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Tonga

Articles by Tonga

SPRINT
26 April 2022

SPRINT: Sexual and reproductive health in crisis and post-crisis situations

  The SPRINT Initiative provides one of the most important aspects of humanitarian assistance that is often forgotten when disaster and conflicts strike: access to essential life-saving sexual and reproductive health services. We build capacity of humanitarian workers to deliver essential life-saving sexual and reproductive health services in crisis and post-crisis situations through the delivery of the Minimum Initial Service Package (MISP) for reproductive health in emergencies.   Through funding from the Australian Government's Department of Foreign Affairs and Trade (DFAT), our SPRINT Initiative has brought sexual and reproductive health to the humanitarian agenda, increased capacity and responded to a number of humanitarian emergencies. Australia has funded the SPRINT initiative since 2007. Since then, the SPRINT initiative has responded to 105 humanitarian crises and worked with partners in 99 countries. SPRINT has reached over 1,138,175 people, delivering 2,133,141 crucial SRH services, and continues to respond to ongoing emergencies. In each priority country, we work with an IPPF Member Association to coordinate and implement life-saving sexual and reproductive activities. Through these partnerships, SPRINT helps strengthen the enabling environment, improve national capacity and provide lifesaving services during times of crisis. You can read more about IPPF Humanitarian’s Programme here. Australia's location in the Indo-Pacific provides DFAT with a unique perspective on humanitarian action. Australia is committed to helping partner governments manage crisis response themselves. This is done through building the capacity of the national government and civil society to be able to respond to disaster. DFAT also works with experienced international partners to prepare for and respond to disasters, including other donors, United Nations agencies, the International Red Cross and Red Crescent Movement and non-government organisations.          

Some IPPF volunteers - Zero Discrimination Day
28 February 2019

1 March: Zero Discrimination Day

On Zero Discrimination Day, IPPF stands for respect, dignity, compassion and care for all. We are committed to providing quality healthcare to every person that visits one of our Member Association’s clinics, regardless of their age, sex, gender identity, race, ethnicity, sexual orientation, religion, economic status or anything else.  When you provide healthcare with dignity and respect, you can inspire others to do the same. Meet some of people who were so motivated by the discrimination-free healthcare they received from our Member Associations, or by the potential to support their communities in need, that they decided to become much-valued volunteers. Lakshmi from Nepal, living with HIV – Community care mobiliser with the Family Planning Association of Nepal “I made a plan that I would come back home [to Palpa], disclose my status and then do social work with other people living with HIV, so that they too may have hope to live. I said to myself: I will live and I will let others living with HIV live.” Read more about Lakshmi Leilani, a trans woman from Tonga – Volunteer at the Tonga Leiti Association, supported by Tonga Health Family Association “I think Tonga Family Health has done a lot up to now. They always come and do our annual HIV testing and they supply us [with] some condoms.They really, really help us a lot. They [are the] only one that can understand us.” Read more about Leilani Eric from the USA – Outreach volunteer for the Planned Parenthood Federation of America  “The first thing I do when I have hardcore substance abusers sitting in front of me, I first show them identification, I let them know I understand just how they feel. I’ve been there feeling hopeless, helpless, confused about where to turn.” Read more about Eric Hasina from India – Sex worker and volunteer at the Family Planning Association of India “Selling my body doesn’t make me a bad person, but working as a peer educator has helped enabled me to help many like me.” Read more about Hasina Milan from Nepal, living with HIV – Community care mobiliser with the Family Planning Association of Nepal “There are 40 children in this area living with HIV,” he says. “I talk to them, collect information from them and help them get the support they need. And I tell them: ‘If I had given up at that time, I would not be like this now. So you also shouldn’t give up, and you have to live your life.” Read more about Milan Joseph from Botswana, a gay man living with HIV – Client at the Botswana Family Welfare Association “I never have any problems coming here. I feel comfortable here. At [the government clinic] there is no privacy; most of my friends are there. Sometimes if you go there you find them suspecting something, and everyone will be knowing your status. That’s why I prefer BOFWA [Botswana Family Welfare Association].” Read more about Joseph

