Stories

Five years ago, when Arnilda Simango was 13, she started dating a boy from her community, outside Xai-Xai City, in Gaza Province in southern Mozambique. A year later she got pregnant, at his insistence, and he left her shortly after the baby was born. AMODEFA’s youth services offered her counselling and advice throughout her pregnancy and became the network through which she made new friends.  Today, at the age of 18, she is raising her son, with help from her mother and plans to return to school. “When I started dating, I thought I wanted a partner who could take care of me and that could maybe fill the void I felt for not having a father. When I started the relationship with my boyfriend, he insisted that he needed a son because all his friends already had one. I had little space to say no because he threatened to date someone else and I was convinced he was the right person for me. When I got pregnant in 2016, he started behaving strangely. He stopped being affectionate and gave indications that he did not want to be with me anymore. That's when a friend of mine told me that there was a youth center where I could get advice on how to proceed in this situation". The Adolescent and Youth Friendly Services (SAAJ) center, based at the Patrice Lumumba Urban Health Center, on the outskirts of Xai-Xai, is run by AMODEFA and provides HIV testing and treatment, prenatal and postpartum consultations, and other information and services around sexual health and rights. The center is supported by the Women’s Integrated Sexual Health (WISH2ACTION) programme, led by IPPF.   "One day I walked there and received a lot of advice. As I was already 4 to 5 months pregnant, I was advised to open a prenatal form. They did all the follow-up until I gave birth to my son.” "Believe me, being a single mother at 14 was a suffocating experience and it could have been worse if I had not been accompanied by [the SAAJ]. I do not know how to thank them. I practically felt alone without knowing what to do, but I had a lot of advice here and made friends with other girls". Planning for the future  Arnilda dropped out of 7th grade once she became pregnant and helped her mother selling basic goods from a stall in her home. It is from this small business that her mother supports her two children who are still living at home, as well as five grandchildren. Arnilda plans to return to school next year to continue her studies now her son is old enough to stay with his grandmother. Her dream is to be a professional model. Until then she does not want to have another child, so she goes to the SAAJ for family planning purposes. Arnilda says she walks 50 minutes to the center every three months for the contraceptive injection.  "I wanted the implant, but it doesn't settle well with me, so I renew the injection every three months.  I do this because I need to continue studying to have a decent job that allows me to support my son. Next year I will go back to school. "A second child is not in the plans. I still consider myself a minor. Even the first child I only had because at the time I had no one to give me advice and show me the best way. I believed in my ex-boyfriend and today I have this lesson. Today I can say that I have come to my senses, not only from the experience of being a mother, but from everything I learn here [at the SAAJ]. There is no friend of mine who does not know SAAJ. I always advise them to approach here because I know they will have all kinds of counselling and accompaniment.”

In May 2017, flash flooding in Sri Lanka triggered landslides resulting in many people losing their homes, forcing them to seek shelter in camps. IPPF’s member association the Family Planning Association of Sri Lanka (FPASL) assisted those affected and provided health camps with the support of IPPF Humanitarian. Chathurika Jayalath, a youth volunteer for FPASL, took part in the response. Chathurika is a 24-year-old student from Kegalle, a large town about 80 km from Colombo, and she has been working with FPASL for the last three years. She started out as a youth volunteer and recently became a member of the Youth Technical Advisory Committee. During her engagement with FPASL, Chathurika has learned about sexual and reproductive health and rights (SRHR) and gender issues and has organized workshops on similar topics in her own community. In fact, she runs a youth club at her university to inform her peers about SRHR.  Shortly after the floods began, Chathurika received a WhatsApp message from FPASL where they called for youth volunteers to take part in the response.  “I wanted to volunteer during the response,” Chathurika told us. “As a university student I didn’t have money to donate so I figured I could contribute with my strength instead. I volunteered in the health camp. There, I assisted the medical staff with basic things such mobilizing affected people, making sure they queued up when seeking health care and packed medicine.” Ongoing SRHR needs, even in a crisis Chathurika is keen to learn more about humanitarian work. She received training with FPASL on the needs of people in humanitarian settings in which she and other trainees were presented with different case studies. “There was particularly one story that struck me. We were told that when the flash floods came, women fled without anything, they fled with the only pair of clothes they were wearing,” recalls Chathurika. “When they reached the camp, they received donated water and food. Some of them got their period while living in the camp. They did not have any sanitary pads nor additional cloths. Some of them even fled without underwear. This story made me realize that people’s SRHR needs don’t disappear just because there is a crisis.” Youth empowerment is important to Chathurika and she would like to continue this work while learning more about development and humanitarian work. She is a firm believer “that young people can contribute. Through my own experience I have seen that it is possible.”   

