Establishment of a Regional no-scalpel vasectomy (NSV) training center of Urmia University of Medical Science

Background

The Urmia No. 9  Health Center is an Urban Health Center which covers a population of approximately 800,000. The center provides a full range of RH services, i.e. family planning, safe motherhood, vaccinations, child health, prenuptial counseling, counseling for high-risk behaviour etc.

The center is headed by Dr. Eslamlou, who has established the NSV center within that center. Dr. Eslamlou is a MD, who has a PhD in public Health and is the only master trainer in Iran, who is both a master trainer in NSV and FP counseling.

The NSV center is located in the above-mentioned center, which is the most prominent and crowded health center in Urumieh, which began its activities in 1997. Following promotion of Dr. Hameed Reza Farrokh Eslamloo, head of education unit of the center, to the senior country-level educator for training NSV, and reproductive health counseling in 2000,  the center has trained many physicians from all over west Azarbaijan province. In 2005 the center was changed to a country-level center for training of vasectomy and since then it trains general practitioners introduced by all Medical Science Universities of the country.

NSV Service Delivery in the Center

The center offers NSV services of very good quality. Clients are welcome during health center working hours.  In case a person wants to undergo NSV, he will be guided to the reception area of the NSV center. There he is counseled by a trained counselor on not only NSV, but on all family planning methods. This is done by using the newly developed family planning flipchart. After being counseled, the client is given a brochure on vasectomy and other FP methods to take home and study. The brochure includes instructions on what to do prior to a vasectomy.

In case the client chooses to undergo a vasectomy, on the day of vasectomy, he has to come together with his wife. There the wife also has to sign the informed consent form, after the couple has again been counseled for all FP methods and the particular case of vasectomy. The management of the center is well aware that this procedure might reduce the number of clients for vasectomy, however they believe in the importance of holding up a high quality of counseling and ensuring a fully informed choice.

The clinic has two entrances, and there is one direct entrance form the street, so that the vasectomy client who does not want to go through the whole clinic can directly access the NSV clinic from the street.

Having chosen to undergo a vasectomy, the client is directed to a changing room, which has lockers. He can change into the operation gown and can lock his private belongings. Washing rooms are available next door.

Next to the changing room is the physician’s change and examination room. The room is used for pre-operational and follow-up examinations of the client.

The center has two neighboring operating theatres, which comply with the latest international standards and can even accommodate big operations. This is different from other centers, in which NSV is performed in normal rooms.

Staff of the center is constantly coming up with new ideas, which improve the quality of the services. As an example, Dr. Eslamlou has introduced a new mode of operation site bandage, which reduces the possibility of hematoma occurrence.  

The operation theatre is equipped for emergencies with a standard emergency box that contains, among others, the full range of emergency drugs. Furthermore the center is in the immediate neighborhood of a specialized hospital.

Since scrotum elevation is one of the key steps of post-operational care, the client is given a testicular suspensor, free of charge, along with the instruction on how to wear it after the operation. The client has to put on the suspensor in front of the physician. This is unique to the Urumieh center. In other centers, clients are advised to either wear tight briefs or buy a suspender.

Due to the above-mentioned measures, the center has a significantly lower complication rate than the globally stated complications rates of 1-2%. In Urumieh NSV center the complication rate is one tenth of this figure.

Follow-up  

Immediately after the operation the client is given a package, which includes brochures on postoperative care, 20 anti-inflammatory tablets, 10 condoms and a form to request for a sperm count after three months. The fact that the post operative sperm count is done in the center itself and free of charge is another unique feature of the center. Follow-up examinations of the client include one sperm count after three months and one after four months. In case needed, more sperm counts are done. The laboratory follows WHO standards, which include several other indicators in addition to the sperm count.

One of the problems of other centers is the low rate of follow-up. This is due to the fact that clients are asked to refer to the private sector for the sperm count. However, the center does active follow-up for the clients to refer to the center. Since the services are free of charge and the clients already know the staff, they are more inclined to use the follow-up services. The results of the sperm count are entered in the computer and documented in the file of the client.