Katherine Mafi, Programme Manager for TFHA, Tonga
04 July 2018

Preparing emergency outreach teams in Tonga after Cyclone Gita

In February 2018, Tropical Cyclone Gita hit Tonga – the strongest storm in 60 years. This blog was written in its immediate aftermath. In a crowded classroom on a Saturday morning in February, almost 50 reproductive health nurses gather to learn about detecting and responding to gender-based violence (GBV) in emergencies.  It’s hard to fathom that only days ago, their tiny island Kingdom of Tonga was ravaged by Tropical Cyclone Gita. But they are here, and keen to learn.  They will all be part of various emergency outreach teams in Tonga; including the response by IPPF member the Tonga Family Health Association (TFHA).  The TFHA team will travel to communities affected by the cyclone to provide life-saving sexual and reproductive healthcare and information. Some island communities they will reach have never had consistent access to sexual and reproductive healthcare, even during stable times.  Saving time and money During an IPPF emergency response, teams of clinical staff go to the affected communities. This saves people time and money, two resources that quickly deplete after an emergency.  This mobility and access to remote communities also provides an opportunity to scan for signs of gender-based violence. During a humanitarian crisis, many factors such as decreased protection mechanisms and increased instability exacerbate GBV-related risks, so it is vital to prevent, monitor and respond to cases of GBV. Another way the outreach teams access women is through the distribution of ‘dignity kits’: bags containing simple hygiene and protection items that help women maintain their dignity after a disaster. Katherine Mafi is the Programme Manager for TFHA. She says, “coming face to face with the recipient of a dignity kit is quite an experience, it's a magic moment watching these women.” The TFHA teams harness this as chance to discuss contraception, STIs and HIV, and pap smears with women, in the privacy of their own homes. In a deeply religious and conservative country like Tonga, it isn’t always easy getting women to talk about sexual and reproductive health.  "We have the solution" Some women are reluctant, even, to get a pap smear. In a country where many women die from cervical cancer, this could be a deadly reluctance.  Vika Finau, TFHA nurse and part of the emergency response team, talks about her experience encouraging women to have a pap smear in Tonga: “The challenge is encouraging them to come forward, they keep hesitating because of the procedure. They have to expose their genital area. Twenty women might agree to come for pap smear and at the end only nine or ten will come forward.” Once a woman is receiving a pap smear, however, Vika can gently broach the subject of sexual and reproductive health issues, and screen for signs of gender-based violence. It’s in this way that emergencies can create opportunities that wouldn’t have otherwise been there. IPPF’s emergency responses provide services, as well as information, often at the same time. “We don’t just preach information, but we have something. We have the solution. We have to offer something. You can't talk about maintaining dignity without the kits, and you can't just talk about the services without the services being present.”

Joshua Sefesi meeting the Queen
03 July 2018

IPPF youth campaigner presented with Queen’s award

We were thrilled to see IPPF youth campaigner Joshua Isikeli Sefesi presented with a Queen’s Young Leaders Award at Buckingham Palace. The inspiring young Tongan was invited to London to receive his award from the Queen. The Duke and Duchess of Sussex watched on, along with sports personality David Beckham, former British prime minister John Major and comedian Lenny Henry.   Joshua received his award for the transformative work he is doing to raise awareness of sexual reproductive health and women’s rights in his community in Tonga. Upon receiving his award, Joshua described the event as: “Mind-blowing, such an incredible opportunity and privilege to represent my country and receive an award from the Queen herself.” Exciting young change-makers Joshua helps to educate young people in his community about prevalent issues faced by women and girls, such as teenage pregnancy and gender-based violence.  He holds sessions with men to educate them on equality and safe sexual practices, informs women about the support available to them, and is a champion for better quality, comprehensive sex education. The Queen’s Young Leaders Awards programme, now in its fourth and final year, celebrates the achievements of some of the most exciting young change-makers from across the Commonwealth.  This year’s cohort from 38 Commonwealth countries are finding solutions to global issues such as climate change, food scarcity, gender-based violence, mental health, and access to education.  “Hope and optimism” As a Queen’s Young Leader, Joshua has gained access to bespoke mentoring and training through the University of Cambridge’s Institute of Continuing Education.  Joshua says he told the Queen “that with this award I will inspire other people, and she told me to continue to do more.” Asked what he will do in the future, Joshua said “I hope to approach people that are involved in governments and especially in schools as well, so we can negotiate something to include [my work] in the schools, and to reach out for more young people.” The Queen’s Young Leader programme was designed to develop the recipients’ leadership skills further, and ensure they are best placed to lead the way in the future to tackle some of the world’s most pressing issues. We look forward to seeing what incredible progress Joshua makes next. The Duke of Sussex put it best when giving a speech about the 240 recipients of the award: “You are the hope and optimism the world needs and we will all do whatever we can to support you in it.” Find out more about the Queen's Young Leaders programme

