As providers of primary health care we devote a lot of our time to advising clients on the different contraceptive methods available. Clients are often dissatisfied with a given method and we need to help them explore different options. For this reason, a refresher course on family planning, control of sexually transmitted diseases and basic psychosexual medicine was very welcome. Most of the course was directed and taught by Professor John Guillebaud, a world-renowned authority on family planning and reproductive health. He was assisted by the Principal Medical Officer, Dr. Udonwa, who covered the diagnosis and management of sexually transmitted infections in the Seychelles context, using the syndromic approach. Mr. Ken Barrand assisted with the session on vasectomy. Dr. H. Shamlaye, Specialist Medical Officer in Family Planning, organised the course and ran it with help from two senior nurses, Mrs. J. Confait and Mrs. M.A. Hoaureau. The course was mainly funded by the United Nations Population Fund. Arrangements for Professor Guillebaud’s travel and accommodation were made by the Soroptimist International Club of Victoria, Mahé, which acquired the air ticket from the President’s office.

1. The course gave us the opportunity to rethink our family planning practices and also address psychosexual counseling – a new concept for many of us. The participants comprised medical practitioners from the district health centres and from the department of obstetrics and gynaecology and nurses from the district health centres, the communicable disease control unit and the Youth Health Centre. The course included a pre- and post-test, audiovisual presentations and group participation and discussions. We spent a very fruitful week with Professor Guillebaud who, through his superb teaching technique, kept us all attentive and receptive. He emphasised the following:
2. The importance of psychosexual counselling in the provision of family planning and other reproductive health services. This was a new concept that we need to adopt cautiously but that is nevertheless important when we consider the holistic approach to serving our clients. The use of case studies helped us to grasp the basics of psychosexual counselling. The newness and importance of this topic to the participants was illustrated by the fact that in the evaluation of the course, 69% of them said it was the most interesting topic covered and 75% said that of all the different parts of the course, the psychosexual counselling part would be most useful in their work.
3. Emergency contraception, an option that is greatly under-utilised in this country because people are unaware of it, was explored with regards to the efficacy and potential side-effects of the different methods. Equally important were the ethical dilemmas such methods could pose for some providers and clients.
4. Intrauterine contraceptive devices have been developed, and are now commonly in use, which are more effective than some common methods of female sterilisation. A common fear with intrauterine contraceptives was the increased risk of infection. However, this fear was dispelled by a WHO study, conducted in many countries. It showed that the risk of pelvic inflammatory disease in users and non-users of the method was the same except in the first three weeks following insertion, when there was an increased risk in those communities with a significant prevalence of asymptomatic infection.
5. Vasectomy is an efficient and easy to perform irreversible method of contraception with a low complication rate. Professor Guillebaud recommended that we make more of an effort to promote its use in Seychelles.

Professor Guillebaud contributed tremendously towards imparting valuable knowledge to all those who attended the course and those who will learn from them. It is hoped that this is already being translated into the provision of better quality care. Those of us who came to know the professor would very much appreciate more visits from him in the future.

Agnes Vel, MD, HIV/AIDS Programme Manager & Specialist Medical

Dilip Hajarnis, MD, Department of Obstetrics and Gynaecology, Victoria Hospital