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Pathfinder Field Journal
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“They don’t understand”
GHANA: Wednesday, June 25, 2008
In the afternoon I visited three health facilities around Accra where, for the past year, Pathfinder has initiated Youth-Friendly Postabortion Care (YF PAC) programs. Postabortion care (PAC) is medical treatment for women suffering from the complications of unsafe abortion. The purpose of PAC is twofold: (1) to save the lives of the suffering women who enter the health facility for treatment and (2) to provide family planning counseling and services so that the women will not find themselves in this life-threatening situation again. This project was undertaken with private funds in eight countries in Africa because of the dire need for PAC services on the continent and to address the specific needs of adolescents in seeking and receiving treatment.
Since people might be unfamiliar with some of the background on this issue, here are some links to relevant info:
 Today was a challenging day for me. Although I am continually learning about and intrigued by the notion of public health and the important work that is being done in developing countries, visiting the health facilities was very difficult. I appreciated talking to the nurses and doctors, asking them questions about their work and the project. Nurses at each facility were trained to treat the women as they come in so that no patient would have to wait in pain for a doctor to care for them. The nurses at one facility, in particular, were obviously empowered by this training and their ability to directly help the women who are suffering. Nurses at another facility mentioned that before the training they had to refer the patients to another facility to receive emergency care from an available doctor; now they can perform the procedures themselves and other nurses have requested the same training. I appreciated seeing the facilities themselves, noticing the differences between a large general hospital, a clinic dedicated solely to maternal and child health, and a more rural facility—modest in its structure.
I had a difficult time coming to grips with the high-level of need and the evident suffering of the women who were there to receive services. I can’t imagine the pain and trauma that brought them to the facility. I found myself being drawn to the fact that these services are geared toward youth, who are probably scared and confused. A nurse at the first facility we visited emphasized the point that the adolescents don’t understand what is happening to their bodies when they arrive and need more time for counseling and reassurance throughout their time at the hospital. Moreover, each woman at each facility was there alone. This is probably an uncommon and insignificant fact, but this point exaggerated the feeling that these women were fighting by themselves—that this is an easily forgotten problem and undesirable project. I was also confronted by some of the challenges this ground-breaking project has faced—challenges that must plague public health projects around the globe.
 Changing Lives, Saving Lives is Pathfinder’s slogan, used on letterhead, banners and throughout various pieces of writing. I always thought the slogan was too general for PI’s mission and found it unhelpful in illuminating the diverse projects undertaken throughout the world. Visiting the health facilities today has warmed me to that slogan. The YF PAC project, although with challenges, is saving lives everyday by providing much needed quality care to women who would otherwise not receive it; the program’s emphasis on family planning as well as the budding outreach efforts will change lives and attitudes in these communities for years to come. Moreover, the innovative emphasis on the needs of adolescents, a group especially vulnerable to stigma and the least likely to seek treatment, is one that could be replicated and learned from throughout Africa and the world.
“If it’s for money, nobody would sit here”
GHANA: Wendesday, June 18, 2008
 Lucy, the nurse who leads one of Pathfinder’s Youth Friendly Services programs in the Volta region, reiterated the point many times over that the peer educators and service providers she organizes are involved in this work for the betterment of their community for the good of “our people.” I don’t doubt her; in fact, it’s obvious from the remarkable initiative of the peer educators and the dedication of the service providers that nothing else could be motivating their work. Not to mention the fact that the peer educators work entirely on a volunteer basis and the service providers receive no monetary payment over their district salaries except for modest travel and meal stipends received on meeting days. The supervisors also receive a token each quarter for meals and transportation.
Yesterday I traveled to the Volta region of Ghana (the southeastern region bordering Togo) to attend a monthly assessment meeting for PI’s Youth Friendly Services (YFS) program in both the Ho and Akatsi districts. The YFS program has two main components: (1) making reproductive health facilities more “youth-friendly” (separate procedure and counseling rooms, more convenient hours, lower fees, staff trained to talk to adolescent groups in a non-judgmental manner etc.) and (2) training peer educators to perform outreach efforts in order to disseminate sexual and reproductive health information as well as refer their peers to the health facilities, if necessary. Assessment meeting is really too formal a title for what I observed; the meetings were an opportunity for the peer educators and the service providers (mainly nurses and midwives working at the YF facilities) to come together and share both the successes and challenges of their work.
It was really amazing for me to listen to the peer educators talk about their work. Both YFS and peer educators are terms that I’ve heard thrown about during my two years at PI, but I don’t think I ever fully understood the need or the importance of these types of programs before today. Many of the peer educators in the Akatsi District talked about how STIs, HIV/AIDS, unwanted pregnancy, and drug abuse are plaguing the young people of their community. I asked many of the peer educators why they became involved in this work (they range in age from 17 to mid-twenties) and every one cited these problems in the local community and the need he/she felt to help his/her peers. When asking this question, I was expecting a more involved—or at least more varied—response, but I think the simplicity of that answer reveals both the complexity of the problem and the (small but) meaningful impact of the singular actions of these peer educators.
One young man, Patrick, led a group of four fellow peer educators, to visit two schools to talk about STI transmission, prevention, and treatment as well as the dangers of teenage pregnancy within the context of a broader discussion on family planning. He relayed the fact that the students at the schools were quite engaged and very participatory during the session and the schools’ administration, because of the positive response by the students as well as the peer educators’ ability to lead the session in the local language, requested a second visit by the group. Beyond this success at the school, Patrick went to talk to the local assemblyman and arranged for the airing of the peer educators’ presentation on a local radio station that is broadcast in public areas throughout the town; the presentation is expected to air in three towns in the coming weeks. The initiative needed to organize and perform all those tasks—while receiving no pay…while talking about sexual health with perfect strangers…while traveling long distances—is truly extraordinary…at least, that’s more than I do in an average day.
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