Aftermath of Tropical Cyclone Gita in Tonga
23 May 2018

Watch: Aftermath of Cyclone Gita

In February 2018, Tropical Cyclone Gita hit Tonga – the strongest storm in 60 years. Humanitarian disasters mean an increased risk of STI/HIV transmissions and gender-based violence. The consequences can be truly dire.  That's why in crises like this one, IPPF Humanitarian aims to provide sexual and reproductive healthcare through local partners.

Katherine Mafi, TFHA at Eua Hospital.
26 April 2018

Emergency creates the opportunity to expand access to healthcare

In a crowded classroom on a Saturday morning in February, almost fifty reproductive health nurses gather to learn about detecting and responding to gender-based violence (GBV) in emergencies. It’s hard to fathom that only days ago, their tiny island Kingdom of Tonga was ravaged by Tropical Cyclone Gita. But they are here, and keen to learn. They will all be part of emergency outreach teams in Tonga; including the response by IPPF Member Association, the Tonga Family Health Association (TFHA). During an IPPF emergency response, teams of clinical staff go to the affected communities. This saves people time and money, two resources that quickly deplete after an emergency. The TFHA team will travel to communities affected by the cyclone to provide life-saving sexual and reproductive healthcare and information. Some island communities they will reach have never had consistent access to sexual and reproductive healthcare. This mobility and access to remote communities also provides an opportunity to scan for signs of gender-based violence. During a humanitarian crisis, many factors such as decreased protection mechanisms and increased instability exacerbate GBV-related risks, so it is vital to prevent, monitor and respond to cases of GBV. Another way the outreach teams access women is through the distribution of ‘dignity kits’: bags containing simple hygiene and protection items that help women maintain their dignity after a disaster.   Katherine Mafi is the Programme Manager for TFHA. She says; “coming face to face with the recipient of a dignity kit is quite an experience, it's a magic moment watching these women.” “We don’t just preach information, but we have something. We have the solution. We have to offer something. You can't talk about maintaining dignity without the kits, and you can't just talk about the services without the services being present.” The TFHA teams see this as an opportunity to discuss contraception, STIs and HIV, and pap smears with women, in the privacy of their own homes. In a deeply religious and conservative country like Tonga, it isn’t always easy getting women to talk about sexual and reproductive health. Some women are reluctant, even, to get a pap smear. In a country where many women die from cervical cancer, this could be a deadly reluctance. Vika Finau, TFHA nurse and part of the emergency response team, talks about her experience encouraging women to have a pap smear in Tonga: “The challenge is encouraging them to come forward, they keep hesitating because of the procedure. They have to expose their genital area. Twenty women might agree to come for pap smear and at the end only nine or ten will come forward.” Once a woman is receiving a pap smear, however, Vika can gently broach the subject of sexual and reproductive health issues, and screen for signs of gender-based violence. It’s in this way that emergencies can create opportunities that wouldn’t have otherwise been there. IPPF’s emergency responses provide services, as well as information, often at the same time.  

