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Gynaecological

Articles by Gynaecological

trail

The Migrant Experience: “They understand us and that is so hard to find”

Three million Venezuelans, fleeing a national crisis of economic depression and political oppression have found themselves seeking refuge in Latin America and the neighbouring islands of the Caribbean. About 40,000 of those have come to Trinidad and Tobago’s shores, with the hopes of finding a better life. Anything would be different from what they have left behind.  Neighbourhoods that once echoed the voices of playing children, were now riddled with the sounds of gunshots. Business places with broken store fronts, empty grocery and pharmacy shelves, elderly persons homeless and impoverished. Those with well-paying jobs could no longer make enough money to feed their families so walking the streets in your own neighbourhood put you at risk of kidnapping for menial ransoms.  This was the situation in Cumana Sucre that caused Marina Lopez to flee with her husband and two daughters in 2018. She was a preschool teacher and a good one at that. She loved the interaction she had with her students, seeing them grow in both knowledge and stature in their formative years, but it wasn’t enough to allay her fears of her own family’s survival.  As persons living with HIV, Marina and her teenaged daughter depended on constant access to medicine and healthcare, neither of which was still accessible. With daughters in tow, Marina and her husband braved the waters in search of new life in Trinidad.  About the same time, Ana Camacho, a young mother with dreams of migrating to Canada, said goodbye to her teary-eyed mother, sisters and 12-year-old daughter. She once held a good job as an administrator in Anaco, Venezuela, but when the company closed, she could no longer make the money needed to provide. A life in Canada seemed very promising and she and a friend decided that they would work for 3 months in Trinidad to gather the funds for the move up North. However, when she gained employment in Trinidad, her mother became ill and she was forced to postpone her plans and settle on the island in order to continue working.   “Everyone was so friendly and treated us like people” Both Marina and Ana can vividly recount the experiences that brought them to Trinidad 3 years ago. Today, they are both clients of the Family Planning Association of Trinidad and Tobago (FPATT) receiving care to meet their varying sexual and reproductive health needs.  “I was told about the Clinic from the UNHCR. They suggested that my daughter and I come here for treatment. When we got here everyone was so friendly and treated us like people. They understand us and that is so hard to find. They also referred us to the hospital in San Fernando for further treatment and it has been great since. We feel very comfortable here,” Marina disclosed. For 34-year-old Ana, her experience at FPATT is an interesting one. “When I first heard about the Clinic, I thought I would come in for a pap smear. I was in a new country, working and sending what I made back home for my family. I didn’t want to risk getting sick so I booked an appointment to get the test. When I came in, the nurses asked me if I was pregnant, and I said no, only to find out that I was. I was shocked, but I knew that the doctors and nurses at the clinic are good people and would take care of me during pregnancy. My son is now 14 months and now I come in for my contraceptive shot. I bring my son with me and everyone treats him like their own,” she says.  Ana was also a participant in the webinar series hosted by FPATT in January 2021. The 8-module Zoom series was based on IPPF’s One Curriculum, but designed to meet the specific needs of the migrant community. Although the series covered many topics including Nutrition, Gender-Based Violence and Sexual and Reproductive Health Rights, the one module that stood out for Ana was Self Defense.  “One day I was on my way to work in a taxi and I realized that the driver was not taking the route that other drivers do. I asked him where he was going and he wouldn’t answer me. I got very scared because I was in the taxi by myself. I started to shout at him and he still wouldn’t answer me until finally he stopped and I ran out of the taxi. I went to a police station and the officer asked me what I was doing alone in the taxi. I told him that I was trying to get to work. After that, I never worked again. It’s too risky. I wish I had seen that self-defense class before that evening,” she said.  Many migrants have had similar experiences to that of Ana’s. Incidences of sexual exploitation, gender-based violence, and xenophobia are rampant among the women in the community and so they are grateful for the refuge they find at FPATT. “In here, they genuinely look out for us,” Ana says, “and that’s different from how we are treated when we walk the street. They live up to their name as Family.”  

YAM member Millenia Mathurinand and Youth Liaison Officer Shashlee Pierre Louis receiving award
08 June 2021

St. Lucia YAM Awarded Outstanding Youth Organization

The Youth Advocacy Movement (YAM) of St. Lucia Planned Parenthood Association (SLPPA) was recently recognised by the St. Lucia Government - Ministry of Youth Development and Sport, they received an award for Outstanding Youth Organization, which is given to an outstanding organization/group which has for the past 2 years achieved community, national or regional recognition in promoting youth development through its programmes and or policies. Currently, the organization is conducting exciting grassroots initiatives in Saint Lucia, such as youth training programmes within under-served communities island-wide and tackling a wide range of issues such as parenting, self-awareness, and gender-based violence. Now more than ever we support and encourage our young leaders as they educate and innovate in their communities, making sexual and reproductive education and health more accessible.  Follow them at www.instagram.com/yam_slu SLPPA aims to promote family welfare and reduce the incidence of unwanted pregnancies, particularly among adolescents, through a strengthened family life education programme and quality sexual and reproductive health (SRH) care services that complement government provision.

peru

Counseling in Sexual and Reproductive Health, a space where you can talk.

