Dressed in a sparkling white medical coat, Alinafe runs one of Family Planning Association of Malawi (FPAM) mobile clinics in the village of Chigude. Under the hot midday sun, she patiently answering the questions of staff, volunteers and clients - all while heavily pregnant herself.  Delivering care to remote communities  “Most NGOs don’t come here because it’s so hard to reach,” she says, as women queue up in neat lines in front of two khaki tents to receive anything from a cervical cancer screening to abortion counselling. Without the mobile clinic, local women risk life-threatening health issues as a result of unsafe abortion or illnesses linked to undiagnosed HIV status. According to the Guttmacher Institute, complications from abortion are the cause of 6–18% of maternal deaths in Malawi.    District Manager Alinafe joined the Family Planning Association of Malawi in 2016, when she was just 20 years old, after going to nursing school and getting her degree in public health. She was one of the team involved in the Linkages project, which provided free family planning care to sex workers in Mzuzu until it was discontinued following the 2017 Global Gag Rule.  Seeing the impact of lost funding on care  “This change has reduced our reach,” Alinafe says, explaining that before the Gag Rule they were reaching sex workers in all four traditional authorities in Mzimba North - now they mostly work in just one. She says this means they are “denying people services which are very important” and without reaching people with sexual and reproductive healthcare, increasing the risk of STIs.    The reduction in healthcare has also led to a breakdown in the trust FPAM had worked to build in communities, gaining support from those in respected positions such as chiefs.    “Important people in the communities have been complaining to us, saying why did you do this? You were here, these things were happening and our people were benefiting a lot but now nothing is good at all,” explains Alinafe.    Still, she is determined to serve her community against the odds - running the outreach clinic funded by Global Affairs Canada five times a week, in four traditional authorities, as well as the FPAM Youth Life Centre in Mzuzu.  “On a serious note, unsafe abortions are happening in this area at a very high rate,” says Alinafe at the FPAM clinic in Chigude. “Talking about abortions is a very important thing. Whether we like it or not, on-the-ground these things are really happening, so we can’t ignore them.”

Mary, a 30-year-old sex worker, happily drinks a beer at one of the bars she works at in downtown Lilongwe. Her grin is reflected in the entirely mirrored walls, lit with red and blue neon lights.    Above her, a DJ sat in an elevated booth is playing pumping dancehall while a handful of people around the bar nod and dance along to the music. It’s not even midday yet.    Mary got introduced to the Family Planning Association of Malawi through friends, who invited her to a training session for sex worker ‘peer educators’ on issues related to sexual and reproductive health and rights as part of the Linkages project.    “I learnt about condoms and even female condoms, which I hadn’t heard of before,” remembers Mary.  Life-changing care and support   But the most life-changing care she received was an HIV test, where she learnt that she was positive and began anti-retroviral treatment (ART). “It was hard for me at first, but then I realized I had to start a new life,” says Mary, saying this included being open with her son about her status, who was 15 at the time.    According to UNAIDS 2018 data, 9.2% of adult Malawians are living with HIV. Women and sex workers are disproportionately affected - the same year, 55% of sex workers were estimated to be living with HIV.    Mary says she now feels much healthier and is open with her friends in the sex worker community about her status, also encouraging them to get tested for HIV.  “Linkages brought us all closer together as we became open about these issues with each other,” remembers Mary.  Looking out for other sex workers   As a peer educator, Mary became a go-to person for other sex workers to turn to in cases of sexual assault. “I’ll receive a message from someone who has been assaulted, then call everyone together to discuss the issue, and we’d escort that person to report to police,” says Mary.    During the Linkages project - which was impacted by the Global Gag Rule and abruptly discontinued in 2017 - Mary was given an allowance to travel to different ‘hotspot’ areas. In these bars and lodges, she explains in detail how she would go from room-to-room handing out male and female condoms and showing her peers how to use them.    FPAM healthcare teams would also go directly to the hotspots reaching women with healthcare such as STI testing and abortion counselling. FPAM’s teams know how crucial it is to provide healthcare to their clients ensuring it is non-judgmental and confidential. This is a vital service: Mary says she has had four sex worker friends die as a result of unsafe abortions, and lack of knowledge about post-abortion care.    “Since the project ended, most of us find it difficult to access these services,” says Mary, adding that “New sex workers don’t have the information I have, and without Linkages we’re not able to reach all the hotspot bars in Lilongwe to educate them.”

