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In the mountains of Kumera on Tanna Island, Vanuatu, the village women of Kamahaul normally spend over 10,000 Vatu ($83 USD) to travel to the nearest hospital.  It takes an hour to travel up the steep, rugged, tire-track terrain by car, but it takes two hours by foot - the normal form of commute for villagers.  Alani*, a 22-year-old mother of three, said that after Tropical Cyclones Kevin and Judy hit Vanuatu in March 2023, it has been even harder to travel to the hospital.  “After the cyclone, my crops were destroyed. I usually take my kids with me to the market and sell produce but after the cyclone, I do not have any money. If I have to go to the hospital for my 3-month injectable [contraceptive], I spend 5,000 Vatu one way, then 500 for medicine at hospital then I pay 5,000 Vatu to come back.” This is equivalent to over 100 AUD, which is unaffordable for most people like Alani.   Village spokesperson, Jimmy, said that the community is grateful for the Vanuatu Family Health Association (VFHA) as they are the first medical team to visit the remote community.  “I feel sorry for our mamas, they must spend so much money just to get medicine,” he said. “In our village, we have a lot of young single mothers and most of the time, trucks refuse to come up here because of the bad road. They must walk for two hours just to get to the main road, sometimes whilst pregnant, holding bags and their many children. This is why I invited VFHA to come here, so women don’t have to spend so much money and time just to get health services.”  The outreach programme was part of VFHA’s humanitarian response to the cyclone.  “We’ve been overwhelmed by the testimonies of hardships shared by the women in this community,” said Kalowi Kaltapangm VFHA Programme Manager. “Girls and women should not be paying over 100 AUD just to have access to sexual reproductive health services – it is not right. We thank Australia through DFAT for allowing us to reach more people post-disaster.”  Jimmy added that the community is grateful for the VFHA visit and hopes they set up a clinic in Kumera.  “After Tropical Cyclones Judy and Kevin, we lost about 21 homes across the communities here and most of the food crops are gone. If you travel further, you will still see some families still in tents. People are still rebuilding their lives and it's hard to rebuild if women fall pregnant again.’  The VFHA response team reached a total of 21 communities and more than 3,000 beneficiaries across Tafea Province. This included mobile outreach to 15 communities on Tanna Island, three communities on Futuna and three communities in Aneityum.   

“Very traditional.” These two words are often used to describe the people of Tanna in Vanuatu, one of the most populated islands in the small country in the Pacific.  Between 1 and 5 March 2023, the Vanuatu islands were hit by two consecutive Category 4 cyclones (“Judy” and “Kevin”) with widespread damage to the northwest and northeastern islands. Authorities report that some 250,000 people were affected, representing more than 80 per cent of the population.  Since 28 March, The Vanuatu Family Health Association (VFHA) has been conducting their humanitarian response on Tanna. Team Leader, Enneth Ilaisa, said that they are very surprised by their breakthrough with communities - especially with the men.   “Tanna is known to be very traditional, even in the past it was almost impossible get access to these communities to talk about sex, but now it is slowly changing, and we are surprised. In our recent field visits, we have seen men step forward bringing their wives and even their daughters to get family planning!” says Ilaisa.  Levi, a 47-year-old father, said that he brought his daughter to the VFHA site to get Jadelle [a long-acting contraceptive] because he does not want his daughter to fall pregnant.  “After the cyclones, I saw pregnant mothers walking to the hospitals for check-ups and I told myself that I do not want that for my daughter. I do not want her to suffer if the boy runs away. Some men were talking about VFHA, and I was surprised that even though most were hesitant to get family planning for their daughters because it meant that they were able to have sex, they also did not want their daughters to suffer,” says Levi.   Ilaisa added that they have seen more men step forward due to their work with community chiefs to ensure men attend the information sessions.  “We talk to the men too, we educate them. Then after they go to nakamal (a traditional meeting place in Vanuatu used for gatherings and ceremonies), they tell all the men about what they learnt. I believe because people are still recovering from the cyclones, men have seen the firsthand challenges of women getting pregnant and the hardships of looking after a pregnant woman when you have lost everything after a cyclone. “  31-year-old Rose, from Kumera, said that she is surprised her husband advocated for her to get family planning.   “I can’t thank VFHA enough, my husband, who previously accused me of cheating when I told him I wanted to get family planning, is the same man who now wants me to get family planning. I thank VFHA for also speaking to the men as they are usually the problem when it comes to family planning!” says Rose.  VFHA Programme Manager, Kalowi Kaltapang thanked his hardworking humanitarian team for their perseverance in breaking down barriers of sex in communities, but most importantly, the great support from DFAT in funding the humanitarian response.  “It's always been tricky to engage men in these spaces, but I thank DFAT, IPPF and the hardworking VFHA humanitarian team, who are steadfast in their mission to ensure that everyone has access to SRH services.”    