Leny de la Mata Aquino has been working at Inppares since 2003, after working in public health establishments in the highlands of Peru and moving to the capital. “I came to Inppares invited by a colleague and I liked that we were working on rights; it was an awakening in sexual health. Because, although it is true, I am an obstetrician, I had not been trained in sexual and reproductive health and rights. And I learned a lot,” she recalls. “I also liked the camaraderie and working in a small institution, we treated each other like family. I had many perspectives in the sense of knowing a different environment because I had worked in the provinces for a long time and the realities are completely different”, says Leny. From her work experience at Inppares, Leny de la Mata highly values ​​the bond that is developed with the people who come to the services, which contributes a lot to an informed decision and a strengthening of self-care. “When you are close to people, you contribute a lot. As obstetricians, we dedicate ourselves to patients, we feel the many needs of users who come to the service, with many doubts regarding their sexual and reproductive health, with much ignorance of sexually transmitted diseases. Many people protect themselves from pregnancy, but not from STIs,” she says. As a counselor in sexual and reproductive health, Leny is aware of the importance that the empowerment of a women has on her body. “We also seek to empower women so they can recognize they have rights, which are above the decision of their partner. Before, couples had to consent to the choice of voluntary surgical intervention, but now it is not necessary and women have to make their own decisions. So far, we have users who ask their partners to determine a method of contraception, but we insist that the decision be made by her, we ask her: "What would you like?" It is important to empower them because sometimes the partner wants one thing and the woman wants another,” she says. In the day-to-day of counseling, Leny must also provide attention to cases surrounded by gender-based violence, which represents a very great challenge: “Machismo is cultivated since childhood.  That, in some way, is making it difficult to correct some things so far, because it’s part of the culture transmitted from generation to generation”, she reflects. “Inppares services are comprehensive; in other places, the counseling focuses only on contraceptive methods because they only see it as family planning, but here the counseling is comprehensive; from the moment the patient is admitted, he or she comes as a whole person. If I find a problem that I cannot solve, we have other professionals who can provide care, that helps us to provide the care people need”, Leny concludes.

 Jonathan Trinidad FPA IEC coordinator

Providing tailored comprehensive sexuality education

A passionate advocate for comprehensive sexuality education, Jonathan is Famia Planea Aruba’s (FPA) IEC coordinator and manages the scheduling, guiding, and delivery of school projects. As part of this role, he works closely with students to help support and shape their projects.  “We are approached almost on a daily bases, throughout the school year, by students needing appointments for their school projects. These projects can vary from information about sexual and reproductive health and rights to the internal structure of FPA as an organization. That is why it is very important to first ask what kind of project the student has been tasked with. Questions such as school, grade level, course name, number of students, project goal and due date are among just a few of the primary questions that must be asked when scheduling a school project”, Jonathan says. FPA has developed information packages that are topic-ready for most of the general projects. These are used as an information base, while the presentation and appointment are tailored to each individual student.  “We will sometimes receive multiple students or groups for the same project, this is bound to happen when an entire class receives the same project, it is then up to me to make each appointment different while providing the same information. Digital presentation is usually my tool of choice. This provides me the possibility to incorporate all the necessary information, but I can always make a few tweaks to personalize each presentation”, says Jonathan.  During project weeks at most of the schools, the FPA office can be busy with visiting students.  “After the start of the COVID-19 pandemic most of the school project appointments became digital meetings. Removing the human contact can sometime provide new challenges for both the students and us. This demands that the student be more prepared than before with sharper questions, since the traditional conversation that usually leads to more questions is different when using digital methods, but we will do our best to help the student in every way possible”, Jonathan mentions.  

 Marvin Maduro FPA IT

Aruba’s innovation in sexual and reproductive healthcare services

Famia Planea Aruba’s (FPA) online store is a successful social enterprise initiative, which is now one of their most innovative approaches to healthcare provision. Developing and managing a fully operational digital store with the added option for live chat and product guidance and information has enabled FPA to expand its reach.  Marvin is an experienced IT specialist who studied Computer Engineering Technology at Valencia Community College in the U.S. An integral member of the team, Marvin maintains FPA’s website and manages the online stock availability, delivery schedules, and public information. He is also responsible for their social media platforms.  FPA’s expert and dedicated team work from the heart to ensure they are able to adapt and deliver healthcare digitally.   “When returning back to home base in Aruba, I decided to help out in different companies and projects to further the digitalization of all platforms on the island. FPA started with just a small website back in 2010 and has grown into different projects and a very up-to-date website and online store”, says Marvin. “I take pride in helping FPA being a very technology forward organization.”

