Why medical students are practicing abortions on papayas


Amid fears of a future abortion ban, a group teaches a discreet procedure using a fruit that looks a bit like the female reproductive system

Cheyenne Mangolds hands shook ever so slightly as she reached with a long metal instrument to catch hold of what looked like the cervix. The medical student was attempting, for the very first time, the rudiments of performing an abortion.

As she inexpertly brought the pincers together on the soft flesh, you might have expected a little yelp of pain from the patient.

There was silence. Not because the patient was brave, but because it was a papaya.

Mangold was at a special workshop organized by a not-for-profit group whose mission is to make up for the lack of instruction on contraception and abortion at many US medical programs. But it doubled as a lesson in using a no-frills kit of basic instruments that, in the event of the practice becoming illegal in the US, could be stashed and carried discreetly, to perform covert abortions safely.

And it so happens that the papaya, with its little fruity neck and a central cavity full of seeds and pulp, is a serviceable approximation of a womans cervix and womb for the purposes of basic initiation for a medic in training.

Papayas
Papayas sit alongside instruments. Photograph: Mark Makela for the Guardian

Mangold was in a roomful of 60 rookies from across the country. They juggled fruit and tools as they began their journey, come what may, to become the next generation of abortion providers an increasingly scarce species in some parts of the US.

They paired up. One held a papaya, the other fumbled with a plastic speculum and small manual vacuum pump, all fingers and thumbs.

Mangold had traveled to Philadelphia from Lubbock, where shes a third year student at Texas Tech University Health Sciences Center and aspires to become an obstetrician/gynecologist (OB-GYN).

Its already a five-hour drive to the nearest abortion clinic from Lubbock, she said.

The community is very anti-choice. When it comes to abortion, theres no education at my school. You have to seek it out and thats a travesty, she said.

Mangold belongs to Medical Students For Choice (MSFC), a US not-for-profit organization with members at medical schools in several countries who arent getting family planning and abortion education because of conservative mores or laws.

Medical students dont specialize until later in their careers and could learn about it then, but the MSFC executive director, Lois Backus, said many schools left abortion out of the curriculum entirely but erectile dysfunction medication is in there every time.

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Leah Trippell, a medical student, reacts while practicing performing an abortion. Photograph: Mark Makela for the Guardian

Oyebola Oyewoles brow furrowed in concentration as she tried to insert a vacuum aspirator into the papaya. The 24-year-old, a student at Morehouse School of Medicine, in Atlanta, said it felt strangely intuitive in relation to female reproductive organs.

I can visualize it even though its just a fruit, she said. Im hoping to become a pediatrician but I want to be able to provide this service if a teen needed it and cant get it anywhere else.

How would she feel about performing an illegal abortion?

If necessary I would risk going to prison or losing my license. No one should have to do a self-induced abortion, she said.

Marta Rowh had flown in from Bend, Oregon, to help teach two papaya workshops as part of an MSFC conference that had drawn 450 med students from the US and Canada. Shes the only abortion provider for two-thirds of her state. Before demonstrating the standard manual technique used in the first 10 weeks of pregnancy, she arrayed some mostly disposable tools.

These are designed to be used in a hut in rural Zambia with no electricity if necessary, she said. There was a plastic speculum to hold open the vagina, a metal tenaculum, or pincers, to grip the cervix, steadying the opening to the uterus, a plastic rod for dilation, and a large, plastic syringe-type device used for the common practice of manual vacuum aspiration (MVA). She squeezed two buttons on the device to seal it, then pulled back the plunger, making a vacuum in the cylinder, then attached a tube from a sterile packet.

The students were transfixed. Apart from an encounter with a cadaver, their medical training had been all lecture halls so far.

Rowh put the tube inside the papaya and moved it carefully around to simulate dislodging fetal tissue and the related products of pregnancy from the walls of the womb.

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The tools would be something you could have in your closet in a small bag that you could pull out and go, said an instructor. Photograph: Mark Makela for the Guardian

When she released the buttons on the plastic syringe, it unsealed the vacuum and bright orange fruit flesh and dark seeds automatically shot out of the papaya and were sucked into the cylinder. It was so fast and effective, the onlookers gasped. The whole procedure had taken about three minutes; the time and the consistency of matter collected in the syringe were not dissimilar to what would take place during an actual abortion, Rowh said. In a power cut or need for extreme secrecy, it could be done by the light on a cellphone.