Katherine Mafi, TFHA at Eua Hospital
24 April 2018

Humanitarian disaster in Tonga brings opportunity through access to healthcare

Following the devastation wrecked by Tropical Cyclone Gita on the island of Kingdon of Tonga, the Tonga Family Health Association deployed an emergency response team. The team was able to bring vital sexual and reproductive health care to local communities. By taking services to the people, the team has been able to expand the types of care that many women would not readily access including pap smears and the opportunity to raise awareness around gender-based violence.   Combining service delivery, as well as information, is part of our tailored approach to humanitarian crises; ensuring we meet need, wherever it is, whoever requires it, for as long as they want it.  Photography © IPPF/Alana Holmberg

Leilani

"I have a feeling the future will be better"

Leiti is a Tongan word to describe transgender women, it comes from the English word “lady”. In Tonga the transgender community is organized by the Tonga Leiti Association (TLA), and with the support of Tonga Family Health Association (TFHA). Together they are educating people to help stop the discrimination and stigma surrounding the Leiti community. Leilani, who identifies as a leiti, has been working with the Tonga Leiti Association, supported by Tonga Health Family Association to battle the stigma surrounding the leiti and LGBTI+ community in Tonga. She says "I started to dress like a leiti at a very young age. Being a leiti in a Tongan family is very difficult because being a leiti or having a son who’s a leiti are considered shameful, so for the family (it) is very difficult to accept us. Many leitis run away from their families." Frequently facing abuse Access to health care and sexual and reproductive health service is another difficulty the leiti community face: going to public clinics, they often face abuse and are more likely to be ignored or dismissed by staff. When they are turned away from other clinics, Leilani knows she can always rely on Tonga Health Family Association for help. 'I think Tonga Family Health has done a lot up to now. They always come and do our annual HIV testing and they supply us (with) some condom because we do the condom distribution here in Tonga and if we have a case in our members or anybody come to our office we refer them to Tonga Family Health. They really, really help us a lot. They (are the) only one that can understand us." Tonga Family Health Association and Tonga Leiti Association partnership allows for both organisations to attend training workshops run by one another. A valuable opportunity not only for clinic staff but for volunteers like Leilani. "When the Tonga Family Health run the training they always ask some members from TLA to come and train with them and we do the same with them. When I give a presentation at the TFHA's clinic, I share with people what we do; I ask them for to change their mindset and how they look about us." Overcoming stigma and discrimination  With her training, Leilani visits schools to help educate, inform and overcome the stigma and discrimination surrounding the leiti community. Many young leiti's drop out of school at an early age due to verbal, physical and in some cases sexual abuse.  Slowly, Leilani is seeing a positive change in the schools she visits.  “We go to school because there a lot of discrimination of the leiti's in high school and primary school too. I have been going from school to school for two years. My plan to visit all the schools in Tonga. We mostly go to all-boys schools is because discrimination in school is mostly done by boys. I was very happy last year when I went to a boys school and so how they really appreciate the work and how well they treated the Leiti's in the school." In February, Tonga was hit by tropical cyclone Gita, the worst cyclone to hit the island in over 60 years. Leilani worries that not enough is being done to ensure the needs of the Leiti and LGBTI+ community is being met during and post humanitarian disasters. "We are one of the vulnerable groups, after the cyclone Gita we should be one of the first priority for the government, or the hospital or any donations. Cause our life is very unique and we are easy to harm." Despite the hardships surrounding the leiti community, Leilani is hopeful for the future, "I can see a lot of families that now accept leiti's in their house and they treat them well. I have a feeling the future will be better. Please stop discriminating against us, but love us. We are here to stay, we are not here to chase away."    Watch the Humanitarian teams response to Cyclone Gita

Tonga Family Health Association

Within Tonga's well-developed healthcare system and infrastructure, reproductive health (RH) services are made up of a well-defined clinical / curative component and a public health / preventative component. The government of Tonga acknowledges the crucial role played by the Tonga Family Health Association (TFHA) in the Reproductive Health Programme for the achievement of the Millennium Development Goals (MDGs), in particular the health-related MDGs 4, 5, and 6.

TFHA supplies family planning (FP), maternal and child health (MCH) support, fertility and counselling assistance through 20 service points which include two permanent clinics and 15 community-based distributors (CBDs).

