VASECTOMY IN – reaching urban and rural areas

Dr Jack Siwainao Obstetrician Gynaecologist Naonal 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• Dissecng 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 infecons was 0.91%

• In a New York study – 238 men had no evidence of infecon or hematoma Advantages

1. No incision

2. No stches

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 Province Province

Makira Province

Renbel 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 Distribuon By Province 2006-2009 (accumulave)

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 aer NSV Total Populaon : 26,686 Central Islands Province 13,350 Male Pop Choisuel Province

Isabel Province

Western Pro

HONIARA

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 Iniate 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

Movaon in Men’s Clinic

Men to Men Movaon Movaon 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 Operang 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 Educaon level Employment

8% 8% Nil 28% Primary Villager 33% Secondary Work 51% Terary 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%

• Infecon – 0.34%

• Significant pain – 0.68%

CHALLENGES

• Cerficaon 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 reproducve health services e.g. family planning including NSV

• Meeng for Men as Partners

• Men – support person in labour where possible

THE MESSAGE

TAGIO TUMAS