Marinho, 30, works as an activista for Amodefa’s Challenge TB programme, bringing treatment to remote villages in the Ribaué district of Nampula. Since August last year he has identified 84 cases of TB in the eight communities in which we works; “75 patients are in treatment at the moment, the rest are recovered,” he says. Before Amodefa started work in Nampula, Marinho says, “people were dying because they couldn’t reach the hospital, but with this programme it is becoming easier because we bring the medication to the patients.” However, lack of transport means it is a challenge for him to keep on top of all his cases. “The distances are far and the few bikes we have are breaking,” Marinho says. Yesterday he travelled 40 km to visit his patients. Some of the communities he visits are up to 50 km away. In the first quarter of this year 1,318 people were tested for TB in the eight districts where Amodefa operates; in the second quarter, 2,106 were tested; and in the third quarter, the number reached 3,154. More than half of these people were diagnosed to have TB. The surge in the number of people going for tests is in a large part due to Amodefa’s ‘Day of the Cough’.  On the 27th of each month teams of activistas and volunteers go into communities, schools and jails to educate people about TB.   Before volunteers had to go from house to house to identify patients, “but now, with the lectures, it’s easy to find people who are TB positive because they are identifying themselves,” says Marinho. Children are particularly receptive to Amodefa’s message, Marinho says. He remembers one woman who had been sick for a long time and her daughter, knowing he was an activist, sought him out. The patient’s initial test for TB came back negative, so she was given alternative medication.  “She took the tablets but she was still sick - she was unable to walk or to eat,” Marinho says.  “We brought her here to the clinic, examined her and she immediately started TB treatment. Now she has started her recovery and is able to sit.” Lessons taught during the ‘Day of the Cough’ means communities are also now taking greater precautions against the disease, he says. Steps such as opening windows, cleaning the house, not eating from one communal bowl, and practising ‘coughing etiquette’ have all helped limit the spread of TB.  “People understand now and are taking serious measures to prevent it,” Marinho says. However, the US decision to withdraw funding from Amodefa following the introduction of the Global Gag Rule , could halt the Challenge TB programme just as it is gaining momentum. “If the programme stops the people will suffer,” says Marinho. “For people who live too far from the hospital to receive treatment, this programme saves their lives. Knowing Amodefa has come to eliminate TB, it can’t stop. If they stop now the TB will get resistant, so we’ve got to keep going, we’ve got to get stronger.”   SUPPORT OUR WORK WITH A DONATION

Antonio Junior Xiranza is 12 years old. He lives with his Aunt Talita Agosto Mujovo, 39, and her three children in Maputo, Mozambique, after his parents both died from HIV-related illnesses. Antonio is HIV positive, something that Talita was able to reveal to him over the course of nine counselling sessions through IPPF Member Association AMODEFA’s Ntyiso programme. When Antonio was sent to Talita in 2015 he had no understanding of his illness. He was severely underweight and wouldn’t take his medication. “I didn’t think he was going to make it,” says Talita. But following AMODEFA’s intervention last year Antonio’s health has improved rapidly and is gaining weight. This is in large part because Antonio, though still young, has chosen to take on the responsibility for managing his illness himself.  “He takes his medication without being told”, says Talita. “If he’s injured he knows the other children can’t touch his wound.” Antonio is still small for his age but says he feels stronger. He is well enough now to attend school regularly and is already thinking about the future; when he grows up he wants to be a fireman.“I am happy about life here,” he says, shyly. Talita says she is “relieved” to see these changes in Antonio. “At first I was not going to say anything. I would have waited until he was 18 to tell him,” Talita says, which would have continued to put pressure on the entire family. “But with the help of the counselling I had through Ntyiso I was able to tell him now.” While Ntyiso was intended to help parents speak more openly about HIV with their children, it has given Talita the confidence to discuss the illness more widely. “I was able to tell my father, who was sick and had a wound, that he should get tested for HIV,” she says. Her father was diagnosed positive and is now in treatment. “Before I wouldn’t have advised people to take the test, I would have just kept quiet,” she says. Read more about AMODEFA's tireless work in Mozambique