Training facilities

The center has an adequate classroom (skill lab), as well as one smaller and one big seminar room. All rooms are equipped with audiovisual equipment. The class room has a bookshelf containing reference material on anatomy, gynecology, urology, etc., both in English and Farsi.  NSV training models are available in the classroom. The feedback received for the models was very positive. The models are extremely useful in teaching the physicians on how to locate the vas deferens, which is the most important step for the NSV operation. Previously this has been a problem, as it was difficult to conduct this training on the clients and the physicians were advised by the trainers to try and locate the vas deferens on themselves.

Trainees of this center receive training not only in NSV, but also in FP counseling. The training follows a high standard and only 8 out of 10 trainees manage to receive the certificate, which has a limited duration of 2 years. After two years the trainees have to undergo another assessment. In case required, they have to attend either refresher training or even undergo the full course again.

The director of the NSV center has managed to obtain refresher training course credits for the NSV training for physicians. Since all physicians are required to obtain a certain amount of refresher training credits, this has led to a high number of requests for participation in NSV trainings.

    After successful completion of course, each trainee is given a full package with training manual and other material, including readily packed NSV set

Accommodation for trainees from outside Urumieh is available and very close to the center.

In 2005, the center conducted a successful country-level seminar, examining and certifying senior trainers of NSV, with the presence of professor Li Shunqiang , founder of NSV technique in the world. In a report to the United Nations Population Fund (UNFPA), Dr. Li praised and confirmed the physical possibilities, equipment, and professional manpower of Urmia vasectomy training center and suggested transforming it to an international center for training vasectomy. Therefore, in the past two years, UNFPA, the MOHME, the "population, family and health training office of the Ministry of Health", and the West Azarbaijan University of Health and Medical Education have been supporting the center, and so far more than Rials 800 million have been spent by the university, the health undersecretary and UNFPA, in order to achieve international standards in areas of NSV services and NSV training.

Some staff from UNFPA and physicians from China visited Urmia regional NSV training center in 2007 to review whether it has international standards in training to provide quality services in the NSV area and also to check if it has any role in reducing fertility and increasing participation of men in reproductive health. They reviewed and confirmed its activities based on the following validity-assessing standards:

Availability of educational kits, curriculum, reference books and leaflets, educational guides for senior trainers, educational texts for the trainers, etc.

 

1. Quality of service providing, number of applicants, level of access to the equipments and tools of surgery, potential of preventing infections, (ensuring quality of surgery by academic resources).

2. Trainers: quality of education and services provided, their work experience, clinical training skills.

3. Trainees: cooperating in providing quality NSV services according to the national standards.

It had been decided that before admission of the first group of foreign physicians for training in Urmia regional NSV training center, a mission from the Islamic Republic of Iran will visit the world’s sole international vasectomy center. In this connection, in late 2007, Dr. Mohammad Reza Tarjomaan, Deputy of the University in Health Affairs and Dr. Hameed Reza Farrokh Islamloo, faculty member and head of the international center of training vasectomy in West Azarbaijan University of Medical Science, along with Dr. Mohammad Eslami, head of the family planning office in the Ministry, visited the international center for training vasectomy in Sichuan province of China with financial support from UNFPA.                    

The initial agreement to establish the research center for reproductive health in the location of the regional vasectomy training center was given by the Undersecretary for Research and Technology of the Ministry of Health in 2008.

 

The average number of vasectomies performed in the center is 100 cases per month.

Activities of the Center:

a) Research activities:

* Conduct of fundamental and applied research in various fields connecting to reproductive health based on research priorities in this area.

* Preparing appropriate conditions for students, assistances and researchers to develop their thesis and research by providing proper data bases

* Cooperation with national and international organizations in connection with reproductive health, especially UNFPA, to conduct joint research projects

b) Educational activities:

* Training reproductive health counseling and no-scalpel vasectomy to local physicians.

* Classical training of matters related to reproductive health for medical, nursery, assistants to gynecologists and urologists and M.A.s in epidemiology.

* Training and retraining of graduates of medical disciplines, specialists in urology and gynecologists in the areas related to reproductive health, especially NSV, IUD, and IVF.

* Training of country-level reproductive health counseling trainers and trainers of NSV technique and IUD insertion, and practical periodical monitoring of trainers in cooperation with the health undersecretary of the Ministry.

* Arranging research method workshops.