Girls and women from nearby villages flock to mobile health clinics set up by the Vanuatu Family Health Association (VFHA). The response team from VFHA consists mostly of women, who have already been away from their families for over six weeks. Team Leader, Enneth Ilaisa, mentally prepares her team for the long day ahead.  The 12-member team, consisting of nine women and three men, have been conducting community outreach on Tanna Island, Vanuatu since 28 March 2023, as part of their humanitarian response to Tropical Cyclones Judy and Kevin, which tore through Vanuatu.   “Our team consists of nine mothers who have left their families to provide these essential services to vulnerable communities. When people visit us, we must put on a happy face to make them feel welcome but sometimes it gets hard,” says Ilaisa.  Ilaisa said that the women in the medical team have been away from their homes for so long that their husbands would sometimes be overwhelmed with looking after the children and often would call the women on the team ‘selfish’ for choosing to leave their families.  Sexual and reproductive health nurse, Cindy Mahi, said she sometimes feels bad for leaving her partner alone to look after the children. When she sees clients with their children, she says she feels homesick.  “I call my family every morning, and sometimes my husband complains about me being away – and it really hurts, especially if I hear my children in the background asking when I will be back. I feel so guilty sometimes as a mother!” says Mahi.  Ilaisa added that the stress from leaving their families is compounded by an intense working environment delivering vital sexual and reproductive healthcare to remote communities.  “Our work is such that we leave our accommodation before sunrise and return after sunset. People are very tired and sometimes we are so busy helping clients that we often work through lunch to ensure we help everyone,” says Ilaisa.  Mahi said that these are things people don’t see when they come to receive services.  “When women come to see us for help, we put on a warm smile, but they do not know about the hardships we face. They do not see what is running at the back of our mind.”   Ilaisa said when it comes to the mental health of the team, she ensures she is creating a safe space where her team members can openly share.  “I offer counselling to them, and I encourage them to share the important work that they do in the field with their husbands, so they know exactly what they do. I sit there and listen to them and sometimes we cry together.”  Ilaisa said that apart from counselling, she encourages the mothers to practice self-care by taking the weekend off and making sure they take adequate breaks throughout the day.  “I tell them, if you feel you need to take a break in the middle of work – do it! When we debrief after our field work, we share the numbers of women who received SRH services, and the feeling of accomplishment is what makes our work worthwhile. When we hear these numbers it reminds us of our purpose, it reminds us of why we are here, and for a second, our family problems fade away because we know we are serving a purpose greater than ourselves.” 

