Posted by: rhoban | March 8, 2009

Day 7 – Lusaka, Zambia

First day at University Teaching Hospital

I arrived to the University Teaching Hospital in Lusaka early in the morning. I was supposed to meet Dr Stephen Mupeta, one of the lead OB/GYNs at UTH. Mupeta left me waiting for several hours past our appointed time to finally meet up with me. I was angry at first, but over the next few days I learned something important – Mupeta is one of the few OB/GYNs at the entire hospital and he is very, very busy.

University Teaching Hospital has 1800 beds – that’s about twice as many as are at the behemoth UNC hospital. But the footprint is tiny in comparison – why? Because patients are jammed into small wards, sometimes two to a bed. Mupeta does deliveries, caesarian section surgeries, emergencies, consults, procedures, is on call every other weekend and gets followed around by a string of residents. And he’s not even a full doctor – he’s the chief resident, not an attending. During the four days I spent hanging around the CO3 – the gynecologic emergency ward – I never saw an attending physician.

One person Mupeta introduced me to was Iness Kabamba, a nurse-midwife, who counsels women on contraceptive use and assists with MVA procedures. MVA is short for manual vacuum aspirator, a low-tech, but high-impact instrument manufactured and marketed by Chapel Hill based NGO Ipas.

Ipas was created in 1973 to complete research, development and implementation of the MVA when the US government got out of the business of helping countries create access to safe abortion.

Manual Vacuum Aspirator

Manual Vacuum Aspirator

Ipas has worked in Africa for twenty years, training health care providers on using the MVA properly. One of the strengths of the technology is that the one instrument solves a number of medical problems for places with few resources: the problem of incomplete miscarriage (known by it’s medical term spontaneous abortion) or of resolving an unsafe abortion (known by the medical term incomplete abortion); the need to biopsy the uterine wall; and the need for a safe method of performing abortion.

The organization also trains health care providers on Post Abortion Care, or PAC. PAC is not just basic patient teaching about how to deal with the aftermath of an induced abortion (bleeding, cramping, etc), but how to prevent unwanted pregnancies in the future. During PAC, women are given information about contraceptive choices, instructed on how to talk to partners about safe sex and, when available, given the contraceptive that they think will work best for them.

Ipas has also worked more recently in Zambia helping government officials assess the need for contraceptive services, determine the extent of unsafe abortion and find out how much people know about Zambian laws surrounding safe abortion.

Zambia has one of the most liberal abortion laws in all of Africa. A woman can ask a doctor for an abortion based on five criteria: 1) risk to the life of the woman, 2) risk to the mental or physical health of the woman, 3) another child poses a risk to the mental or physical health of existing children in the family, 4) the unborn child has gross congenital abnormalities. Three doctors need to agree that the abortion is necessary, and then the woman can have the procedure performed in a hospital or clinic setting.

The penalties for unsafe, illegal abortions are steep – the woman receiving the abortion is liable for 14 years in prison, the person who performs the procedure is liable for 7 years in prison. So why do women continue to go to local practitioners when they have an unwanted pregnancy? Because it seems most women in Zambia just don’t know that it’s possible to have an abortion without risking her life.

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