* Arranging workshops based on the WHO method to train how to analyze sperm.

c) Service and therapeutic activities:

* Public education in the field of protection and promotion of reproductive health of the society.

* Providing reproductive health counseling services, providing all contraception methods (temporary methods and infertility), counseling, prevention and treatment of behavioral, venereal diseases and HIV / AIDS, counseling, prevention and treatment of infertility.

d) Personnel and management:

*Urmia country- level center of vasectomy training works as an independent unit since 1381 and has close connections with health, educational and research undersecretaries the Ministry.

* President of the university selects its dean.

* IVF center of the university and the country-level center of vasectomy training, constituted " reproductive  health research center" in 1384.

* Public health education, urology and gynecology departments of the university cooperate in scientific and educational areas.

* 5 full-time, 9 half-time faculty members and 8 full-time paramedical personnel cooperate with reproductive health research center.

Urmia University of Medical Science

 

Vice president                  Vice president                                  Vice president

for education                   for health affairs                              for research

 

Public health                      Regional vasectomy                         Reproductive health

educational group               training center                                 research center

 

Urology educational group

 

Gynecology educational                 IVF center

group

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Conducted Research Projects:

* "Review of time and number of ejaculations required to produce azoospermia (or severe azoospermia or severe oligozoospermia) after NSV, Urmia 1383" with rials 37,300,000 credit , which was provided by the general office of family health and population of health undersecretary of the Ministry.

  • * "Comparative study of the two injectable contraception methods of Depo medroxy progesteron acetate (DMPA) and Cyclofem by clinical tests  phase III (Urmia 1385-86)" , with rials 71,570,200 credit , that was provided by the general office of family health and population of health undersecretary of the Ministry.
  • * " Monitor and assessment of conducting fillip chart for presentation  performance ratings of family planning in selected units and centers of four pilot cities (Noor, Urmia, Semnaan and Chahbahaar) " with rials 221,000,000 credit that is provided by the United Nations Population Fund (UNFPA).
  • *" Raising quality of family planning services, through integrating the presentation of services guide into the family planning program in the selected health-treatment centers of Urmia-1386" with rials 11,000,000 credit that was provided by the research vice presidency of the University.
  • * Securing vasectomy standards in NSV method with rials 100,000,000  credit that has been provided by UNFPA.
  • Situation Financial
  • * So far costs of equipping the center have been paid by UNFPA, health undersecretary of the Ministry of Health and Urmia University of Medical Science.
  • * Current and staff costs are paid by Urmia University of Medical Science.
  • * Credits for research are provided by health undersecretary of the Ministry of Health,  Urmia University of Medical Science and international organizations like UNFPA.
  • Successes Achieved :
  • *More than 400 medical students, 550 nursing students, and 250 health students have been trained and retrained.
  • *More than 80 general practitioners and 25 assistant urologists have successfully passed short-term NS V training courses and received related certificates.
  • *Performance of more than 200 general practitioners who conducted no-scalpel vasectomy has been monitored and assessed.
  • * 16 reproductive health counseling workshops have been conducted in country level.
  • * More than 9,000 men have undergone no-scalpel vasectomy.
  • * 50 paramedical personnel have successfully passed IUD insertion training courses.
  • * Successful holding of a country level seminar for testing senior trainers of NSV with presence of professor Li Shunqiang , the founder of NSV in the world.
  • Buildings:
  • Building No. 1: Regional NSV training center and related laboratories in 1,500 square meters area.
  • Building No. 2: Kousar section with laboratory and IVF clinic in 1,000 square meters area.
  • Laboratories and Workshops:
  • * Central laboratory of Urmia health center.
  • * Professional laboratory of IVF section.
  • * Skill Lab workshop, specific to training of no-scalpel vasectomy (NSV).

 

The West Azarbaijan University of Health and Medical Education believes that the center is now ready to conduct NSV trainings for foreign physicians, and would like to announce to neighboring countries their readiness to accept the first group of physicians from neighboring countries.  The first training round is suggested to be held in October, which would coincide with the visit of Professor Liu from the Sichuan RH Center.

 

 


 

آدرس : اروميه - خيابان شهيد بهشتي - جنب بيمارستان آذربايجان تلفن : 3465098 فاکس : 3440197


Email : phc@umsu.ac.ir