FPA Client Christopher Robles Age: 35 Occupation: Account Manager Marketing Agency

Reaching 7,000 clients

Famia Planea Aruba (FPA) is proud to be able to serve over 7,000 clients and celebrated its 50th anniversary in November 2020. FPA strives to live up to the motto, ‘Improving your quality of life’, by ensuring its healthcare provision is accessible to everyone.  One regular client is Christopher, an account manager at a local marketing agency. “I am truly a big fan of FPA, they are really good at being inclusive to men as well as women. The entire staff is very client orientated, I have never felt judged or discriminated against while using any of their services, or while at their office. They are always ready to answer any questions I may have or ease any concern.” FPA has built a strong bond of trust and communication with its clients by sharing regular updates on their work and projects.  “I try as much as possible to stay up-to-date with FPA, I have followed all of their projects so far and have really enjoyed them. I can still remember when I was younger and had my first girlfriend, FPA was my go-to for information, guidance, tips and tricks. They are very good at adapting to each situation, whether it is personal, local or even global”.  FPA places great emphasis on listening to the community it supports to better understand their needs. This enables the team to provide their clients with carefully researched and targeted healthcare.  “Over the years, FPA has gone above and beyond to provide both myself and my partner with information and contraceptives. Over the last few years, in addition to visiting their office, I can follow-up my consultation by asking them additional questions through their social media counseling or even the delivery service”, says Christopher.  

 Lisen Lalwani Information, Education, and Communication Support Staff at FPA.

Information is the key to health and wellbeing

During the 1970’s Aruba’s population was rapidly growing; yet one-third of all pregnancies were unplanned. With the arrival of Famia Planea Aruba (FPA), local communities were able to access health and contraceptive care. For more than 50 years FPA has evolved and adapted its healthcare provision to meet the needs of the growing and changing community. Access to contraception continues to be FPA’s most in demand healthcare provision.  “As a recently graduated Social Worker, I feel it is very important to provide both, men and women, with information and products regarding sexual and reproductive health and rights. We hear far too often that preventing an unwanted pregnancy should be the woman’s responsibility, especially from our male counterparts”, says Lisen, one of the Information, Education, and Communication Support Staff at FPA. During a one-on-one consultation at the FPA office, everyone is provided with information individual to their own needs as well as that of their partner. This information is provided by a trained IEC member of the team.  “I believe in the values of FPA, and that information is the key to health and a prosperous future. When counseling an individual, I try to take time to get to know the person the best I can in what is usually a short period. By building a trust relationship with each client they are more inclined to open up and ask the questions they truly need help with. What for one person might seem a small issue might be something huge for another one when as a counselor you are able to assess each individual, you can achieve so much”, Lisen says. What sets FPA apart from a pharmacy is the integrated care provision. This includes guidance provided with the contraceptives, the individually tailored care for each client, and working in close partnership with family practitioners, midwives and the local general health insurance provider. “There are some clients that you see so often that they almost become like family in a way, as soon as you see them you can already anticipate their needs. I am just 25 years old which means that some of the clients are my age, some older, some younger. Seeing someone you helped out in public and having them greet you or tell you that you did a great job helping them is such a wonderful feeling, I don’t know if I will ever get used to it”, Lisen says.

Ghislaine Koeiman, Head of Information, Education, and Communication Support at FPA

Delivering contraception directly to the client

Famia Planea Aruba’s (FPA) contraceptive delivery service is an added personal touch to its online store. The site is accessible to both members and non-members who can shop in privacy for their contraceptives and schedule a delivery. Orders are delivered by FPA staff with clients having the option to pay cash or debit upon delivery. To ensure a clients’ privacy and confidentiality orders are delivered discreetly. Ghislaine Koeiman, Head of Information, Education, and Communication Support at FPA has been managing the delivery service since it started in August 2018. “Since the start of the delivery service in 2018, our clients were enthusiastic however, the usage started slow. I believe this was due to the unfamiliarity, and people were still in the transition phase to online services. Moreover, clients believed that the delivery transportation would have been in a car completely covered in images of condoms, sperm cells and pills, which made them skeptical of using the service due to embarrassment”, says Ghislaine.  As with any new service comes challenges as well as opportunities. “Some of the challenges we face are the overload of deliveries on one day.” Even though Aruba is a small island and there are traffic jams only at specific hours in the day. “Sometimes I get stuck in traffic and try to rush myself to deliver the products in the time slot and at times I find myself in places that I barely recognize and discover new locations.” “The part I enjoy is the communication with the clients. Building a relationship with the client and vice versa provides a smoother transition of service but also provides the comfort and safe feeling for the client”. Ghislaine says the service often calls for more than the delivery of contraceptive orders, as clients may have questions or need support about their health. FPA’s bespoke healthcare delivery has seen successful growth since it started, with an increase of 115% during 2019 and 170% in 2020. “There has been an immense increase in the service in 2020 due to the pandemic. We already had the service in place, so we just had to fill in the gaps; for example, providing more hours and dates for clients to make use of the service.” <img src="https://tracker.metricool.com/c3po.jpg?hash=8b2b54e62fc802a9ae3ee7903a883415"/>

José Ángel Alvarado ADS Pro-Familia

"I changed first"

