Over the past 20 years, the story of minilaparotomy under local
anesthesia in the Dominican Republic has been one of success.
Doctors perform an interval minilap procedure.
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Hundreds of general practitioners throughout the country have been
trained to perform "minilap"--a female sterilization method that
reduces risk, cost, and length of hospital stay--and it has become
an important family planning option for Dominican women. Female
sterilization is the family planning method of choice forwomen in
the Dominican Republic.
Now that the program has matured, AVSC and its partners in the
Dominican Republic are ready to take the next step and share their
knowledge and expertise with the world by offering international
training in delivery of the method.
A Model Program
Dr. Carmela Cordero, senior director of AVSC's technical resources
worldwide, has been instrumental to the introduction of this technique.
She credits the program's success to two important elements: a focus
on meeting client needs and a strong commitment to the technique
on the part of all involved.
"The services have worked so well for so many years, they can
certainly serve as a model for building well-organized, client-centered
services in other low-resource settings," says Cordero.
International Training Center
Dr. Carmela Cordero (second from left)
and the staff of AVSC's office in the Dominican Republic.
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Since the beginning of the program in 1980, AVSC has provided technical
assistance for minilap in the Dominican Republic. In 1983, AVSC
helped start the National Training Center at Maternidad Nuestra
Senora de la Altagracia ("Maternidad" for short), a Ministry of
Health hospital.
"Doctors from all over the country came to Maternidad to be trained
or receive refresher training in minilap under local anesthesia,"
Cordero offers. "AVSC even sent its own medical staff there for
training. The hospital had a committed, supportive director, which
greatly contributed to the program's success."
Now AVSC has begun working again with the MOH on plans for expanding
their training program.
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Minilap in the Dominican Republic
Dr. Carmela Cordero has worked with minilap
since its introduction in the Dominican Republic nearly 20
years ago. Minilap was first offered in response to public
demand for the method. The program was designed to meet local
needs and quality standards.
"In Dominican culture, it is very important
for a woman to prove that she can be a mother," Cordero explains.
"So she gets married very young, has two to four children
one after the other, and then has a surgical procedure. The
women like having a permanent solution so that they can close
the childbearing chapter of their lives and move on to other
interests."
Women in the Dominican Republic typically do
not use short-term or temporary methods to space their children.
Many opt for female sterilization without ever using another
method.
The women like minilap because it is easy,
safe, and inexpensive. "When AVSC first proposed minilap services,
there was an immediate response," she adds.
An outpatient procedure, minilap can be performed
using standard surgical instruments in any basically equipped
surgical area by any doctor who has received training in the
method.
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An Ideal Host for Training
"Based on Maternidad's interest, knowledge, and experience in
medical staff training, we are talking about setting up an international
training center there," says Cordero. "We hope to resume the kinds
of activities we held between 1983 and 1986, when we trained many
doctors from other countries in minilap. The long-range goal is
to make the center financially self-sustaining."
There are a number of reasons why Maternidad would
be an ideal host for international training. Staff at the hospital
are skilled in providing all forms of family planning and can solve
the kinds of problems public-sector institutions often face, such
as lack of resources. Thus, the center could serve as a model for
other institutions. In addition, Dominican laws allow doctors from
other countries to perform surgery in the Dominican Republic, so
there is not a barrier to clinical practice.
A Recipe for Model Services
Much of the success of the minilap program in the
Dominican Republic is owed to the dedication and commitment of providers
in the country's public and private sectors.
"If I had to summarize why the program has been so
successful, I would say it's because the Ministry of Health was
very committed to improving the quality of minilap services and
offering counseling," says Cordero.
The program's effectiveness also stems, says Cordero,
from a client-centered approach and a strong emphasis on counseling
training.
Another key element was the issuance of the Female
Voluntary Sterilization Guidelines in 1984. The guidelines, which
are currently being revised and updated by the National Family Planning
Program with assistance from AVSC and other collaborators, set standards
for surgical contraception and were distributed to all private-sector
clinics and MOH hospitals.
Future Development
Minilap clients receive counseling from
a practicing surgeon. |
Cordero met with AVSC's partners in the Dominican Republic in October
1998 to begin strategic planning for the expanded international
training center and to help Maternidad obtain equipment and financial
and technical support for training and quality improvement.
AVSC continues to be a catalyst for positive change in the Dominican Republic. The result is a model program that offers clients the family planning choice they prefer, safe conditions, and high-quality services.
Peg Dardenne is a writer and editor for AVSC.
