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PERU POSTABORTION PROGRAM. Miguel Gutiérrez MD Project Coordinator Jhony Juárez MD Consultant. PERU POSTABORTION PROGRAM. GOAL : To improve the reproductive health status of poor women in Peru and contribute to the reduction of maternal deaths - PowerPoint PPT Presentation
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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.
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
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.
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
ACTIVITIES
Hospitals assesments Training Monitoring and Follow-up Advocacy
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
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
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
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.
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
Specific Learning Objectives
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.
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
Specific Learning Objectives
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.
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
MODULE TRAININGSimulated Skills Practice
Manual Vaccum aspiration (MVA) Paracervical block. Proper infection prevention procedures. Counseling.
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
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.
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
MODULE TRAININGClinical Practicum Objectives
Trainees will demostrate the following: History taking. Physical examination. Manual Vaccum Aspiration. Paracervical Block. Proper infection prevention procedures. Counseling
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
Training /Learning Methodology Participants handouts. Discussion. Brainstorming. Role play. Demonstration/Return demonstration. Trainer presentation/short lecture. Case studies Group exercises. Simulation practice. Clinical practicum.
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
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
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
TRAINING METHODOLOGY (Materials)
1. Training Modules: Clinical Counseling
2. Pelvic model to perform practices of the MVA technique
3. Brochures
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
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)
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
MVA PROCEDUREPATHFINDER´S MODEL
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”.
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
MVA PROCEDUREPrepare sterile instrument tray
““No Touch” AreaNo Touch” Area
““Gloved hand” Area Gloved hand” Area
MVA PROCEDUREPATHFINDER´S MODEL
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
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
MVA PROCEDURE PATHFINDER´S MODEL
MVA PROCEDUREPATHFINDER´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
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
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
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
COUNSELING MODEL
Counseling is performed in three diferent care phases and has accurate obsjectives:
Before the procedure During the procedure After the procedure
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
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
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
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.
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
PATHFINDER´S POST ABORTION CARE MODEL
PatientPatient
Medical EvaluationMedical Evaluation
DiagnosisDiagnosis
MVA ProcedureMVA Procedure
RecoveryRecovery
DischargeDischarge
BeforeBeforeDuringDuring
AfterAfterContraceptionContraception
CCoouunnsseelliinngg
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
ECU
AD
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AMAZONAS AMAZONAS
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Dist
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1997
- 200
1Sep
t.
421
215
249
885
Number of professionals trained PhysiciansPhysicians
MidwivesMidwives
NursesNurses
TOTAL:TOTAL:
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
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
PERU POSTABORTION PROGRAMPERU POSTABORTION PROGRAM
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 PROGRAMPERU POSTABORTION PROGRAM
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