VASECTOMY IN SOLOMON ISLANDS – reaching urban and rural areas Dr Jack Siwainao Obstetrician Gynaecologist NaDonal 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 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 % CPR in 11 10 9 8 6 5 0 CIP MUP ISA Mala Temo GP Hon WP SI Provinces NSV Distribu/on By Province 2006-2009 (accumulave) 120 110 100 181clients 80 60 No. Clients 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 aSer NSV Total Populaon : 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 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% • Infec/on – 0.34% • Significant pain – 0.68% CHALLENGES • Cer/ficaon 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 .