Albertina Machaieie has been working with HIV patients for Amodefa for 38 years and is their longest serving nurse. “I’m going to work forever,” she says. “I like helping people, that’s why I do this job.” Albertina heads up Amodefa’s home care programme which provides medical, nutritional and emotional support to HIV positive patients living in the poorest suburbs of Maputo, the capital of Mozambique. She has seen a dramatic change in attitudes to HIV in the 19 years she has been running the service. In the past she had to hide her car and would visit her patients anonymously. “People feared HIV so they feared me coming to them,” she says.Now people welcome her into the community as a friend and will direct new patients to her. “They call us ‘Muhanyisse’”, which means saviour in the local language Shangaan, she says. Albertina and another nurse work with a large team of volunteers, or ‘activistas’, most of whom are also HIV positive. As well as delivering medication and food to patients and performing health examinations, an important part of Amodefa’s work is continuing to change attitudes towards HIV. “The homecare project encompasses everything,” she says. “It’s not just treatment for illness, we also work with the mind – people need to change their mindset.” She and the activistas give lectures in the community to raise awareness of HIV, and also offer counselling to patients, many of whom find it difficult to accept their HIV positive status. “Husbands and wives stop understanding each other when one is living in denial of HIV,” says Albertina. “They blame the illness on witchcraft.” In other cases, those carrying the virus are scared to tell their families for fear of being rejected. “There are many stories of family members, particularly of wives, who have found they are HIV positive and partners have threatened to leave,” she says. “But when Amodefa has stepped in and advocated, the husband has stayed.” This holistic approach to its homecare has been so effective that medical and psychology students have come from Brazil, the US and Mexico to Mozambique to study the programme and to learn from Albertina’s experience. “I am the library for Amodefa,” she jokes. Over the course of her career Albertina has worked with many challenging cases – particularly men. “Women are more open to treatment because they want to get better so they can care for their children,” she says, “but men often won’t seek help until their health has severely deteriorated.” She recalls one case where a woman tested positive for HIV while she was pregnant. She told her husband to get tested but he refused, and he also prevented his wife from taking any treatment. As a result her baby was born HIV positive - as were her second and third born. “With her last child she started taking the treatment without her husband’s knowledge and the baby was born without HIV,” says Albertina. “This man now says, ‘People, you need to be open – I have three positive children and it is my fault because I would not accept the truth.’” “Children who are HIV positive and don’t know often abandon their medication because they are tired of taking the drugs,” says Albertina. “Ntyiso teaches the importance of taking the medicine. When they are aware of their status, they start taking the medicine normally.” Albertina worked with ten families during the pilot phase of the programme. “Already I have seen great changes in the children, it shows why this project of revelation is so important.” The Ntiyso is a pilot project implemented in Maputo City and it has its focus on disclosure of the HIV + status to adolescents. It targets mothers, parents and caregivers of adolescents. The main activities are: Education and training of Mothers, Parents and caregivers of adolescents to reveal HIV+ status to their adolescents. Due to the Global Gag Rule this project lost its funding and was forced to close.

Palmira Enoque Tembe, 54, is HIV positive She lives with two sons, who are also HIV positive, and four grandchildren in a small house in Bairro Feiroviaro on the outskirts of Maputo. Three times a week she is visited by Amodefa volunteers and once a week by a nurse who provide medication, food and therapy to the family. “Amodefa counsels me through the difficulties in life,” Palmira says. Palmira found out she had HIV when her youngest child was nine months old. He was diagnosed as HIV positive. Palmira asked her husband to get tested too,“He refused” says Palmira. “He said I was possessed by evil spirits and was trying to kill him and my son". Her husband abandoned the family and Palmira was left to battle the illness and raise the children on her own. “I was terrified. I lost hope. I didn’t want to do anything, just sit in my room and cry,” she says. Now, however, the nutritious food, medication and regular medical check-ups she receives as part of the homecare programme have given her a new lease on life. “I’m fine and I am making plans for the future. I know now to get ill is not to die,” says Palmira, who has started to subsistence farm again. At first she was wary of the service. “It seemed like an advertisement for having HIV and I didn’t want my neighbours to isolate me,” she says. “But now I depend on it.” It was through Amodefa’s new pilot counselling project, ‘Ntyiso’ - which translates as ‘The Truth’ in the local language, Shangaan - Palmira was finally able to open up to her son that he had HIV too. While he had always suspected he was carrying the virus, he needed to hear it from his mother for it to become real.“It has changed by life,” she says. “It has improved our relationship because I no longer feel ashamed.” The Ntiyso is a pilot project implemented in Maputo City and it has its focus on disclosure of the HIV + status to adolescents. It targets mothers, parents and caregivers of adolescents. The main activities are: Education and training of Mothers, Parents and caregivers of adolescents to reveal HIV+ status to their adolescents. Due to the Global Gag Rule this project lost its funding and was forced to close. Read more about AMODEFA's tireless work in Mozambique