“One day, when I returned from work, Ms. Glenda and Mr. Martin from ADS Pro-Familia were at my house, I heard what the volunteering was about, regarding the education of the men in the community, how to teach, how to stop machismo, to be less violent, how to give the talks and visit the clients; they also talked about the contraceptive methods, medicines and many things that would change people's lives, the proposal seemed important to me and I accepted since I like to work for my people”, recalls José. Since 2008, male participation in sexual and reproductive healthcare in rural communities has been an integral component of the Community-Based Program (PBC), addressing issues of masculinity, behavior, and access to healthcare. "When I gave the talks on masculinity, they questioned me: 'Why can't you scream at home, if you're the man?' Or 'Who you think you are to say those things?', questions that I also asked myself once", says José. “Thanks to the training I have had and the support of the Pro-Familia staff, I have managed to learn and clarify my doubts. During the process I have had a personal change, I no longer respond if someone seeks me to fight and now, I don’t carry my knife everywhere as I used to, I take care of my own health, I share the responsibilities at home, I take care of my two-year-old son; before volunteering, I thought it was a woman’s job, I didn't do that”, reflects José. Educational activities on sexual and reproductive healthcare remain a challenge. Yet, health promoters can help break down some barriers through counseling for couples and the provision of contractive supplies - especially condoms - and medicines. “I like the communication I have with the Pro-Familia staff and the training reinforcements, they should keep it that way, because it's the way to learn and do things better in the community,” he says. “The change begins with oneself and then transmits it to others. I gather men in talks, make visits to their homes, give guidance on prevention of sexually transmitted infections, family planning and not to be violent”, says José. "Older adult men are more difficult to change." Changing attitudes to contraception  José has seen a change in the attitudes of men in his local community and those small achievements encourage him to keep going. “When men ask me about violence and condom use, I feel encouraged. For example, a co-worker uses a condom and confidently tells me that he does it because he learned from the talks he received, that motivates me to continue guiding towards new masculinities." For male clients who are referred by their local health promoter for a voluntary surgical contraception (VSC) procedure, the care is free of charge thanks to the Community-Based Program’s special fund. José is aware that there is still work to be done; "the issue of vasectomy is difficult with men in the community, the challenges continue." “In the community, young people ‘get to live together at an early age (marital union), maybe I cannot change that, but I can help them to be better people, to respect each other. Just as I changed, so can other men,” says José.  

Marta Alicia Hernández Monge

"Being a volunteer is my inheritance"

“I am a volunteer promoter by inheritance. First, my mother volunteered with Pro-Familia for 15 years, she resigned because she had to go to the United States. I learned to volunteer since I was little because I saw how my mother did it”, Alicia recalls. Alicia Hernández Monge, 43, remembers that with her mother leaving the country, the community spent some years without a volunteer health promoter. In those years, women came to her to encourage her to re-establish contact with Pro-Familia so the program would resume in the Santo Domingo village, one and a half hours outside of San Salvador.  In the absence of a local public health facility, Alicia decided to become a volunteer health promoter to support her community. “When my mother left, I agreed to collaborate just to promote the cervical screening clinic, but Pro-Familia suggested that I be a volunteer, like my mother, and I accepted. Today, it’s been two years. They have trained me at home on sexual and reproductive health issues, counseling, home visits, and the use of brochures, and I also learned to inject, with all that I do a better job in my community, especially with women”, says Alicia. Alicia is an entrepreneur with a strong spirit of care towards her family and community. Every day she attends her small business that provides the community with basic products.  “I help change people's lives; the women are happy and grateful because they no longer go to Guazapa to buy contraceptive methods. Pro-Familia trains me and I coordinate with other institutions in the community, such as the church, to help people”, she says.  Alicia says that counseling is the most important part of her work. “Counselling is very important, women learn to use (contraceptive) methods and stop thinking that it is a sin, I help them to understand that family planning is a right. (…) I had a case of a client where the husband was the one who decided which method to use and make her changed very often (contraceptive method) because he wanted her to lose weight; one day I explained to him about the benefits of using only one family planning method, the effects of changing very often on her menstruation and that she had the right to decide whether or not to change, and that the weight could be due to other reasons. He understood and thanked me for taking the time to speak to him; from that day on the client keeps one family planning method and the husband respects her decision,” she says. Alicia dreams of having a larger place for her clients, or have a table to administer the injectable, but despite the limited space, she enjoys her work. "I like it and I am happy to know that I can help, many users come at night to pick up their methods because they work out of the house and I take care of them with great pleasure, when they miss their appointment, I look after them, I speak to them by phone or I send them a WhatsApp message", she ends. They prefer her for the confidence she brings Ruth Séfora Manzano has known Alicia for several years before she had children. “I like Alicia because she is a respectful person, she likes to help people, she gives me confidence, and you can trust your personal things to her because she doesn't tell anyone, she looked after me when I got pregnant and she also cares about my daughter, she guides me on how taking care of myself and the baby, she is a kind person, that's why I plan with her, and if I need other medicines I also buy them from her. I also like it because it is close to my house, she gives me the shots, and I don't have to go elsewhere, I am grateful for her help and Pro-Familia´s."