Provision of sexual and reproductive healthcare for all, regardless of age, is at the core of Famia Planea Aruba’s (FPA) work. Over the years FPA has developed different information packages specifically aimed at reaching and supporting young people, families, and educators.   The inspiration for delivering comprehensive sexuality education digitally to young people was propelled by the COVID-19 lockdown. Like other frontline healthcare providers, FPA was faced with unforeseen challenges about how to continue reaching their communities. Undeterred, the team embraced the challenge to create, develop, and launch FPA’s first Online Puberty Educational News Program (OPEN).   Responding to clients' needs digitally  “In the last few years, FPA’s in-school Comprehensive Sexuality Education (CSE) program was growing rapidly, and then all of a sudden we hit a wall; our Island was in complete lockdown and all schools were closed. At first, we were very sad, since we were fully booked for the upcoming few months, and would lose the opportunity to reach thousands of young people”, says Evelyn Yarzagaray, FPA’s Executive Director.   Typically, during April and May FPA usually focuses on students between the ages of 11 and 13 and supporting with the transition from elementary school to secondary school. At this age young people are starting to experience changes to their bodies and hormones.   “We were all of a sudden bombarded with parents who started requesting one-on-one counselling sessions for their kids, but due to safety regulations this was not an easy option. That was when we started looking for a way to reach both parent and child in the safety of their own homes. By converting materials used during our in-person CSE program, we developed an educational video that can be viewed by both parent and child”, says Evelyn.  The OPEN platform has been designed with a colourful background, emojis, and animation to appeal to its target audience. Users can access valuable information through the FAQ section, international news, and video content such as an interview with a Family Physician.   “The filming and editing were the longest and most difficult part of the entire process, but once it was launched, we immediately saw that is was completely worth it, reaching over 42,000 people on social media”, Evelyn says.  “I know it's all part of the growing up process”  Jeanira, 37, is a doctor’s assistant and has two young children aged two and 12. She has been a member of FPA for many years, but only recently learned that FPA provides healthcare for all ages and stages of life – particularly young people.   “About a year ago I had begun researching the best way and time to start talking to my daughter about her upcoming body changes, sexuality, and puberty in general”, explains Jeanira.  It was a family member who suggested the FPA video on social media about puberty that was in Jeanira’s native language.   “The video is fun, educational, featured local professionals and related to my daughter’s age. I love the fact that I could introduce the video to her and let her watch it in her own comfort zone. At the end, it did stimulate conversations and questions for a few days after and it truly made it easier for us to talk about some of the topics that can sometimes be a little hard to approach”, says Jeanira.  11-year-old Xiqiën really enjoyed the video: “My favourite part was to be able to recognize some changes that I am going through right now. There are some changes that I would like to skip but I know it’s all part of the growing up process. I’m so thankful that FPA had the idea to make such a fun video for us to learn from. There was some stuff that I already knew, but I also learned some new things. I did ask my mom a lot of questions after the video, mostly because they said that everyone is different, and I really wanted to know how my mom is different from me. I don’t feel quite as worried to talk to my mom about these things anymore, I know that she will try to help.”    

Accessibility to information and contraceptives has always been a priority for Famia Planea Aruba (FPA) – whether through the office, delivery service, or in schools.   For over 15 years FPA has worked in partnership with one of the largest secondary schools on the island. The FPA team visits the school every month to provide guidance, counselling, and contraceptive care to students, and to help ensure they stay in school to complete their education.   “One of my first experiences providing comprehensive sex education with FPA was at the EPB School, during my education as a social worker. Many years later I still very much enjoy this”, says Richenella, FPA’s Finance and Information, Education and Communication (IEC) support staff.  Building trust  FPA’s client is at the heart of its healthcare provision. The FPA team works with students to build trust and ensure they feel safe to talk openly. This helps to provide a sense of consistency for the student, as well as efficiency for the team being familiar with specific students and cases. They are better able to notice if something changes, and if a student needs a referral to a medical doctor or other organization for additional treatment.  “The consultations are always fun; you get a change of scenery by stepping out of the office. Over the years you see so many faces and still somehow you manage to remember most of them. After just a few visits you can start to build a profile of most students; you can start to tell who the class clown is, the Mister Popular, the shy one, the loud one, and the one who just wants to take his time to avoid going back to class”, Richenella laughs.  Working in partnership with the school social worker   FPA places great value on the 14-year relationship they have with Adriana, the social worker at EPB San Nicolas School. Adriana is the person who has the most contact with the students, and the one most student’s turn to when they need help.   “Most of the time you get to have fun with the students, however every now and then you will come across a heartbreaking case. Since Aruba has so many different migrants, very often you will come across one person who is not insured at the moment, who needs products and can’t afford it – and you figure out a way to help”, Adriana says.  For registered youth under 21 years of age, the costs of the healthcare provision are covered by the national health insurance, however, some students fall outside of the system.  “For our second, third and fourth-year students, FPA has been collaborating with us to provide a monthly session where the students receive contraceptives and guidance on school grounds. Since around this age, most of our students are already sexually active, we try to help them stay safe in and out of school.”  “The love, patience, and dedication that FPA has shown our students over the years are outstanding. At the beginning of the COVID-19 crisis we had to stop the consultation hours, but thankfully we are now back at it, bigger and better. Due to the collaboration with FPA we were able to finish out our 2018-2019 school year with no new pregnancies, which was a first for our school. We hope to accomplish this again, now that we can continue our consultations, and keep our kids educated and in school for as long as we can so they can achieve the best possible future”, Adriana says.   

