Stories

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.”  

“You work with people who have HIV? Why?”  That was the question asked to Dr. Gregory Boyce by the young intern that stood before him. He had come to the hospital ward to visit a client who was known to be living with HIV. He approached the intern at the desk and gave his name and designation. The intern looked at him, confused and somewhat amused and asked the question that he has neither forgotten, nor understood to this day.  However, this young intern’s question comes from a mindset that Dr. Boyce is working fervently to change. As Deputy Director of the Medical Research Foundation of Trinidad and Tobago (MRF), Dr. Boyce provides clinical as well as administrative support to a team of doctors and nurses whose daily vocation is to persons living with HIV. Due to MRF’s long-standing work in HIV research and healthcare, the Family Planning Association of Trinidad and Tobago (FPATT), has navigated many of its clients to Dr. Boyce and his team, especially clients from the LGBTQI community.  “Persons coming to us from key populations, have very layered needs. They are facing unique challenges in addition to living with the virus. There is still that myth that being HIV positive means that you will positively die. Added to that, there’s the discrimination that the community faces in every aspect of their lives on a daily basis. As a staff, we’ve had to seek special training to guide the way we interact with these clients so that we can meet all their needs appropriately and sensitively,” explains Dr. Boyce.  He continued “Apart from medical interventions which are needed to ensure that our clients continue to live healthy lives, we focus heavily on their psychosocial needs. It’s easy to think that because a client is physically healthy that they are also emotionally healthy. We have clients that won’t leave abusive relationships because they think no one else would accept them. We have other clients that are dealing with long-term medication fatigue because they have been taking pills for over 10 years. With that sometimes comes depression and other drug addictions, which is why it’s necessary for us to maintain open and honest relationships to address those accompanying issues.” Making HIV a non-issue Having worked with persons living with HIV for over 20 years, Dr. Boyce remembers the early days that led him to this specialization. He had worked at the Port of Spain General Hospital after graduating, during which time, medicine for persons living with HIV was expensive and out of reach for many. A few years later, through government programmes, medicine became more affordable, and treatment centers were opening up across the island. However, Dr. Boyce realized that the mortality rate had not changed by much. He wondered why people were still dying from a virus when medicine was easily accessible. That was when he decided to follow his heart and commit to helping persons with HIV understand that there is hope.  “That first conversation – giving a client the news that they’ve tested positive – is very important. We get to show them that HIV is not an impediment. Most times, with the wrong information, they start to draw up a list of things that they can no longer do, like go after a promotion or start a family. Then they go through life shrunken and unrecognizable, not the person they once were. So to answer that intern’s question about why I work with persons living with HIV: I want to make HIV a non-issue,” he states.   Dr. Boyce hopes to see HIV disclosure become as acceptable as other chronic illnesses such as cancer or diabetes, where an entire family would work towards caring for the affected person, instead of alienating them. He also hopes to see more inclusion and tolerance towards persons living with HIV, especially those within the LGBTQI community.  “Until a gay or transgender person can walk the streets freely and not be jeered at by passers-by, we still have a long way to go. Until they can access treatment at any public facility without fear or judgment, we have a lot of work to do. It would take a lot of education to change the stigma and discrimination but there is absolutely no reason why another person’s life should be miserable because their expression is different to ours,” he commented.  He commends the work of FPATT in upholding the sexual and reproductive health rights of the LGBTQI community, through ensuring that they have a safe and non-judgmental environment for HIV and other STI tests. He says that the Medical Research Foundation values the great relationship that the two organizations have had for years, even as FPATT works towards becoming its own full-service antiretroviral treatment site for persons living with HIV.  