SPRINT
26 April 2022

SPRINT: Sexual and reproductive health in crisis and post-crisis situations

  The SPRINT Initiative provides one of the most important aspects of humanitarian assistance that is often forgotten when disaster and conflicts strike: access to essential life-saving sexual and reproductive health services. We build capacity of humanitarian workers to deliver essential life-saving sexual and reproductive health services in crisis and post-crisis situations through the delivery of the Minimum Initial Service Package (MISP) for reproductive health in emergencies.   Through funding from the Australian Government's Department of Foreign Affairs and Trade (DFAT), our SPRINT Initiative has brought sexual and reproductive health to the humanitarian agenda, increased capacity and responded to a number of humanitarian emergencies. Australia has funded the SPRINT initiative since 2007. Since then, the SPRINT initiative has responded to 105 humanitarian crises and worked with partners in 99 countries. SPRINT has reached over 1,138,175 people, delivering 2,133,141 crucial SRH services, and continues to respond to ongoing emergencies. In each priority country, we work with an IPPF Member Association to coordinate and implement life-saving sexual and reproductive activities. Through these partnerships, SPRINT helps strengthen the enabling environment, improve national capacity and provide lifesaving services during times of crisis. You can read more about IPPF Humanitarian’s Programme here. Australia's location in the Indo-Pacific provides DFAT with a unique perspective on humanitarian action. Australia is committed to helping partner governments manage crisis response themselves. This is done through building the capacity of the national government and civil society to be able to respond to disaster. DFAT also works with experienced international partners to prepare for and respond to disasters, including other donors, United Nations agencies, the International Red Cross and Red Crescent Movement and non-government organisations.          

Some IPPF volunteers - Zero Discrimination Day
28 February 2019

1 March: Zero Discrimination Day

On Zero Discrimination Day, IPPF stands for respect, dignity, compassion and care for all. We are committed to providing quality healthcare to every person that visits one of our Member Association’s clinics, regardless of their age, sex, gender identity, race, ethnicity, sexual orientation, religion, economic status or anything else.  When you provide healthcare with dignity and respect, you can inspire others to do the same. Meet some of people who were so motivated by the discrimination-free healthcare they received from our Member Associations, or by the potential to support their communities in need, that they decided to become much-valued volunteers. Lakshmi from Nepal, living with HIV – Community care mobiliser with the Family Planning Association of Nepal “I made a plan that I would come back home [to Palpa], disclose my status and then do social work with other people living with HIV, so that they too may have hope to live. I said to myself: I will live and I will let others living with HIV live.” Read more about Lakshmi Leilani, a trans woman from Tonga – Volunteer at the Tonga Leiti Association, supported by Tonga Health Family Association “I think Tonga Family Health has done a lot up to now. They always come and do our annual HIV testing and they supply us [with] some condoms.They really, really help us a lot. They [are the] only one that can understand us.” Read more about Leilani Eric from the USA – Outreach volunteer for the Planned Parenthood Federation of America  “The first thing I do when I have hardcore substance abusers sitting in front of me, I first show them identification, I let them know I understand just how they feel. I’ve been there feeling hopeless, helpless, confused about where to turn.” Read more about Eric Hasina from India – Sex worker and volunteer at the Family Planning Association of India “Selling my body doesn’t make me a bad person, but working as a peer educator has helped enabled me to help many like me.” Read more about Hasina Milan from Nepal, living with HIV – Community care mobiliser with the Family Planning Association of Nepal “There are 40 children in this area living with HIV,” he says. “I talk to them, collect information from them and help them get the support they need. And I tell them: ‘If I had given up at that time, I would not be like this now. So you also shouldn’t give up, and you have to live your life.” Read more about Milan Joseph from Botswana, a gay man living with HIV – Client at the Botswana Family Welfare Association “I never have any problems coming here. I feel comfortable here. At [the government clinic] there is no privacy; most of my friends are there. Sometimes if you go there you find them suspecting something, and everyone will be knowing your status. That’s why I prefer BOFWA [Botswana Family Welfare Association].” Read more about Joseph

