New specialist clinic offers variety of services for women
2009-09-03
Liezl Dyson
THE warm and colourful wallpaper and stylish interior designs of Paarl Hospital are not the only novelty at the newly refurbished hospital: they now also boast a new specialist outpatient clinic department. The hospital functions at a secondary (specialist) level, but also offers district level care as well as limited tertiary care to all patients in the West Coast and Cape Winelands East region. In June the level 2 (specialist) women’s health clinics that were formerly located at the outpatient department at TC Newman community health centre, moved down to the newly completed outpatient department at Paarl Hospital. Women not requiring specialist care are still seen at local clinics in their area. High risk obstetrics clients and all gynaecology referrals for specialist care are managed at the new clinic. Women’s health care offered at the Paarl Hospital includes management of common gynaecology problems such as menopausal symptoms, abnormal bleeding, infertility and contraceptive problems, termination of pregnancy (on demand up to 12 weeks and up to 20 weeks for specific indications), colposcopy and Large Loop Excision of the Transformation Zone-LLETZ (specific treatment for cancer pre-cursors detected on Pap smears) and office hysteroscopy (a small camera used to evaluate the inside of the womb). Because of the high demand for treatment of abnormal Pap smears an additional colposcopy clinic was started. The clinic has acquired a new video colposcopy machine for this service which is used to evaluate the cervix for any microscopic signs of cancer. Two full-time gynaecologists, Doctors Stefan Gebhardt and Judith Spicer, run the Obstetrics and Gynaecology Department and the clinic is managed by Sister J Nel. According to Dr Gebhardt, women can access this service via referrals from their local clinic or general practitioner according to standard protocols. The clinic will also receive a new Betocchi-type hysteroscope system using high definition video to evaluate abnormalities of the womb. Dr Gebhardt said that cervical cancer is the second most common cancer in women after breast cancer and can be detected at an early treatable stage if women go for Pap smears. Pap smears are free at local clinics. “From the age of 30 years a woman should have a Pap smear every ten years and every three years if she is HIV positive.” Gebhardt said that all clinics in the Drakenstein valley are now offering antenatal care to pregnant women using the national Basic Antenatal Care (BANC) package. They meet every two months with all the BANC sisters to discuss administrative and clinical problems and to do training. The BANC clinics are audited every six months as part of a quality of care initiative. All pregnant clients are offered on-the-spot testing for haemoglobin status (testing for anaemia), blood Rhesus status, HIV testing and syphilis testing. All the clients also receive one free ultrasound if they make a booking before they are 24 weeks pregnant, as after that time the ultrasound is not accurate. There is also the programme for prevention of mother-to-child transfer PMTCT) of HIV which is the longest running programme in South Africa and from which excellent results have been obtained under the leadership of Dr Nelis Grobbelaar, head of the infectious disease clinic in Paarl. All women booking for pregnancy care are offered free counselling and HIV testing because awareness of status is an important factor in managing this pandemic. According to the hospital statistics, more than 98% of women undergo HIV testing and the rate of HIV positivity in pregnant women in Paarl is 15%. All HIV positive clients receive a CD4 count and those with a CD4 count below 250 are offered highly-active anti-retroviral therapy (HAART) for life. Those with good CD4 counts (more than 250) are offered AZT from 28 weeks of gestation and Nevirapine during delivery. Babies whose mothers tested positive for HIV are treated after delivery and undergo routine HIV testing at six weeks to determine their status and transmission rates. If HIV positive mothers opt not to breastfeed they are supplied with substitute milk for six months. Gebhardt said that they find there are still a lot of schoolchildren that come for termination of pregnancies (abortion). “This is totally unnecessary, because unwanted pregnancies can be prevented as family planning is offered free at all the district clinics.” According to the hospital annual report for 2008 the perinatal death rate (an indicator relating to quality of obstetric care) was 19,8 per 1000 deliveries (much better than the national average of 40 deaths per 1000 deliveries). In 56% percent of babies that died there were avoidable factors related to the patient, for example pregnant women who did not attend antenatal clinic.
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