trail

The Migrant Experience: “They understand us and that is so hard to find”

Three million Venezuelans, fleeing a national crisis of economic depression and political oppression have found themselves seeking refuge in Latin America and the neighbouring islands of the Caribbean. About 40,000 of those have come to Trinidad and Tobago’s shores, with the hopes of finding a better life. Anything would be different from what they have left behind.  Neighbourhoods that once echoed the voices of playing children, were now riddled with the sounds of gunshots. Business places with broken store fronts, empty grocery and pharmacy shelves, elderly persons homeless and impoverished. Those with well-paying jobs could no longer make enough money to feed their families so walking the streets in your own neighbourhood put you at risk of kidnapping for menial ransoms.  This was the situation in Cumana Sucre that caused Marina Lopez to flee with her husband and two daughters in 2018. She was a preschool teacher and a good one at that. She loved the interaction she had with her students, seeing them grow in both knowledge and stature in their formative years, but it wasn’t enough to allay her fears of her own family’s survival.  As persons living with HIV, Marina and her teenaged daughter depended on constant access to medicine and healthcare, neither of which was still accessible. With daughters in tow, Marina and her husband braved the waters in search of new life in Trinidad.  About the same time, Ana Camacho, a young mother with dreams of migrating to Canada, said goodbye to her teary-eyed mother, sisters and 12-year-old daughter. She once held a good job as an administrator in Anaco, Venezuela, but when the company closed, she could no longer make the money needed to provide. A life in Canada seemed very promising and she and a friend decided that they would work for 3 months in Trinidad to gather the funds for the move up North. However, when she gained employment in Trinidad, her mother became ill and she was forced to postpone her plans and settle on the island in order to continue working.   “Everyone was so friendly and treated us like people” Both Marina and Ana can vividly recount the experiences that brought them to Trinidad 3 years ago. Today, they are both clients of the Family Planning Association of Trinidad and Tobago (FPATT) receiving care to meet their varying sexual and reproductive health needs.  “I was told about the Clinic from the UNHCR. They suggested that my daughter and I come here for treatment. When we got here everyone was so friendly and treated us like people. They understand us and that is so hard to find. They also referred us to the hospital in San Fernando for further treatment and it has been great since. We feel very comfortable here,” Marina disclosed. For 34-year-old Ana, her experience at FPATT is an interesting one. “When I first heard about the Clinic, I thought I would come in for a pap smear. I was in a new country, working and sending what I made back home for my family. I didn’t want to risk getting sick so I booked an appointment to get the test. When I came in, the nurses asked me if I was pregnant, and I said no, only to find out that I was. I was shocked, but I knew that the doctors and nurses at the clinic are good people and would take care of me during pregnancy. My son is now 14 months and now I come in for my contraceptive shot. I bring my son with me and everyone treats him like their own,” she says.  Ana was also a participant in the webinar series hosted by FPATT in January 2021. The 8-module Zoom series was based on IPPF’s One Curriculum, but designed to meet the specific needs of the migrant community. Although the series covered many topics including Nutrition, Gender-Based Violence and Sexual and Reproductive Health Rights, the one module that stood out for Ana was Self Defense.  “One day I was on my way to work in a taxi and I realized that the driver was not taking the route that other drivers do. I asked him where he was going and he wouldn’t answer me. I got very scared because I was in the taxi by myself. I started to shout at him and he still wouldn’t answer me until finally he stopped and I ran out of the taxi. I went to a police station and the officer asked me what I was doing alone in the taxi. I told him that I was trying to get to work. After that, I never worked again. It’s too risky. I wish I had seen that self-defense class before that evening,” she said.  Many migrants have had similar experiences to that of Ana’s. Incidences of sexual exploitation, gender-based violence, and xenophobia are rampant among the women in the community and so they are grateful for the refuge they find at FPATT. “In here, they genuinely look out for us,” Ana says, “and that’s different from how we are treated when we walk the street. They live up to their name as Family.”  

YAM member Millenia Mathurinand and Youth Liaison Officer Shashlee Pierre Louis receiving award
08 June 2021

St. Lucia YAM Awarded Outstanding Youth Organization

The Youth Advocacy Movement (YAM) of St. Lucia Planned Parenthood Association (SLPPA) was recently recognised by the St. Lucia Government - Ministry of Youth Development and Sport, they received an award for Outstanding Youth Organization, which is given to an outstanding organization/group which has for the past 2 years achieved community, national or regional recognition in promoting youth development through its programmes and or policies. Currently, the organization is conducting exciting grassroots initiatives in Saint Lucia, such as youth training programmes within under-served communities island-wide and tackling a wide range of issues such as parenting, self-awareness, and gender-based violence. Now more than ever we support and encourage our young leaders as they educate and innovate in their communities, making sexual and reproductive education and health more accessible.  Follow them at www.instagram.com/yam_slu SLPPA aims to promote family welfare and reduce the incidence of unwanted pregnancies, particularly among adolescents, through a strengthened family life education programme and quality sexual and reproductive health (SRH) care services that complement government provision.

peru

Counseling in Sexual and Reproductive Health, a space where you can talk.