Katherine Mafi, Programme Manager for TFHA, Tonga
04 July 2018

Preparing emergency outreach teams in Tonga after Cyclone Gita

In February 2018, Tropical Cyclone Gita hit Tonga – the strongest storm in 60 years. This blog was written in its immediate aftermath. In a crowded classroom on a Saturday morning in February, almost 50 reproductive health nurses gather to learn about detecting and responding to gender-based violence (GBV) in emergencies.  It’s hard to fathom that only days ago, their tiny island Kingdom of Tonga was ravaged by Tropical Cyclone Gita. But they are here, and keen to learn.  They will all be part of various emergency outreach teams in Tonga; including the response by IPPF member the Tonga Family Health Association (TFHA).  The TFHA team will travel to communities affected by the cyclone to provide life-saving sexual and reproductive healthcare and information. Some island communities they will reach have never had consistent access to sexual and reproductive healthcare, even during stable times.  Saving time and money During an IPPF emergency response, teams of clinical staff go to the affected communities. This saves people time and money, two resources that quickly deplete after an emergency.  This mobility and access to remote communities also provides an opportunity to scan for signs of gender-based violence. During a humanitarian crisis, many factors such as decreased protection mechanisms and increased instability exacerbate GBV-related risks, so it is vital to prevent, monitor and respond to cases of GBV. Another way the outreach teams access women is through the distribution of ‘dignity kits’: bags containing simple hygiene and protection items that help women maintain their dignity after a disaster. Katherine Mafi is the Programme Manager for TFHA. She says, “coming face to face with the recipient of a dignity kit is quite an experience, it's a magic moment watching these women.” The TFHA teams harness this as chance to discuss contraception, STIs and HIV, and pap smears with women, in the privacy of their own homes. In a deeply religious and conservative country like Tonga, it isn’t always easy getting women to talk about sexual and reproductive health.  "We have the solution" Some women are reluctant, even, to get a pap smear. In a country where many women die from cervical cancer, this could be a deadly reluctance.  Vika Finau, TFHA nurse and part of the emergency response team, talks about her experience encouraging women to have a pap smear in Tonga: “The challenge is encouraging them to come forward, they keep hesitating because of the procedure. They have to expose their genital area. Twenty women might agree to come for pap smear and at the end only nine or ten will come forward.” Once a woman is receiving a pap smear, however, Vika can gently broach the subject of sexual and reproductive health issues, and screen for signs of gender-based violence. It’s in this way that emergencies can create opportunities that wouldn’t have otherwise been there. IPPF’s emergency responses provide services, as well as information, often at the same time. “We don’t just preach information, but we have something. We have the solution. We have to offer something. You can't talk about maintaining dignity without the kits, and you can't just talk about the services without the services being present.”

Joshua Sefesi meeting the Queen
03 July 2018

IPPF youth campaigner presented with Queen’s award

We were thrilled to see IPPF youth campaigner Joshua Isikeli Sefesi presented with a Queen’s Young Leaders Award at Buckingham Palace. The inspiring young Tongan was invited to London to receive his award from the Queen. The Duke and Duchess of Sussex watched on, along with sports personality David Beckham, former British prime minister John Major and comedian Lenny Henry.   Joshua received his award for the transformative work he is doing to raise awareness of sexual reproductive health and women’s rights in his community in Tonga. Upon receiving his award, Joshua described the event as: “Mind-blowing, such an incredible opportunity and privilege to represent my country and receive an award from the Queen herself.” Exciting young change-makers Joshua helps to educate young people in his community about prevalent issues faced by women and girls, such as teenage pregnancy and gender-based violence.  He holds sessions with men to educate them on equality and safe sexual practices, informs women about the support available to them, and is a champion for better quality, comprehensive sex education. The Queen’s Young Leaders Awards programme, now in its fourth and final year, celebrates the achievements of some of the most exciting young change-makers from across the Commonwealth.  This year’s cohort from 38 Commonwealth countries are finding solutions to global issues such as climate change, food scarcity, gender-based violence, mental health, and access to education.  “Hope and optimism” As a Queen’s Young Leader, Joshua has gained access to bespoke mentoring and training through the University of Cambridge’s Institute of Continuing Education.  Joshua says he told the Queen “that with this award I will inspire other people, and she told me to continue to do more.” Asked what he will do in the future, Joshua said “I hope to approach people that are involved in governments and especially in schools as well, so we can negotiate something to include [my work] in the schools, and to reach out for more young people.” The Queen’s Young Leader programme was designed to develop the recipients’ leadership skills further, and ensure they are best placed to lead the way in the future to tackle some of the world’s most pressing issues. We look forward to seeing what incredible progress Joshua makes next. The Duke of Sussex put it best when giving a speech about the 240 recipients of the award: “You are the hope and optimism the world needs and we will all do whatever we can to support you in it.” Find out more about the Queen's Young Leaders programme

