Stories

"One day, when I returned from work, Ms. Glenda and Mr. Martin from Pro-Familia were at my house. I heard what the volunteering was about, regarding the education of the men in the community, how to teach how to stop machismo, to be less violent, how to give the talks and visit the clients. They also talked about the contraceptive methods, medicines and many things that would change people's lives. The proposal seemed important to me and I accepted, since I like to work for my people," recalls José.  In 2008, the Asociación Demográfica Salvadoreña (Pro-Familia) developed a project focusing on sexual and reproductive health and the active participation of men in rural areas. It concentrated specifically on the integration of male participation in sexual and reproductive healthcare. Since 2014, the project has been integrated into the Community-Based Programme as part of the provision of healthcare for rural men.  "When I gave the talks on masculinities, they questioned me: 'Why can't you scream at home, if you're the man?' Or 'who do you think you are to say those things?', questions that I also asked myself once", says José. "Thanks to the training I have had and the support of the Pro-Familia staff, I have managed to learn and clarify my doubts. I take care of my own health, I share the responsibilities at home, I take care of my two-year-old son – before volunteering, I thought it was a woman’s job, I didn't do that."  Ensuring access to information and contraception   Educational activities in sexual and reproductive health remain a challenge, but Pro-Familia is committed to delivering their strategy. The role of the health promoter is to advocate – with other men – the use of contraception, counselling couples, and providing supplies (especially condoms) and medicines.   "I like the communication I have with the Pro-Familia staff, and the training reinforcements – they should keep it that way, because it's the way to learn and do things better in the community," he says.  "The change begins with oneself and then transmits it to others. I gather men in talks, make visits to their homes, give guidance on prevention of sexually- transmitted infections, on family planning, and how not to be violent", says José. "Older adult men are more difficult to change."  Increasing contraceptive use among men   José has seen the positive change among men in his community and those small achievements encourage him to keep going. "When men ask me about violence and condom use, I feel encouraged. For example: a co-worker uses a condom and confidently tells me that he does it because he learned from the talks he received, that motivates me to continue guiding towards new masculinities."  The Community-Based Program has a special fund for clients who are referred by promoters for a voluntary surgical contraception (VSC) procedure, so the service is free of charge for clients. In this regard, José is aware that there is still work to be done: "The issue of vasectomy is difficult with men in the community, the challenges continue."  "In the community, young people 'get to live together' [marital union] at an early age. Maybe I cannot change that, but I can help them to be better people, to respect each other. Just as I changed, so can other men," says José. 

"I decided to become a volunteer at Pro-Familia when I heard a talk the staff were giving at the Acajutla City Hall, where they explained what they were doing in the communities with the program, and they invited us to be part of the volunteer service. I liked what I could do with the men in the community. It’s been two-and-a-half years." Juan Martinez Leon is a volunteer with the Asociación Demográfica Salvadoreña (ADS/Pro-Familia) community-based programme. Juan’s remit is broad, working mainly with men to provide information on contraceptive methods and counselling to individuals and couples. He also provides contraceptive methods including the Pill, injectables and, especially, condoms. For some hormonal contraceptive methods, Juan refers his clients to Pro-Familia clinics or other public health facilities. Putting community first "I like to work for my community, despite the difficulties, and I help in four more communities for them to have the [contraceptive] methods and medicines, because they come to get me," says Juan. "I give talks on the soccer field in front of my house or I have meetings at my house. My children help me invite men to come and they also learn and admire the work." Juan visits clients at home and organizes talks – mainly with other men – to promote the importance of contraceptive use, and women and children's health. The importance of men’s health and their family group is a key element in Juan's role as a health promoter. “I like providing family planning counselling, because sometimes men don't like women using anything to prevent pregnancy. When I talk with the men of my community, people's lives change and you see the difference: you no longer see the domination over women, they let women plan, and [the woman] no longer requests the method secretly – although there are still some women who hide from their husbands. That's why we have to continue working on counselling, that's what awakens them." Changing behaviour and attitudes Juan runs informative talks on reproductive health and the prevention of STIs and HIV. "In some talks, some men have come out angry and questioned me. Who am I to tell those things? ‘Someone who has learned and who respects people's rights,’ I tell them. Now men come to ask for condoms, and even my wife confidently gives the condoms to them. She also supports me." Some men thank Juan for having "awakened their minds", and encouraged them to change to respect women and to help at home. “I think I help my community a lot. You wake them up. I like what I do, I like to help. Before there was no promoter and they had women submerged. Little by little that is changing, but only by talking to men is it achieved. I want to continue learning about sexual and reproductive health issues, it never ends. I would like to continue in training as we used to before the pandemic, and for Pro-Familia to come more often. Until God tells me, I feel that it is my obligation to attend to men or whoever seeks me to help them. That's what I'm for.”

