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  1. 1
    047153

    Trip report, Burundi, 21 - 24 July 1987.

    Ben Salem B

    [Unpublished] 1987. 7 p.

    During the July 21-24 trip to Burundi, discussions were held about possible Association for Voluntary Surgical Contraception (AVSC) assistance in creating a training center at the University Hospital which could serve as a site for training medical personnel from Burundi and other French-speaking African nations. Practical training is urgently needed at this time to allow health personnel to feel comfortable about dispensing a wide range of contraceptive methods/information. A great need exists for the training of nurses in IUD insertion and for copper-T commodities. Family planning method acceptance is growing steadily: the number is said to double every 6 months. As yet, voluntary surgical contraception plays a minor role and is available only at a limited number of centers. As previously reported, several donors, including the UN Fund for Population Assistance, World Bank, and the African Development Bank, are involved in activities/proposals related to maternal/child health and family planning. The major objective of AVSC assistance to the Ministry of Public Health is to increase access to VSC by integrating quality services into ongoing maternal/child health/family planning activities in 4 regional referral hospitals. The project is expected to last for 4 years with a total budget of slightly over $200,000. During this visit, the basics were worked out for a program in which AVSC would provide assistance for training 10 physicians/year in minilap (both postpartum and interval) using local anesthesia. Trainees would be residents and interns and, if possible, physicians from government facilities. It is hoped that a training program document can be developed for presentation at the December 1987 meeting of AVSC's International Committee. The site visit was useful to the effort of moving the pending project with the Ministry of Public Health along and for discussing possible cooperation with the University Hospital. Program success is likely for several reasons: the Ministry of Public Health generally is favorable and supportive; chances for "institutionalization" are good; the basic hospital infrastructure is sound; and the rising demand for VSC is recognized by health officials and service providers.
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  2. 2
    041926

    Association for Voluntary Sterilization - Consultant Team. Trip report: the People's Republic of China, Beijing, Chongqing, Wuhan, Guangzhou, June 19-30, 1985.

    Huber D; Fathalla M; Gojaseni P; Goldstein M; Lippes J; Minor K; Rauff M; Sciarra J; Rauff A

    [Unpublished] 1985. 41, [6] p.

    The Association for Voluntary Sterilization consultant team visited Beijing, Chongqing, Wuhan and Guangzhou, China in June 1985, to review innovative nonsurgical methods of male and female sterilization. There are 2 variations on vasectomy, performed with special clamps that obviate a surgical incision. The 1st is a circular clamp for grasping the vas through the skin, and the 2nd is a small, curved, sharp hemostat for puncturing the skin and the vas sheath, used for ligation. Vas occlusion with 0.02 ml of a solution of phenol and cyanoacrylate has been performed on 500,000 men since 1972. The procedure is done under local anesthesia, and is controlled by injecting red and blue dye on contralateral sides. If urine is not brown, vasectomy by ligature is performed. The wound is closed with gauze only. Semen analysis is not done, but patients are advised to use contraception for the 1st 10 ejaculations. Pregnancy rates after vasectomy by percutaneous injection were reported as 0 in 5 groups of several hundred men each, 11.4% in 1 group and 2.4% in another group. The total complication rate after vasectomy by clamping was 1.8% in 121,000 men. 422 medical school graduates with surgical training have been certified in this vasectomy method. Chinese men are pleased with this method because it avoids surgery by knife, and asepsis, anesthesia and counseling are excellent. Female sterilization by blind transcervical delivery of a phenol-quinacrine mixture has been done on 200,000 women since 1970 by research teams in Guangzhou and Shanghai. A metal cannula is inserted into the tubal opening, tested for position by an injection of saline, and 0.1-0.12 ml of sclerosing solution is instilled. Correct placement is verified by x-ray, an IUD is inserted, and after 3 months a repeat hysteroscopy is done to test uterine pressure. Pregnancy rates have been 1-2.5%, generally in the 1st 2 years. Although this technique is tedious, requiring great skill and patient cooperation, it can be mastered by paramedicals. The WHO is assisting the Chinese on setting up large studies on safety and effectiveness, as well as toxicology studies needed, to export the methods to other countries.
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