Aftermath of Tropical Cyclone Gita in Tonga
23 May 2018

Watch: Aftermath of Cyclone Gita

In February 2018, Tropical Cyclone Gita hit Tonga – the strongest storm in 60 years. Humanitarian disasters mean an increased risk of STI/HIV transmissions and gender-based violence. The consequences can be truly dire.  That's why in crises like this one, IPPF Humanitarian aims to provide sexual and reproductive healthcare through local partners.

Katherine Mafi, TFHA at Eua Hospital.
26 April 2018

Emergency creates the opportunity to expand access to healthcare

In a crowded classroom on a Saturday morning in February, almost fifty reproductive health nurses gather to learn about detecting and responding to gender-based violence (GBV) in emergencies. It’s hard to fathom that only days ago, their tiny island Kingdom of Tonga was ravaged by Tropical Cyclone Gita. But they are here, and keen to learn. They will all be part of emergency outreach teams in Tonga; including the response by IPPF Member Association, the Tonga Family Health Association (TFHA). During an IPPF emergency response, teams of clinical staff go to the affected communities. This saves people time and money, two resources that quickly deplete after an emergency. The TFHA team will travel to communities affected by the cyclone to provide life-saving sexual and reproductive healthcare and information. Some island communities they will reach have never had consistent access to sexual and reproductive healthcare. This mobility and access to remote communities also provides an opportunity to scan for signs of gender-based violence. During a humanitarian crisis, many factors such as decreased protection mechanisms and increased instability exacerbate GBV-related risks, so it is vital to prevent, monitor and respond to cases of GBV. Another way the outreach teams access women is through the distribution of ‘dignity kits’: bags containing simple hygiene and protection items that help women maintain their dignity after a disaster.   Katherine Mafi is the Programme Manager for TFHA. She says; “coming face to face with the recipient of a dignity kit is quite an experience, it's a magic moment watching these women.” “We don’t just preach information, but we have something. We have the solution. We have to offer something. You can't talk about maintaining dignity without the kits, and you can't just talk about the services without the services being present.” The TFHA teams see this as an opportunity to discuss contraception, STIs and HIV, and pap smears with women, in the privacy of their own homes. In a deeply religious and conservative country like Tonga, it isn’t always easy getting women to talk about sexual and reproductive health. Some women are reluctant, even, to get a pap smear. In a country where many women die from cervical cancer, this could be a deadly reluctance. Vika Finau, TFHA nurse and part of the emergency response team, talks about her experience encouraging women to have a pap smear in Tonga: “The challenge is encouraging them to come forward, they keep hesitating because of the procedure. They have to expose their genital area. Twenty women might agree to come for pap smear and at the end only nine or ten will come forward.” Once a woman is receiving a pap smear, however, Vika can gently broach the subject of sexual and reproductive health issues, and screen for signs of gender-based violence. It’s in this way that emergencies can create opportunities that wouldn’t have otherwise been there. IPPF’s emergency responses provide services, as well as information, often at the same time.  