When Famia Planea Aruba (FPA) saw a gap in the market, the team developed an online contraceptive store and bespoke delivery service to better reach their clients. The online store is available in the local Aruban language, Papiamento, and has been designed to provide quick access to various contraceptive methods, with supporting information to help clients make choices based on their needs.   Ghislaine, Head of Information, Education and Communication Support at FPA has been managing the delivery service since it started in August 2018.  “Since the start of the delivery service in 2018, our clients were enthusiastic however, the usage started slow. I believe this was due to the unfamiliarity, and people were still in the transition phase to online services. Moreover, clients believed that the delivery transportation would have been in a car, completely covered in images of condoms, sperm cells and pills, which made them sceptic of using the service due to embarrassment”, says Ghislaine.   The site is accessible to both FPA members and non-members who can shop in privacy for their contraceptives and schedule a delivery. Orders are delivered by FPA staff with clients having the option to pay cash or debit upon delivery. To ensure a clients’ privacy and confidentiality orders are delivered discreetly.  Challenges and opportunities  As with any new service comes challenges as well as opportunities. “Some of the challenges we face are the overload of deliveries on one day.” Even though Aruba is a small island and there are traffic jams only at specific hours in the day. “Sometimes I get stuck in traffic and try to rush myself to deliver the products in the time slot and at times I find myself in places that I barely recognize and discover new locations.”  “The part I enjoy is the communication with the clients. Building a relationship with the client and vice versa provides a smoother transition of service but also provides the comfort and safe feeling for the client.”  Ghislaine says the service often calls for more than the delivery of contraceptive orders, as clients may have questions or need support about their health.  Personal and convenient healthcare  Damara is a data analyst and a member of the Sustainable Development Goals Commission. She started using FPA contraceptive delivery service a year ago.   “It definitely has made my life much easier, especially when I have a busy schedule. With the delivery service I simply order my products through the online store and choose the date and time that is most convenient for me”, she says.  Damara values the personal service and the convenience of paying by card and choosing a preferred delivery time. “I love this service because sometimes I place an order a few days before and the employees at FPA call to confirm the order the day of the delivery, which is great because it is like a personal reminder! The best part is that they also have a portable ATM machine. I get my products, guidance and have it delivered to my location, what more can you ask for?”  FPA’s bespoke healthcare delivery has seen a successful growth since it started, with an increase of 115% during 2019 and 170% in 2020. “There has been an immense increase in the service in 2020 due to the pandemic. We already had the service in place, so we just had to fill in the gaps; for example, providing more hours and dates for clients to make use of the service”, says Ghislaine.  Hilyann, a journalist, is another regular user of the online store. “Shopping on the FPA online store makes me feel very in control and empowered. I hope that more people of all ages take advantage of this service. I hear far too often that people say they don’t have time, nobody has actually, but FPA is there for you. Take control of your sexual and reproductive health, empower yourself, be the boss of your time and your body.”   