Prijani and Chandana were forced to flee their home during the floods of May 2017 in Sri Lanka. They didn’t have time to take any belongings, so ran with their two small children. After the floods, they attended gender based violence training run by Family Planning Association of Sri Lanka, where they learned about child protection needs. “We weren’t informed that the floods were going to come, but when the water reached our knee level we knew we have to move. We just took the kids and left” says Prijani. “I was worried about two things: my kids, as we were staying at a camp in the school, and losing my house. I allowed a workshop run by Family Planning Association of Sri Lanka to be held in my garden as we had the most room. There I learnt a lot about child protection the teacher gave a lot of examples of child protection and what can go wrong. We learned about sexual violence that kids face from older people”. “One day, I saw my son masturbating and I asked him how he knew how to do that, and that’s when he told me about what happened at school. The workshop taught me to look out for these signs” says Chandana, who is planning to report the incident to the school when it re-opens. “I never thought the issue was that bad. Now, we are a lot more attentive to our kids”.   Stories Read more stories from Sri Lanka

Nimal* and her family were asleep when the floods came into their house on the 27 May 2017. She and her husband took their young children to safety upstairs. Since the floods, Nimal and her family attended the clinic set up by The Family Planning Association of Sri Lanka (FPA-SL), and received medical care and gender based violence training. This training to families enables them to openly talk about issues that can help provide a safer environment for themselves and their children. "We were all sleeping in this house when the flood came in the night," Nimal recalls. "When we woke up we were surrounded by four feet of water in the house. Our van and bicycle were damaged. We specifically constructed this house to be flood resistant, but this flood was higher even than that level. We took the children and mattresses upstairs to be safe." "We found out through word of mouth about the The Family Planning Association of Sri Lanka (FPA-SL) clinic. I went two to three days after the flood to the clinic, which was being held out of a temple. My children were treated there as they had a cold from the flooding. I was also treated as I kept fainting." "I attended the training on Gender Based Violence awareness with my husband, and learnt a lot about parenting adolescents, and how to prevent domestic violence between a husband and wife. For example, by avoiding alcohol and to openly discuss our problems. It’s good to have this knowledge before my children reach adolescent age so I am prepared." *names have been changed at the request of the interviewee  Stories Read more stories from Sri Lanka  

Incessant rains across Sri Lanka during May 2017 affected over half a million people in seven districts. Most affected was the Ratnapura district where over 20,000 people faced flash floods, and where 46 deaths were reported. IPPF Humanitarian, in partnership with FPA Sri Lanka, responded to this catastrophe through the distribution of over 700 dignity kits in Ratnapura Dr. Rohan Jayasuriya and midwife Chaturika Lakmale were on the ground during and after the floods providing family planning services and contraception to women affected by the disaster. “When the floods came our clinic was located on higher ground, so it wasn’t damaged. The floods finished on the 31 May 2017, and we reopened one day later on the 1 June 2017. After the floods, we arranged several special clinics just for family planning, and distributed condoms and emergency supplies of the pill to camps in case women missed their regular form of contraception like injectables, implants or IUDs. In Sri Lanka, approximately 67% of couples use family planning, 26% of which prefer IUDs” We offered condoms and emergency supply of the pill. We told women to keep one packet of the pill in their handbag, and one in their home, should they ever have to run quickly in an emergency. One pregnant woman was delivering at this time, so she had to go on a boat to dry land, and then onwards in a vehicle to the hospital. Once we reopened the clinic, two of our own midwives were unable to attend work as the floods had affected them, but I was here. It was so busy.” Stories Read more stories from Sri Lanka

Incessant rains across Sri Lanka during May 2017 affected over half a million people in seven districts. Most affected was the Ratnapura district where over 20,000 people faced flash floods. “When the flood came, my husband was feeding my eldest child and the baby was asleep in the bed. I was outside of the house. My mother was brushing her teeth outside the back of the house. I looked up and saw trees falling near my neighbour’s house up the hill. My neighbours died. I couldn’t take any possessions – I just had to run for my life. My husband took my younger child. They were all screaming. Since then, I have had my children checked here in the Ministry of Health clinic; their weight, height and nutrition. We had two houses on the one block of land, but we will only get compensation for one house. We can’t live in a tent with a baby so are currently renting a house with our own money, but for a while my mother and father slept in this clinic.” Stories Read more stories from Sri Lanka