“They don’t understand”

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: http://www.pathfind.org/site/DocServer/PAC_7-30-07.pdf?docID=12041

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 as another facility mentioned that before the training they had to carry the patients to another ward 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.