In many health facilities throughout Rwanda, working in limited resource areas is challenging. What was most challenging for Dr. Fazili Hakizaimana, though, was to let women return home after giving birth without being able to offer them their requested family planning methods.
One of the methods Dr. Fazili was not able to provide to them was tubal ligation, a method normally done under spinal or general anesthesia, and most often associated with cesarean section. Due to the use of the anesthetic, this procedure can pose a high of risk of complication and possible death, and is not easily accessible to majority of women who want it.
Rwanda’s Ministry of Health (MOH), in partnership with MCHIP, decided to tackle this problem by building the capacity of providers to perform tubal ligations. For the first phase of the project, six district hospital providers were targeted to be trained and equipped.
Dr. Fazili was one of the providers selected to attend the training on tubal ligation under local -- rather than general -- anesthesia. The 10-day training comprised both theoretical and practical sessions. Before the training, women were counseled on all methods including tubal ligation, which helped to recruit women for tubal ligation as well as to strengthen the counseling skills of providers. When Dr. Fazili was asked to give his impression about the training, he said:
“I’m very happy that the number of women coming to seek this service after the sensitization has increased because now they only [have to] come for 1-2 hours and do not require hospitalization and there has been no complaint of headache as it was before. As I’m talking to you now, I have three women in front of me waiting for this service.”
While the MOH had planned to initiate mini-laparotomy for tubal ligation since 2008, MCHIP has now provided the training and resources to make the service available to Rwandese women.