At the end of a long day, Anicia, closes the clinic with praise for her colleagues who never turn anyone away. "We open at 8am. From 8am we will be receiving a variety of clients for different services - whether post-abortion care, whether antenatal care - we have to give them all the services. We may end up to 10pm, because we'll never chase our clients, we'll never close the place when we have a client inside. People come when they have no hope. You receive them, and you give them hope by treating them properly and giving them quality services. The client gets better and will never forget you. And follow them up on the phone. "How are you doing?" It's good for us to know that they're doing well. Others even tell us 'The way you handle us, we love it so much'." Follow a day in the life of our team and clients in Gulu, Uganda 07:00 08:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 22:00 Prev Next 7am: The team prepare for the long day ahead "Every year tens of thousands of Ugandans come to our clinic. Everyone is welcome. Here are just a few of the people that we served in one day last month." READ MORE 8am: Nancy, 19, becomes a volunteer "I was suffering but when I came here, I was treated and I got better. Now I'm inspired to volunteer here" READ MORE 9am: Monica, 25, a sex worker's story "I am sex working. I came here for Hepatitis B testing and also counselling. I have so many personal problems, but here….they’re so caring." READ MORE 10am: Jane, 23, saved by family planning "After multiple miscarriages, family planning here has helped me a lot. I'm glad we've been able to space the number of children we've had. I am not growing old, I am fresh." READ MORE 11am: Vicky, handling disabilities "I'm deaf so accessing services is hard, but here they really try to speak in sign language." READ MORE 12pm: Dorcus, first time patient "This is the first time I've ever come here, I like the service. They give good counselling so I recommend coming." READ MORE 1pm: Christine, 45, a grandmother's tale of living with HIV "I am living with HIV and had HPV. They treated me and now I'm free of cervical cancer." READ MORE 2pm: Lilian, struggling mother of six with sickle cell " I have sickle cell disease and so do all my children. I want to have my tube removed so that I don't get pregnant again but I don't know if my husband will allow it." READ MORE 3pm: Brenda and Francis get fertility treatments "Fertility treatment is a sensitive issue in Uganda but they help us a lot and we get proper treatment." READ MORE 4pm: Joyce, 25, repected regardless of her disability "I realised that at this place they don't segregate. Us people with disabilities have challenges at the main hospitals. You go there, people around look at you as if you are not a human being and you don't fall sick." READ MORE 5pm: Mobile clinic provides outreach services to remote villages "Our outreach to remote communities is a 'one-stop-centre'. We give family planning, vaccines for HPV, malaria, and Hepatitis B, HIV testing and more." READ MORE 22pm: Still giving the last client our very best "Together, we have great teamwork. Sometimes we're still working up to 10pm because we never chase out our clients. We’ll never close the place when we have a client inside. People come when they have no hope." READ MORE

Every Thursday a team from RHU Gulu district provides a mobile outreach clinic in Atega village in the Omoro district in Northern Uganda. The outreach team goes out into this poor, remote area which would otherwise not have access to sexual and reproductive health services. The night before the outreach clinic RHU driver, Robert Nyeko and Godfrey Bedimot load up tents, chairs, medical equipment and supplies. The clinic needs to be set up and by 7am ready to receive clients from 8am. The outreach clinic provides a range of services including diagnosis, testing and treatment, family planning such as fitting implants, providing condoms and HPV vaccines. Laboratory technician, Denis Bongonyinge carries out testing for malaria, Hepatitis B, HIV/AIDS, pneumonia and other infections. Other members of the team provide immunisations and vaccinations. Typically men, women and children start arriving at the clinic by 7:30am. Two volunteers are on hand to direct them to the appropriate place to get the services they need. Some clients need a range of services. At 8am service provider, Anicia Filda, popularly known a 'Mama' in the community is ready with her team to start the day. There are now more than 200 clients waiting to be seen; with more people arriving to join the long queues. The longest queue is for the immunisation and vaccination services. The majority have come for either the Hepatitis B vaccine, which is a big threat in this community. Priority is given to the many young girls lining up for the Human Papilloma Virus (HPV) vaccine. Denis Bongonyinge takes blood samples for rapid tests for malaria, HIV, HPV and a range of other infections. Each client carries an exercise book where Denis records their results which is then taken to the staff giving out prescriptions. 