Julie was a midwife with the Ministry of Health for 20 years before she joined the Vanuatu Family Health Association (VFHA) as nurse and project manager for IPPF's SPRINT Initiative response in Vanuatu. When Cyclone Pam hit Vanuatu, the SPRINT Initiative and VHFA started providing life-saving services to the Island, Tanna, which was the population worst affected by the typhoon. Many communities there live remotely, in grass huts, with no immediate access to medical care.  Julie was there with the VFHA team. “When I first came here we used the kitchen to operate from. On my second trip, we created a clinic in our youth centre, and used the nearby health post for clinical procedures. Soon we saw more patients pouring in, which created a huge demand for space." Health conditions are very low. Even before the cyclone hit the island, it was reported that the average mother loses two pregnancies each, in her lifetime. Every person in the village knows at least one mother who has died during child birth. Access and knowledge to family planning is overlooked as traditional practices are used first. As Julie explains, advocating about family planning is a challenge in the area, also for language barriers. “Talking about birth-spacing and talking in the regional dialect of Tanna is a problem. Most of us in Vanuatu speak Bislama, but people here in Tanna aren’t well versed with it. However, we try our level best with all possible methods including sign language and demos to impart knowledge about family planning.” Family planning services are just a part of the IPPF-SPRINT Cyclone Pam response, that also included general health check-up, counselling and awareness about Sexual and Gender Based Violence, maternal care and awareness and prevention of HIV and Sexually Transmitted Infections (STI).  

Cyclone Pam, one of the most intense storms of the South Pacific Ocean, caused widespread devastation in Vanuatu’s southern provinces of Shefa and Tafea in May 2015. The International Planned Parenthood Federation (IPPF) through its humanitarian wing, the SPRINT Initiative, supported the Tropical Cyclone Pam affected population by providing them life-saving sexual and reproductive health (SRH) services through the Vanuatu Family Health Association (VFHA), a Member Association of IPPF. “The IPPF-SPRINT and the VFHA team walked for more than 2 hours to Labasilis Community Village in North Tanna, Vanuatu. It had rained continuously the previous night, hence it was impossible to use the 4-wheel drive transport and the team made the entire trek by foot, carrying all the medical equipment! We passed a few small settlements on the way, and in one village, Dr William, a MOH (Ministry of Health) medical doctor who had volunteered with VFHA for the mission treated a young man with a chest infection and a lady with musculoskeletal pain. “There was no such thing as a clinic or shelter, and the makeshift table was on a piece of zinc on the ground, where the medical bag was opened,” explains Subatra Jayaraj, SPRINT Regional Manager, The International Planned Parenthood Federation-East & South East and Oceania Region. After crossing the peak of 3 hills, the team arrived at the Labasilis Village and set up clinic in a tent that had been provided to the community by UNICEF. At least it provided shelter from the storm outside. “It had rained heavily the previous night. However, we started early to reach Labasilis. We started walking slowly. Maintaining one’s balance in the slippery muddy road was a real challenge, everyone decided to walk bare foot – walking though the bush was also preferred for better grip. I was relieved to learn that Tanna soil does not have insects or snakes- may be due to volcanic sand deposit. Many of us slipped or almost slipped couple of times. Each time one team member slipped it was counted as one point and if one almost slipped, then half a point is scored. Need not to mention, that we all contributed towards quite a good score for the team. The scenery was indeed beautiful, but continuous rain and the slippery road kept us focusing on each step we took forward,” said Aditi Ghosh, Acting Director, IPPF-SPRINT Initiative. Thanks to IPPF-SPRINT and VRHA, we served four communities via three outreach mission in the Tanna Island, providing Sexual and Reproductive (SRH) services, including HIV/STI and Family Planning services, Maternal, Obstetric and Neonatal Health Care.