Leny de la Mata Aquino has been working at Inppares since 2003, after working in public health establishments in the highlands of Peru and moving to the capital. “I came to Inppares invited by a colleague and I liked that we were working on rights; it was an awakening in sexual health. Because, although it is true, I am an obstetrician, I had not been trained in sexual and reproductive health and rights. And I learned a lot,” she recalls. “I also liked the camaraderie and working in a small institution, we treated each other like family. I had many perspectives in the sense of knowing a different environment because I had worked in the provinces for a long time and the realities are completely different”, says Leny. From her work experience at Inppares, Leny de la Mata highly values ​​the bond that is developed with the people who come to the services, which contributes a lot to an informed decision and a strengthening of self-care. “When you are close to people, you contribute a lot. As obstetricians, we dedicate ourselves to patients, we feel the many needs of users who come to the service, with many doubts regarding their sexual and reproductive health, with much ignorance of sexually transmitted diseases. Many people protect themselves from pregnancy, but not from STIs,” she says. As a counselor in sexual and reproductive health, Leny is aware of the importance that the empowerment of a women has on her body. “We also seek to empower women so they can recognize they have rights, which are above the decision of their partner. Before, couples had to consent to the choice of voluntary surgical intervention, but now it is not necessary and women have to make their own decisions. So far, we have users who ask their partners to determine a method of contraception, but we insist that the decision be made by her, we ask her: "What would you like?" It is important to empower them because sometimes the partner wants one thing and the woman wants another,” she says. In the day-to-day of counseling, Leny must also provide attention to cases surrounded by gender-based violence, which represents a very great challenge: “Machismo is cultivated since childhood.  That, in some way, is making it difficult to correct some things so far, because it’s part of the culture transmitted from generation to generation”, she reflects. “Inppares services are comprehensive; in other places, the counseling focuses only on contraceptive methods because they only see it as family planning, but here the counseling is comprehensive; from the moment the patient is admitted, he or she comes as a whole person. If I find a problem that I cannot solve, we have other professionals who can provide care, that helps us to provide the care people need”, Leny concludes.

 Jonathan Trinidad FPA IEC coordinator

Providing tailored comprehensive sexuality education

A passionate advocate for comprehensive sexuality education, Jonathan is Famia Planea Aruba’s (FPA) IEC coordinator and manages the scheduling, guiding, and delivery of school projects. As part of this role, he works closely with students to help support and shape their projects.  “We are approached almost on a daily bases, throughout the school year, by students needing appointments for their school projects. These projects can vary from information about sexual and reproductive health and rights to the internal structure of FPA as an organization. That is why it is very important to first ask what kind of project the student has been tasked with. Questions such as school, grade level, course name, number of students, project goal and due date are among just a few of the primary questions that must be asked when scheduling a school project”, Jonathan says. FPA has developed information packages that are topic-ready for most of the general projects. These are used as an information base, while the presentation and appointment are tailored to each individual student.  “We will sometimes receive multiple students or groups for the same project, this is bound to happen when an entire class receives the same project, it is then up to me to make each appointment different while providing the same information. Digital presentation is usually my tool of choice. This provides me the possibility to incorporate all the necessary information, but I can always make a few tweaks to personalize each presentation”, says Jonathan.  During project weeks at most of the schools, the FPA office can be busy with visiting students.  “After the start of the COVID-19 pandemic most of the school project appointments became digital meetings. Removing the human contact can sometime provide new challenges for both the students and us. This demands that the student be more prepared than before with sharper questions, since the traditional conversation that usually leads to more questions is different when using digital methods, but we will do our best to help the student in every way possible”, Jonathan mentions.  

 Marvin Maduro FPA IT

Aruba’s innovation in sexual and reproductive healthcare services

Famia Planea Aruba’s (FPA) online store is a successful social enterprise initiative, which is now one of their most innovative approaches to healthcare provision. Developing and managing a fully operational digital store with the added option for live chat and product guidance and information has enabled FPA to expand its reach.  Marvin is an experienced IT specialist who studied Computer Engineering Technology at Valencia Community College in the U.S. An integral member of the team, Marvin maintains FPA’s website and manages the online stock availability, delivery schedules, and public information. He is also responsible for their social media platforms.  FPA’s expert and dedicated team work from the heart to ensure they are able to adapt and deliver healthcare digitally.   “When returning back to home base in Aruba, I decided to help out in different companies and projects to further the digitalization of all platforms on the island. FPA started with just a small website back in 2010 and has grown into different projects and a very up-to-date website and online store”, says Marvin. “I take pride in helping FPA being a very technology forward organization.”