Never did she think that a job as Clinic Administrator would lead to a career that would change so many lives, but in 2007, Angelie Chotalal embarked on a path that would also change her life for good. Working at the Family Planning Association of Trinidad and Tobago (FPATT) in her late thirties, Angelie found joy in handling the administrative needs of the clinic, ensuring that the doctors and staff had all the resources to function at full capacity. She held that position for 3 years until she transferred into the vocation of Sessional Nurse, caring for the clients and clinic in a more hands-on role.  For the next 8 years, Angelie would devote her energy into education, becoming a Health and Family Life Education Master Trainer, as well as a Master Trainer in HIV Testing.  It was during this time that she also improved her bilingual skills; a decision that would prepare her for great success in the coming years.  “Hola! Como estás? Te ves bien,” she says as she greets a Venezuelan woman in the waiting area of the clinic. Her compassion is soothing and her smile is contagious. In her current role as Clinic Co-ordinator, Angelie has found herself having to be creative, innovative and still down-to-earth in the planning and execution of programmes for FPATT’s 4 static clinics across the country. The young migrant mothers of the clinic have come to know her as a matriarch, as she frequents the clinic floor always ready to attend to a new concern. “What makes them less than human?” Fleeing political oppression, lack of food and medicine and the downfall of the Venezuelan economy, over 40,000 Venezuelans have migrated to Trinidad to seek safer livelihoods. Many of them work to send most of their income home for the families they had to leave behind. “This here is my heartbeat. The work we do with the migrant community is dear to me because when I hear their stories, I know that there is so much more to be done. They are part of a population that has not received equal treatment. They’ve been put into a situation that they couldn’t expect and their only hope was to flee to this country where basic human rights are being withheld from them. What makes them less than human?” she asks, her visage pained with concern. Despite the influx of Venezuelans, Trinidad and Tobago’s migration policy has offered refugees very little access to healthcare and social services. However, FPATT’s mandate is to ensure that every person living within the borders of Trinidad and Tobago receive equal access to Sexual and Reproductive Healthcare (SRH) and Angelie’s personal mission is to ensure that they receive the best treatment when they come to her clinic.  “In 2018, we started offering healthcare specifically for the migrants. We had to ensure that our staff were compatible with our vision, and it was more than being bilingual; we each had to be genuinely empathetic toward the community we were seeking to serve. We worked to remove bias, xenophobia and other ill perceptions from even our own lives,” she noted. “The community is so close knit, that word of our services spread quickly and very soon our clinic for migrants was up and running. They would come in and see that it was a safe space to share their experiences and we took the time to listen, because they wouldn’t get this safety anywhere else.”  Before the FPATT clinic, migrants who needed SRH healthcare have had to book appointments with private doctors who often charge more than the migrants can afford.  “They work 12 hours a day, 7 days a week, get enough income to take care of their families here and those they’ve left behind. We’ve visited homes that house up to 10 migrant families, but it’s merely a shack with no running water or space to sleep. And then COVID hit,” she pauses pensively. “Incomes disappeared and so did options for housing; many of them were left homeless, so women who were already vulnerable were now being exploited. Imagine, your landlord asks you to pay for your rent with sex and a month later, brings his friends to cash in on the same favour, all because he knows you have nowhere else to live.”  Taking SRH Services online FPATT has offered all their regular healthcare services including gender-based violence counselling, birth control and emergency contraception to the migrant community. When Trinidad and Tobago entered a lockdown due to COVID protocols in 2020, FPATT approached the United Nations Population Fund for sponsorship to launch TeleHealth, an online medical consultation programme specifically for the migrant community. Through TeleHealth, clients are able to book 30-minute consultations with a clinical doctor and have their concerns addressed, ailments diagnosed and medicine prescribed, over WhatsApp video call.   In January 2021, FPATT also hosted a webinar series patterned after IPPF’s One Curriculum but tailored to the needs of the migrant community. The series featured FPATT’s team of clinical staff as well as experts in the fields of nutrition, self-defence and gender-based violence. “The response to both programmes is tremendous. The online access works well for our clients and we have developed such close relationships with them that we would love to expand our healthcare, but funding is often our major issue. We need sponsors to come on board, see how the programmes impact the people and help us continue to serve,” she states.  Ms. Chotalal looks forward to working with the Family Planning Association and helping communities that need their services the most.

Two clients of sexual and reproductive health counseling services agree that trust is one of the most valued aspects. Danitza Gonzales, the 28-year-old personal trainer, came to Inppares on the recommendation of a friend: “I felt great with the counseling. The same doctor gave me all the confidence to be able to tell her my issues and my doubts that are still taboo, she knew how to guide me”. Kiamara Meneses, 25, a sociologist, says that she found out about the institution through Facebook and when she arrived at counseling with her partner she felt confident: “We liked the way the explanation was provided and it was all very clear, so we kept coming back all of 2019, until 2020, because I was considering having a subdermal implant and I came to consult”, she commented. “What I liked the most about the counseling service was that there was no such luck of judging people, which had happened to me in other health facilities, where if I asked for a longer-lasting method, such as an implant or an IUD They put limitations on having children before or things like that. Here I understood that there are no restrictions to use a particular method and that seemed super important to me”, adds Kiamara. Among other aspects that the users highlight is the accessible price and the central location. “The cost seemed adequate to me, in addition to the treatment they gave me. So I stayed. When someone asks me where to go to seek contraceptive counseling or advice, I share the experience I have had, in addition to the fact that the place is very central and the price is very convenient,”says Danitza. “What I mainly like are the services Inppares has, in addition to counseling, the ease of accessing the methods, because they always have campaigns and also the HIV test; in addition to the Future Youth Center; so, it is a fairly comprehensive place and I would definitely recommend it. It contributes a lot to the lives of young people because information empowers. Young women can have a differentiated service that meets their needs, empowers them to make informed decisions about their bodies”, concludes Kiamara.  Danitza agrees that “Services like these have a great impact on the lives of women and men in order to make informed and responsible decisions; they should promote them more in schools and universities”.

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.

Famia Planea Aruba (FPA) saw a gap in the market and developed its online store to better reach clients like Hilyann, a journalist, with an active lifestyle and work schedule.  FPA’s online store is open to members and non-members where they shop for their favorite FPA product in a worry- and hassle-free environment from the comfort of their own home, office, school or even on the go. Being able to order products online saves time and also supports those clients with limited access to transport.  “As a young professional, one of the challenges I often face is balancing my profession with my active lifestyle and practicing self-care. This is why I couldn’t be happier with FPA’s online store”, Hilyann says. The visually appealing online store is available in the local Aruban language, Papiamento. The site has been designed to provide quick access to various contraceptive methods, with supporting information to help clients make choices based on their needs. “It is so convenient and allows me to manage my time more efficiently, making it so much easier to be conscious of the necessary efforts with regards to my reproductive health. Above all, it allows me to focus on my personal goals, all while making the right choices when it comes to family planning”, she adds. Clients can browse a range of products and add their selections to the cart. At the check-out clients fill in their preferred time, date, and location for delivery. A confirmation email will be sent to the client while FPA starts to prepare the order for delivery.  “Shopping on the FPA online store makes me feel very in control and empowered. I hope that more people of all ages take advantage of this service. I hear far too often that people say they don’t have time, nobody has actually, but FPA is there for you. Take control of your sexual and reproductive health, empower yourself, be the boss of your time and your body”.