Sitting on the lawns outside the front of the guest house, Wendy gave us a lesson about the implant Sino II. The dog Gus joined in too and was great company (more on him later). The cool sea breeze brought welcome relief from the heat and humidity and the sound of waves was soothing.

The implants have been around for 24 years and researched extensively for their effectiveness in particular in developing nations. There is a recognition that it is difficult for women to travel the distances for health care, in particular traditional family planning medications such as contraceptive pills, depo provera injections or even tubal ligation. The Sino II implant is 2 rubber rods filled with a hormone progesterone which is slowly released into the woman’s body and provides protection against pregnancy for 4-5 years. If she chooses to have another baby, the implants can be removed and her fertility returns within a few days rather than months as per depo injection. The rods are inserted just under the skin of the upper arm.

There is a technique to inserting them and so we began our lesson practising on Wendy’s pillow! First putting in local anaesthetic forming a V shape under the surface of the skin. Then opening the trocar packaging without contaminating the sterile equipment, puncturing the skin with the trocar and then sliding it under the skin as superficially as possible. Leaving the trocar in place, removing the introducer and keeping that sterile, then carefully feeding the implant into the trocar, slowly inserting the introducer again and carefully retracting the trocar, but leaving the implant in place. Forming a V, repeating the process to insert the second implant.

The next morning we visited a village to find some clients to practise on! Debbie and I picked it up very quickly and Wendy was an excellent instructor.


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