FPA Client Christopher Robles Age: 35 Occupation: Account Manager Marketing Agency

Reaching 7,000 clients

Famia Planea Aruba (FPA) is proud to be able to serve over 7,000 clients and celebrated its 50th anniversary in November 2020. FPA strives to live up to the motto, ‘Improving your quality of life’, by ensuring its healthcare provision is accessible to everyone.  One regular client is Christopher, an account manager at a local marketing agency. “I am truly a big fan of FPA, they are really good at being inclusive to men as well as women. The entire staff is very client orientated, I have never felt judged or discriminated against while using any of their services, or while at their office. They are always ready to answer any questions I may have or ease any concern.” FPA has built a strong bond of trust and communication with its clients by sharing regular updates on their work and projects.  “I try as much as possible to stay up-to-date with FPA, I have followed all of their projects so far and have really enjoyed them. I can still remember when I was younger and had my first girlfriend, FPA was my go-to for information, guidance, tips and tricks. They are very good at adapting to each situation, whether it is personal, local or even global”.  FPA places great emphasis on listening to the community it supports to better understand their needs. This enables the team to provide their clients with carefully researched and targeted healthcare.  “Over the years, FPA has gone above and beyond to provide both myself and my partner with information and contraceptives. Over the last few years, in addition to visiting their office, I can follow-up my consultation by asking them additional questions through their social media counseling or even the delivery service”, says Christopher.  

 Lisen Lalwani Information, Education, and Communication Support Staff at FPA.

Information is the key to health and wellbeing

During the 1970’s Aruba’s population was rapidly growing; yet one-third of all pregnancies were unplanned. With the arrival of Famia Planea Aruba (FPA), local communities were able to access health and contraceptive care. For more than 50 years FPA has evolved and adapted its healthcare provision to meet the needs of the growing and changing community. Access to contraception continues to be FPA’s most in demand healthcare provision.  “As a recently graduated Social Worker, I feel it is very important to provide both, men and women, with information and products regarding sexual and reproductive health and rights. We hear far too often that preventing an unwanted pregnancy should be the woman’s responsibility, especially from our male counterparts”, says Lisen, one of the Information, Education, and Communication Support Staff at FPA. During a one-on-one consultation at the FPA office, everyone is provided with information individual to their own needs as well as that of their partner. This information is provided by a trained IEC member of the team.  “I believe in the values of FPA, and that information is the key to health and a prosperous future. When counseling an individual, I try to take time to get to know the person the best I can in what is usually a short period. By building a trust relationship with each client they are more inclined to open up and ask the questions they truly need help with. What for one person might seem a small issue might be something huge for another one when as a counselor you are able to assess each individual, you can achieve so much”, Lisen says. What sets FPA apart from a pharmacy is the integrated care provision. This includes guidance provided with the contraceptives, the individually tailored care for each client, and working in close partnership with family practitioners, midwives and the local general health insurance provider. “There are some clients that you see so often that they almost become like family in a way, as soon as you see them you can already anticipate their needs. I am just 25 years old which means that some of the clients are my age, some older, some younger. Seeing someone you helped out in public and having them greet you or tell you that you did a great job helping them is such a wonderful feeling, I don’t know if I will ever get used to it”, Lisen says.

Ghislaine Koeiman, Head of Information, Education, and Communication Support at FPA

Delivering contraception directly to the client

Famia Planea Aruba’s (FPA) contraceptive delivery service is an added personal touch to its online store. The site is accessible to both members and non-members who can shop in privacy for their contraceptives and schedule a delivery. Orders are delivered by FPA staff with clients having the option to pay cash or debit upon delivery. To ensure a clients’ privacy and confidentiality orders are delivered discreetly. Ghislaine Koeiman, Head of Information, Education, and Communication Support at FPA has been managing the delivery service since it started in August 2018. “Since the start of the delivery service in 2018, our clients were enthusiastic however, the usage started slow. I believe this was due to the unfamiliarity, and people were still in the transition phase to online services. Moreover, clients believed that the delivery transportation would have been in a car completely covered in images of condoms, sperm cells and pills, which made them skeptical of using the service due to embarrassment”, says Ghislaine.  As with any new service comes challenges as well as opportunities. “Some of the challenges we face are the overload of deliveries on one day.” Even though Aruba is a small island and there are traffic jams only at specific hours in the day. “Sometimes I get stuck in traffic and try to rush myself to deliver the products in the time slot and at times I find myself in places that I barely recognize and discover new locations.” “The part I enjoy is the communication with the clients. Building a relationship with the client and vice versa provides a smoother transition of service but also provides the comfort and safe feeling for the client”. Ghislaine says the service often calls for more than the delivery of contraceptive orders, as clients may have questions or need support about their health. FPA’s bespoke healthcare delivery has seen successful growth since it started, with an increase of 115% during 2019 and 170% in 2020. “There has been an immense increase in the service in 2020 due to the pandemic. We already had the service in place, so we just had to fill in the gaps; for example, providing more hours and dates for clients to make use of the service.” <img src="https://tracker.metricool.com/c3po.jpg?hash=8b2b54e62fc802a9ae3ee7903a883415"/>

José Ángel Alvarado ADS Pro-Familia

"I changed first"