In a post-Roe v Wade world, some of these tools would be harder to get hold of. They would be something you could have in your closet in a small bag that you could pull out and go, said Rowh.

MSFC members in some African countries where abortion is illegal call them stealth kits and mainly use them in clinics that fly under the governments radar.

Mariel Cohn, a Philadelphia nursing student, had never used a speculum before and declared the sensation of operating on a papaya freaky, but she added: Ive already started a little kit of various medical supplies I might need in the future.

Shariq Khan, 24, one of a handful of men in the room, is a first-year medical student at Washington University in St Louis, Missouri.

Ooh, its tricky, doing something different with each hand and trying to look inside the papaya, and feeling for the depth, he said.

Instructor Emily Young, an abortion provider from Charlottesville, Virginia, warned the students not to poke too harshly and risk perforating the uterus.

Khan wants to offer family planning especially in underserved areas. But he added: I dont know if I would still provide abortion if it was illegal, which is maybe in our very near future.

The
The papaya is a serviceable approximation of a womans cervix and womb. Photograph: Mark Makela for the Guardian

Marley Rashad, a third year at Morehouse, said the practical training had been enjoyable. Its a very safe procedure, she said.

Would she risk performing a back alley abortion?

I like to think I would. I want to provide a full spectrum of reproductive health for my future patients. But how would I screen people so the right ones get to me? Id be worried about plants, she said.

Hours earlier, the US Senate had passed a tax bill with a provision allowing fetuses to get tax breaks on college savings accounts, seen as a further undermining of abortion rights.

Backus fears the supreme court could overturn the Roe v Wade decision, which legalized abortion in the US in 1973. Even without that move, hardline conservatives in many states have been so effectively using legislation to restrict abortion in the last decade that its very likely theyll weaken Roe until its close to meaningless anyway, she said.

But actually overturning Roe could result in the closure of clinics and an end to legal channels for obtaining pills used for early-stage medical abortions.

Young reckons there are too many smart lawyers defending reproductive justice for Roe to go.

Rowh fears individual states may get the power to decide.

Audrey Jaeger, a student attending the workshop from Rocky Vista University of Colorado, said: Youre not going to get rid of abortion, its been around for ever. Things just go backwards to times when everyone knew someone who almost died because they had a dangerous abortion.

Priya Suri is outraged that Republican lawmakers in Wisconsin, where shes a medical student, are debating legislation prohibiting university faculty from teaching abortion to trainee doctors, despite a shortage of OB-GYNs.

Im so upset. I chose the program because I would learn about abortion; now thats in jeopardy. In a post-Roe world, Id be more on the advocacy side but I could provide the care myself, she said.

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These are life savers, an instructor said of the students. Photograph: Mark Makela for the Guardian

Another instructor, Andrea Chiavarini, said that Barack Obama was the most pro-life president in US history. He did more to prevent abortion than anyone, by making long-term birth control available to so many via the Affordable Care Act, she said.

Chiavarini flies regularly from home in Portland, Oregon, to perform abortions in Oklahoma and at the Kansas clinic where George Tiller worked before his 2009 murder.

Far from a somber tone at the workshop, there was levity and laughter amid the earnest learning.

Chiavarini said: When I do abortions there are patients who need hand-holding and theyre crying. Other patients, were blasting Aretha Franklin and joking around; thats something people are afraid to talk about. Sometimes people feel like they are ending their babys life, and thats what Im doing because thats what they need to do, and Im going to call it their baby. I use the term the patient uses. Sometimes I refer to what Im removing from a womans uterus as the pregnancy, the embryo or the fetus I never just say tissue.

The students chattered away as exhausted papayas piled up in the garbage.

Theres no point in adopting fake reverence, said Chiavarini.

In medicine theres a tendency to dark humor. Its intense, so you have to joke about it sometimes.

What shes serious about is the continued need for tools and training. She waved a hand at the tubes and vacuum devices scattered about, and the students scooting out for coffee.

These are life savers, she said.

Read more: https://www.theguardian.com/us-news/2017/dec/22/why-medical-students-are-practicing-abortions-on-papayas