32-year-Robert Otim pushes his bicycle to the outreach clinic. The single father has ridden 10 kilometres with his two young children. He lost his wife to Hepatitis B when their daughter was just six months. His four-year-old son was born prematurely and is now disabled. He has come today for his last Hepatitis B immunisation. His children need to be vaccinated as well as treated for malaria and coughs. Looking at the long queue, he says he doubts whether he will get the service today but he is lucky as one of the team who once treated his son, Geoffrey, notices Robert and they are given priority for treatment and prescriptions. Already by midday, one of the teams delivering minor surgeries, postnatal services, family planning and post abortion care have seen 47 mothers. This is almost the same as the number of clients they would treat at the Gulu Clinic during a normal day. Anicia Filda sends the driver to collect more supplies from the clinic; the stock is starting to run low because demand is so high There is no break for the team. Samuel Kedi, the only clinician at the outreach camp stands up, and picks up a bottle of water from his backpack for a quick drink before continuing with the next client. The clinic continues to see clients well into the evening. The outreach clinic is scheduled to finish by 5pm but Anicia says there is not one day they have closed on time: “We cannot close when clients are still lining up. It’s the same at the clinic in Gulu,” she says. As the clinic draws to a close for the day, the teams complete their report which records details of the numbers clients served, the types of services delivered and supplies of stock. It has been another busy but successful day for Anicia and her team. Provision of integrated services in such remote areas is vital for the local community; many men, women and children would not be able to receive the types of treatment and care that RHU works diligently to provide. Follow a day in the life of our team and clients in Gulu, Uganda 07:00 08:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 22:00 Prev Next 7am: The team prepare for the long day ahead "Every year tens of thousands of Ugandans come to our clinic. Everyone is welcome. Here are just a few of the people that we served in one day last month." READ MORE 8am: Nancy, 19, becomes a volunteer "I was suffering but when I came here, I was treated and I got better. Now I'm inspired to volunteer here" READ MORE 9am: Monica, 25, a sex worker's story "I am sex working. I came here for Hepatitis B testing and also counselling. I have so many personal problems, but here….they’re so caring." READ MORE 10am: Jane, 23, saved by family planning "After multiple miscarriages, family planning here has helped me a lot. I'm glad we've been able to space the number of children we've had. I am not growing old, I am fresh." READ MORE 11am: Vicky, handling disabilities "I'm deaf so accessing services is hard, but here they really try to speak in sign language." READ MORE 12pm: Dorcus, first time patient "This is the first time I've ever come here, I like the service. They give good counselling so I recommend coming." READ MORE 1pm: Christine, 45, a grandmother's tale of living with HIV "I am living with HIV and had HPV. They treated me and now I'm free of cervical cancer." READ MORE 2pm: Lilian, struggling mother of six with sickle cell " I have sickle cell disease and so do all my children. I want to have my tube removed so that I don't get pregnant again but I don't know if my husband will allow it." READ MORE 3pm: Brenda and Francis get fertility treatments "Fertility treatment is a sensitive issue in Uganda but they help us a lot and we get proper treatment." READ MORE 4pm: Joyce, 25, repected regardless of her disability "I realised that at this place they don't segregate. Us people with disabilities have challenges at the main hospitals. You go there, people around look at you as if you are not a human being and you don't fall sick." READ MORE 5pm: Mobile clinic provides outreach services to remote villages "Our outreach to remote communities is a 'one-stop-centre'. We give family planning, vaccines for HPV, malaria, and Hepatitis B, HIV testing and more." READ MORE 22pm: Still giving the last client our very best "Together, we have great teamwork. Sometimes we're still working up to 10pm because we never chase out our clients. We’ll never close the place when we have a client inside. People come when they have no hope." READ MORE

Joyce Auma, 25, is a business administration graduate currently working as a data clerk with Gulu Women with Disabilities Union.  The union has partnered with Reproductive Health Uganda to extend sexual and reproductive health services to women living with disabilities in Gulu and neighbouring districts in Acholi. Joyce, who lost the use of her legs in childhood, is one of the women with disabilities that normally receive services at Gulu Clinic. “I found out about RHU because they are our partners at Gulu Women with Disability Union. I first came to the clinic to test for HIV and other STIs. We also receive their other services like family planning and cancer screening to people with disabilities.” “The first time I came here I was warmly welcomed. They're very good at talking to the youth. Though the place was new for me, I was given service as if it was not my first time.” Says Joyce. "Us people with disabilities have challenges at the main hospitals. People around look at you as if you are not a human being and you don’t fall sick.” Joyce has since been a regular client of RHU for HIV testing, cancer screening and other diseases. She says her status exposes her to many risks of infection which has to be regularly checked for. “I always come here for testing, there is also cancer screening. They don’t segregate me because of my disability. They give you the services you need.”  