“One day, when I returned from work, Ms. Glenda and Mr. Martin from ADS Pro-Familia were at my house, I heard what the volunteering was about, regarding the education of the men in the community, how to teach, how to stop machismo, to be less violent, how to give the talks and visit the clients; they also talked about the contraceptive methods, medicines and many things that would change people's lives, the proposal seemed important to me and I accepted since I like to work for my people”, recalls José. Since 2008, male participation in sexual and reproductive healthcare in rural communities has been an integral component of the Community-Based Program (PBC), addressing issues of masculinity, behavior, and access to healthcare. "When I gave the talks on masculinity, they questioned me: 'Why can't you scream at home, if you're the man?' Or 'Who you think you are to say those things?', questions that I also asked myself once", says José. “Thanks to the training I have had and the support of the Pro-Familia staff, I have managed to learn and clarify my doubts. During the process I have had a personal change, I no longer respond if someone seeks me to fight and now, I don’t carry my knife everywhere as I used to, I take care of my own health, I share the responsibilities at home, I take care of my two-year-old son; before volunteering, I thought it was a woman’s job, I didn't do that”, reflects José. Educational activities on sexual and reproductive healthcare remain a challenge. Yet, health promoters can help break down some barriers through counseling for couples and the provision of contractive supplies - especially condoms - and medicines. “I like the communication I have with the Pro-Familia staff and the training reinforcements, they should keep it that way, because it's the way to learn and do things better in the community,” he says. “The change begins with oneself and then transmits it to others. I gather men in talks, make visits to their homes, give guidance on prevention of sexually transmitted infections, family planning and not to be violent”, says José. "Older adult men are more difficult to change." Changing attitudes to contraception  José has seen a change in the attitudes of men in his local community and those small achievements encourage him to keep going. “When men ask me about violence and condom use, I feel encouraged. For example, a co-worker uses a condom and confidently tells me that he does it because he learned from the talks he received, that motivates me to continue guiding towards new masculinities." For male clients who are referred by their local health promoter for a voluntary surgical contraception (VSC) procedure, the care is free of charge thanks to the Community-Based Program’s special fund. José is aware that there is still work to be done; "the issue of vasectomy is difficult with men in the community, the challenges continue." “In the community, young people ‘get to live together at an early age (marital union), maybe I cannot change that, but I can help them to be better people, to respect each other. Just as I changed, so can other men,” says José.  

Marta Alicia Hernández Monge

"Being a volunteer is my inheritance"

“I am a volunteer promoter by inheritance. First, my mother volunteered with Pro-Familia for 15 years, she resigned because she had to go to the United States. I learned to volunteer since I was little because I saw how my mother did it”, Alicia recalls. Alicia Hernández Monge, 43, remembers that with her mother leaving the country, the community spent some years without a volunteer health promoter. In those years, women came to her to encourage her to re-establish contact with Pro-Familia so the program would resume in the Santo Domingo village, one and a half hours outside of San Salvador.  In the absence of a local public health facility, Alicia decided to become a volunteer health promoter to support her community. “When my mother left, I agreed to collaborate just to promote the cervical screening clinic, but Pro-Familia suggested that I be a volunteer, like my mother, and I accepted. Today, it’s been two years. They have trained me at home on sexual and reproductive health issues, counseling, home visits, and the use of brochures, and I also learned to inject, with all that I do a better job in my community, especially with women”, says Alicia. Alicia is an entrepreneur with a strong spirit of care towards her family and community. Every day she attends her small business that provides the community with basic products.  “I help change people's lives; the women are happy and grateful because they no longer go to Guazapa to buy contraceptive methods. Pro-Familia trains me and I coordinate with other institutions in the community, such as the church, to help people”, she says.  Alicia says that counseling is the most important part of her work. “Counselling is very important, women learn to use (contraceptive) methods and stop thinking that it is a sin, I help them to understand that family planning is a right. (…) I had a case of a client where the husband was the one who decided which method to use and make her changed very often (contraceptive method) because he wanted her to lose weight; one day I explained to him about the benefits of using only one family planning method, the effects of changing very often on her menstruation and that she had the right to decide whether or not to change, and that the weight could be due to other reasons. He understood and thanked me for taking the time to speak to him; from that day on the client keeps one family planning method and the husband respects her decision,” she says. Alicia dreams of having a larger place for her clients, or have a table to administer the injectable, but despite the limited space, she enjoys her work. "I like it and I am happy to know that I can help, many users come at night to pick up their methods because they work out of the house and I take care of them with great pleasure, when they miss their appointment, I look after them, I speak to them by phone or I send them a WhatsApp message", she ends. They prefer her for the confidence she brings Ruth Séfora Manzano has known Alicia for several years before she had children. “I like Alicia because she is a respectful person, she likes to help people, she gives me confidence, and you can trust your personal things to her because she doesn't tell anyone, she looked after me when I got pregnant and she also cares about my daughter, she guides me on how taking care of myself and the baby, she is a kind person, that's why I plan with her, and if I need other medicines I also buy them from her. I also like it because it is close to my house, she gives me the shots, and I don't have to go elsewhere, I am grateful for her help and Pro-Familia´s."