PAC IN SUBSAHARAN AFRICA 1. The New Developments By Dr. Solomon Orero MD Consultant Obstetrician/ Gynaecologist KMET/CSA KENYA February 2003. PAC IN SUBSAHARAN AFRICA 2.
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The New Developments
Dr. Solomon Orero MD
Consultant Obstetrician/ Gynaecologist
B.A 37 years old para 7 + 1 LD 5 years ago, last abortion a year ago. A known diabetic controlled on Lente Insulin and diet. As at 7.2.2003 she had been admitted for poorly controlled Diabetic. She was 8 weeks pregnant. Her last abortion was an elective abortion on an understanding that with 7 living children, 5 boys and 2 girls. Chronic Diabetic poorly controlled and a housewife. This time round she would have an elective abortion and BTL. Her husband was not in at the time. He arrived just when we were in theatre about to perform the two procedures!! We did neither of the procedures as we were unable to convince the man it was for the benefit of his wife nor could he accept vasectomy. He refused!!
“A woman who has decided to procure an abortion will go ahead and have it irrespective of any other opinions to the contrary, the risks to her life not withstanding.”
In spite of the high fertility rates in Sub Saharan Africa, contraceptive prevalence is very low. It has been found that 30% of women control their fertility by a combination of contraceptives and abortion and 3% use abortion only as a means of fertility control.
“Unsafe abortion is preventable yet remains a significant cause of Maternal Mortality in Sub Saharan Africa.”
“When a woman becomes pregnant in Sub-Saharan Africa whether or not that pregnancy is wanted and the subsequent events that follow may not entirely be her decision”.
Most likely, student, unemployed, Christian, given false identity
“In Sub Saharan Africa; the distance a woman has to walk to access safe abortion services in the public health sector is like the distance between heaven and earth you have to die to reach there.” Khama Rogo 1993
On reflection at some of the answers we have given women who seek abortion services in the public health sector the statement unfortunately is very predictive!
“Mum, young lady, in this hospital we only treat women who are already aborting, we don’t start it here, the law does not allow!” The message by that answer is clear! “Go and induce it by whatever means and then come back!” The case of the women who have suffered unsafe abortion for along time has been to say the least unfortunate. The waiting time averaged 12 hours quite often days to one week, the attitude of the staff appalling; the efficiency disgusting the interaction and communication just simply inhuman!
Defining and Embracing PAC Services
The embracing of the PAC concept has had the effects of:-
Mid Level Providers
(Clinical Officers/Nurse Midwives)
Community Based Health Workers
(CBDS, TBAS, CHES, Herbalists)
Congressman Jim Greenhood visiting KMET PPNW Programme. August, 2002
Dr. Orero during a training session. A participatory practical competency based training.
Participants practical session during PAC training
PD – Monica during a class PAC training session
PAC room rearranged simply for use after training in a public facility Designed by KMET
A cupboard for storage in a training facility Designed by KMET
A simplified procedure bed for MVA
KMET Established a model Clinic in a Peri-urban Kisumu City
KMET collaborate with many partners – PIWH, PPFA Bucks county Pennsylvania
Sub-Saharan African Countries
PIWH/CSA - COBAC 1996 – 2000
This model aims at community level initiatives with the sole focus on:-
The whole intervention is geared towards addressing Abortion issues and their contribution to Maternal Mortality. At the community level initiative we are addressing the community norms, values and attitudes, discussing laws and policies regarding abortion, their interpretation, Health service provision.
M.A. 18 yrs old, a house girl works 450 Kms from home. Got pregnant. Had an unsafe abortion. Who did it could not differentiate the anus from the vagina. Destroyed anus, rectum, bladder, uterus, intestines. The woman lost her uterus, fertility, and to add insult to injury she ended up with a permanent COLOSTOMY! She survived but at what cost? Another preventable statistics. “My heart bled for her as we repaired what was left of her womanhood”
YES – movement forward 2 decades later