forceps will be used to refer to this instrument. Additional instruments and supplies needed for no- scalpel vasectomy are:
1 •A 10-cc syringe with a 1⁄2-inch, 25- or 27- gauge needle (U.S. system). The syringe and needle are used to infiltrate the local anesthetic, both for the skin wheal and the vasal block anesthesia (see Chapter 4). •Straight scissors,to cut the vasa deferentia and ligatures. •Supplies for vasal occlusion (for example, ligature material or a cautery unit). Table 2 presents a complete list of instruments and supplies needed for no-scalpel vasectomy.
8 No-Scalpel Vasectomy: Illustrated Guide EngenderHealth 12 • NO-SCALPEL VASECTOMY (NSV) was developed in China by Dr. Li Shunquiang in 1974
• In 1985, NSV was introduced outside of China
• During 1990-1992, 50,000 men received NSVs in 19 countries NSV is safe
• In China (179,741 men) – Rate of haematoma 0.09% – Rate of infec ons was 0.91%
• In a New York study – 238 men had no evidence of infec on or hematoma Advantages
1. No incision
2. No s tches
3. Faster procedure
4. Faster recovery Advantages
5. Less chance of bleeding
6. Less discomfort
7. High efficacy
SOLOMON ISLANDS
Choiseul Province Isabel Province Western Pro
Central Malaita Province HONIARA Guadalcanal Province
Makira Province
Renbel Province Temotu Province FP Data
30 29
25 25 21 20 20
15 13
CPR in % CPRin 11 10 9 8 6 5
0 CIP MUP ISA Mala Temo GP Hon WP SI Provinces NSV Distribu on By Province 2006-2009 (accumula ve)
120 110 100 181clients
80
60
No. Clients No. 40 29 20 21
8 5 5 2 4 0 0 0 CIP GP Hon TP MP WP CP MUP IP RB Provinces Clients transported Home a er NSV Total Popula on : 26,686 Central Islands Province 13,350 Male Pop Choisuel Province
Isabel Province
Western Pro Malaita Province
HONIARA Guadalcanal Province
Makira Province
Renbel Province Temotu Province CENTRAL ISLANDS PROVINCE (2008 – 2010) 166 clients 50 44 45 43 40 34 35 30 30 25 20 14 15 10 5 1 0 Zone 1 Zone 2 Zone 3 Zone 4 Zone 5 Zone6 IMPACT OF NSV PROGRAM
ANNUAL CPR IN CIP -2005-2006 29 27
30 25
25 19 20
CPR IN % 15 10 5 0 2005 2006 2007 2008
2005 2006 2007 2008 YEARS IMPACT OF NSV PROGRAM
Empty postnatal ward Reduced maternal deaths
ANUAL CASES OF MD IN CIP 2005-2007 6 4 2No. CASES 0 2005 2006YEARS 2007 2008 Ini ate relevant Training & Support for Health workers & partners
§ Nurses -Male Nurses Training for Male Nurses § Midwives § Peer educators § Faith base groups § Stake holders.
Sharing ideas & experiences
Look & Learn event for Male Nurse & Doctors. USE ALL AVENUES FOR MOTIVATION
• Working men – tea/Betel Nut breaks • Workshop/Awareness venues • While wives are in labour • Men’s Clinic • Outreach & tours • Fishing Trips
Mo va on in Men’s Clinic
Men to Men Mo va on Mo va on during workshops
USE THE VAS AS A BAIT KILU’UFI PROVINCIAL HOSPITAL (150 clients) 45 40 40 35 30
25 21 20 14 15 15 11 12 10 9 9 10 4 5 5 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 GUADALCANAL PROVINCE
2013 -2017 – Total of 117 NSVs
2010: “South to South Collaboration”
10/09/17 12:40 DR. AUGUSTIN MELLY. 23 NATIONAL REFERRAL HOSPITAL NSV started in O&G…2009
Outside Opera ng Theatre Pap Smear Clinic
NATIONAL REFERRAL HOSPITAL (297 Clients)
80 71 70
60
50 40 40 38 36 33 34 32 30
20 13 10
0 2009 2010 2011 2012 2013 2014 2015 2016 PROVINCES
120
100 96 95
80
60
40 21 17 15 20 9 5 4 7 3 0 Educa on level Employment
8% 8% Nil 28% Primary Villager 33% Secondary Work 51% Ter ary 72% NUMBER OF CHILDREN
60 52 52 50 50
40
31 30
20 20 18
9 10 5 3 3 0 2 3 4 5 6 7 8 9 10 11 12 13 14 COMPLICATIONS
• Haematoma – 0.34%
• Infec on – 0.34%
• Significant pain – 0.68%
CHALLENGES
• Cer fica on of male nurses
• Men have limited access to our clinic facility
• Fear to come to women’s clinic
• No place for men in our system WAY FORWARD
• Men’s clinic – access to reproduc ve health services e.g. family planning including NSV
• Mee ng for Men as Partners
• Men – support person in labour where possible
THE MESSAGE
TAGIO TUMAS