Katherine Mafi, TFHA at Eua Hospital
24 April 2018

Humanitarian disaster in Tonga brings opportunity through access to healthcare

Following the devastation wrecked by Tropical Cyclone Gita on the island of Kingdon of Tonga, the Tonga Family Health Association deployed an emergency response team. The team was able to bring vital sexual and reproductive health care to local communities. By taking services to the people, the team has been able to expand the types of care that many women would not readily access including pap smears and the opportunity to raise awareness around gender-based violence.   Combining service delivery, as well as information, is part of our tailored approach to humanitarian crises; ensuring we meet need, wherever it is, whoever requires it, for as long as they want it.  Photography © IPPF/Alana Holmberg

Leilani

"I have a feeling the future will be better"

Leiti is a Tongan word to describe transgender women, it comes from the English word “lady”. In Tonga the transgender community is organized by the Tonga Leiti Association (TLA), and with the support of Tonga Family Health Association (TFHA). Together they are educating people to help stop the discrimination and stigma surrounding the Leiti community. Leilani, who identifies as a leiti, has been working with the Tonga Leiti Association, supported by Tonga Health Family Association to battle the stigma surrounding the leiti and LGBTI+ community in Tonga. She says "I started to dress like a leiti at a very young age. Being a leiti in a Tongan family is very difficult because being a leiti or having a son who’s a leiti are considered shameful, so for the family (it) is very difficult to accept us. Many leitis run away from their families." Frequently facing abuse Access to health care and sexual and reproductive health service is another difficulty the leiti community face: going to public clinics, they often face abuse and are more likely to be ignored or dismissed by staff. When they are turned away from other clinics, Leilani knows she can always rely on Tonga Health Family Association for help. 'I think Tonga Family Health has done a lot up to now. They always come and do our annual HIV testing and they supply us (with) some condom because we do the condom distribution here in Tonga and if we have a case in our members or anybody come to our office we refer them to Tonga Family Health. They really, really help us a lot. They (are the) only one that can understand us." Tonga Family Health Association and Tonga Leiti Association partnership allows for both organisations to attend training workshops run by one another. A valuable opportunity not only for clinic staff but for volunteers like Leilani. "When the Tonga Family Health run the training they always ask some members from TLA to come and train with them and we do the same with them. When I give a presentation at the TFHA's clinic, I share with people what we do; I ask them for to change their mindset and how they look about us." Overcoming stigma and discrimination  With her training, Leilani visits schools to help educate, inform and overcome the stigma and discrimination surrounding the leiti community. Many young leiti's drop out of school at an early age due to verbal, physical and in some cases sexual abuse.  Slowly, Leilani is seeing a positive change in the schools she visits.  “We go to school because there a lot of discrimination of the leiti's in high school and primary school too. I have been going from school to school for two years. My plan to visit all the schools in Tonga. We mostly go to all-boys schools is because discrimination in school is mostly done by boys. I was very happy last year when I went to a boys school and so how they really appreciate the work and how well they treated the Leiti's in the school." In February, Tonga was hit by tropical cyclone Gita, the worst cyclone to hit the island in over 60 years. Leilani worries that not enough is being done to ensure the needs of the Leiti and LGBTI+ community is being met during and post humanitarian disasters. "We are one of the vulnerable groups, after the cyclone Gita we should be one of the first priority for the government, or the hospital or any donations. Cause our life is very unique and we are easy to harm." Despite the hardships surrounding the leiti community, Leilani is hopeful for the future, "I can see a lot of families that now accept leiti's in their house and they treat them well. I have a feeling the future will be better. Please stop discriminating against us, but love us. We are here to stay, we are not here to chase away."    Watch the Humanitarian teams response to Cyclone Gita

Tonga Family Health Association

Within Tonga's well-developed healthcare system and infrastructure, reproductive health (RH) services are made up of a well-defined clinical / curative component and a public health / preventative component. The government of Tonga acknowledges the crucial role played by the Tonga Family Health Association (TFHA) in the Reproductive Health Programme for the achievement of the Millennium Development Goals (MDGs), in particular the health-related MDGs 4, 5, and 6.

TFHA supplies family planning (FP), maternal and child health (MCH) support, fertility and counselling assistance through 20 service points which include two permanent clinics and 15 community-based distributors (CBDs).