Follow a day in the life of our team and clients in Gulu, Uganda 07:00 08:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 22:00 Prev Next 7am: The team prepare for the long day ahead "Every year tens of thousands of Ugandans come to our clinic. Everyone is welcome. Here are just a few of the people that we served in one day last month." READ MORE 8am: Nancy, 19, becomes a volunteer "I was suffering but when I came here, I was treated and I got better. Now I'm inspired to volunteer here" READ MORE 9am: Monica, 25, a sex worker's story "I am sex working. I came here for Hepatitis B testing and also counselling. I have so many personal problems, but here….they’re so caring." READ MORE 10am: Jane, 23, saved by family planning "After multiple miscarriages, family planning here has helped me a lot. I'm glad we've been able to space the number of children we've had. I am not growing old, I am fresh." READ MORE 11am: Vicky, handling disabilities "I'm deaf so accessing services is hard, but here they really try to speak in sign language." READ MORE 12pm: Dorcus, first time patient "This is the first time I've ever come here, I like the service. They give good counselling so I recommend coming." READ MORE 1pm: Christine, 45, a grandmother's tale of living with HIV "I am living with HIV and had HPV. They treated me and now I'm free of cervical cancer." READ MORE 2pm: Lilian, struggling mother of six with sickle cell " I have sickle cell disease and so do all my children. I want to have my tube removed so that I don't get pregnant again but I don't know if my husband will allow it." READ MORE 3pm: Brenda and Francis get fertility treatments "Fertility treatment is a sensitive issue in Uganda but they help us a lot and we get proper treatment." READ MORE 4pm: Joyce, 25, repected regardless of her disability "I realised that at this place they don't segregate. Us people with disabilities have challenges at the main hospitals. You go there, people around look at you as if you are not a human being and you don't fall sick." READ MORE 5pm: Mobile clinic provides outreach services to remote villages "Our outreach to remote communities is a 'one-stop-centre'. We give family planning, vaccines for HPV, malaria, and Hepatitis B, HIV testing and more." READ MORE 22pm: Still giving the last client our very best "Together, we have great teamwork. Sometimes we're still working up to 10pm because we never chase out our clients. We’ll never close the place when we have a client inside. People come when they have no hope." READ MORE

After two years of struggling to conceive Brenda Abalo and her husband, Francis Opio, decided to visit Reproductive Health Uganda's clinic in Gulu. Much as there is progressive attitude to modern medicine in this northern Uganda region, fertility treatment remains a sensitive issue for both men and women. Anxious in the waiting room, Francis said he had decided to come to RHU with his wife because he heard their radio show about a similar problem. In addition to fertility treatments, the couple was also given counselling and treatment for another condition. “After sex, my wife was in pain. She was complaining a lot three weeks ago. I also felt some itches. They have given us treatment which we are still continuing with,” said Francis. The couple was given information to ensure that Brenda was in the best possible health to conceive. She is to undergo treatment to reduce the prolactin level in the blood and correct the hormonal imbalance. “This is not my first time at this clinic," says Brenda. “The service here is better in comparison with other health centres. They give much better attention to the patient.” “RHU has been supporting a lot of people. They helped a friend of mine; she was having a problem with miscarriage. So she came here and got properly treated” Follow a day in the life of our team and clients in Gulu, Uganda 07:00 08:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 22:00 Prev Next 7am: The team prepare for the long day ahead "Every year tens of thousands of Ugandans come to our clinic. Everyone is welcome. Here are just a few of the people that we served in one day last month." READ MORE 8am: Nancy, 19, becomes a volunteer "I was suffering but when I came here, I was treated and I got better. Now I'm inspired to volunteer here" READ MORE 9am: Monica, 25, a sex worker's story "I am sex working. I came here for Hepatitis B testing and also counselling. I have so many personal problems, but here….they’re so caring." READ MORE 10am: Jane, 23, saved by family planning "After multiple miscarriages, family planning here has helped me a lot. I'm glad we've been able to space the number of children we've had. I am not growing old, I am fresh." READ MORE 11am: Vicky, handling disabilities "I'm deaf so accessing services is hard, but here they really try to speak in sign language." READ MORE 12pm: Dorcus, first time patient "This is the first time I've ever come here, I like the service. They give good counselling so I recommend coming." READ MORE 1pm: Christine, 45, a grandmother's tale of living with HIV "I am living with HIV and had HPV. They treated me and now I'm free of cervical cancer." READ MORE 2pm: Lilian, struggling mother of six with sickle cell " I have sickle cell disease and so do all my children. I want to have my tube removed so that I don't get pregnant again but I don't know if my husband will allow it." READ MORE 3pm: Brenda and Francis get fertility treatments "Fertility treatment is a sensitive issue in Uganda but they help us a lot and we get proper treatment." READ MORE 4pm: Joyce, 25, repected regardless of her disability "I realised that at this place they don't segregate. Us people with disabilities have challenges at the main hospitals. You go there, people around look at you as if you are not a human being and you don't fall sick." READ MORE 5pm: Mobile clinic provides outreach services to remote villages "Our outreach to remote communities is a 'one-stop-centre'. We give family planning, vaccines for HPV, malaria, and Hepatitis B, HIV testing and more." READ MORE 22pm: Still giving the last client our very best "Together, we have great teamwork. Sometimes we're still working up to 10pm because we never chase out our clients. We’ll never close the place when we have a client inside. People come when they have no hope." READ MORE