"I started as a Pro-Family Health Promoter 30 years ago. I received a visit from Pro-Familia staff on several occasions and I was very interested in what I could do to help in my community as a volunteer, so I accepted. I was trained in sexual and reproductive health issues, and in the technique of injecting [contraceptives]", says Juana Margoth.  Since 1974, the Asociación Demográfica Salvadoreña (ADS/Pro-Familia), has been providing sexual and reproductive healthcare to marginalized communities in rural and peri-urban areas. Through their Pro-Family Health Promoter and community-based programme, the Pro-Familia teams provide information and contraceptive care and supplies to vulnerable populations. Today, the programme has around 900 health promoters throughout El Salvador.  Building relationships and trust   Juana Margoth is one of these health promoters who provides care across four local villages in Hacienda El Edén, in Sonsonate, where the Ministry of Health does not have a presence.   "I like that women know that I am here to help them, also to give advice and understand each person's problem; [to help them] to plan their family, and I like the fact that they want to do it with me," she says.  She receives a quarterly supply of contraceptives that she distributes at low prices to the women in her community.  "I make visits in the communities to the clients I already have, to see if they are okay with the [contraceptive] method, and to receive new clients. Sometimes even the same clients tell me that there is someone who needs a visit. I like that they look to me to help them – I give confidence to the clients, to their partners too. I have clients since two, five or six years ago. There is a lot of need, so I am here, until God wants it." Providing contraceptive advice Juana Margoth also highlights the importance of guiding women and men, providing counselling to clients so that they understand the different methods and contraception, and how to use it: "In other places they only give the contraceptive methods to women and do not explain [on its use]." Veronica has been a regular client of Juana Margoth’s for eight years, receiving counselling and contraceptives. "Margoth has changed our life, mine and my family’s, I have been planning with her for eight years, she is kind and always has the method I use. When I have doubts, I ask her with confidence, without shame, and I can go to her house at any time, she is always there. I don't like going to the health unit, because it costs a lot of money, and sometimes they don't have contraceptives; nowadays, with the pandemic, we have Margoth close and she never stopped treating me, it is very helpful in our community."  Responding to humanitarian disasters   As well as the community-based programme, Pro-Familia supports the network of volunteer promoter's humanitarian crises, such as natural disasters. Pro-Familia conducts a survey of needs and responds with support for reconstruction, healthcare, and food security.  "I have a lot to thank Pro-Familia for. I have learned and continue to learn with them, they are always there when I need to know something, when I run out of contraceptives and without medications [for the program]; I am also grateful because I have my prefabricated house thanks to Pro-Familia who helped me when the earthquake of 2001 happened, several years ago."

"I remember that I joined Pro-Familia on July 1, 2011. I had many fears and questions at that time, because I did not know about sexual and reproductive health issues, and had no experience working with contraceptive methods. It was something completely new for me, but I really wanted to learn," says Elga.  Elga is one of the Community Health Workers in the Asociación Demográfica Salvadoreña’s (Pro-Familia) Community-Based Program team. She remembers that when she first started her training, she felt that her role was small and unimportant – but over the time she learned and gained in confidence, understanding the positive impact she was having in the local communities.  "I found the reason to live, I found a purpose: knowing people’s situations, their difficult situations, that is special for me. Feeling they miss me when they spend days without seeing me because I am in different communities, that is something important, it means they value my work."  Sharing knowledge and experience   Elga believes that she has gained a lot personally. "I have learned a lot about women's rights; I apply everything about sexual and reproductive health in my personal life, I do not allow abuse by my partner and I teach my son to respect people. I learned to use contraception for my own benefit," she says.  Communication was very difficult for Elga. She considered herself shy and was very quiet. Today she talks with people, in front of large groups of students in schools, expresses her ideas and provides counselling.  "I enjoy what I do, I prepare to visit the volunteer promoters, to train them and resolve any doubts or questions that arise. They are very intelligent, and I intend to have the best volunteers. I enjoy visiting families in the community, having the opportunity to give family planning counselling, work on the prevention of cervical and breast cancer, work with young people, help them to change their lives, to find new paths, free from violence, just as I found my purpose."  Communities benefit from access to care  She admires the work of Pro-Familia, as no other organization has permanent programs and subsidized healthcare, which is of enormous benefit to the local community.  Elga has seen many clients since she started volunteering. She recalls encouraging a woman to come to the cervical screening clinic: "The lady had never had a cervical screening. I gave her counselling and a referral so that she could come to the Pro-Familia clinic. Her result was cervical dysplasia – level 1, I followed her until she received the treatment. Now, every time she sees me, she thanks me for guiding her and inviting her to the clinic," Elga says with joy.  She also remembers the first time she suggested a vasectomy to a client. "First, I made the reference to the women client, but because of health reasons she could not be sterilized, and she was very sad because using hormonal methods also affected her health. So I decided to give counselling to the client's partner, who agreed to a vasectomy. The intervention was successful, and he is well, and grateful to me and to Pro-Familia", she recalls.  The issues of sexual and reproductive health and contraceptive care are still taboo in many communities. Changing attitudes to improve the lives of individuals and families remain a vital focus. Counselling is key to recognizing that health and contraceptive care are fundamental rights, and to eliminate myths and beliefs that prohibit the use of contraception. Volunteers like Elga remain integral to this process to bring about positive change for the future. 

"I am a volunteer health promoter by inheritance. First, my mother volunteered with Pro-Familia for 15 years, when she resigned to go to the United States. I learned to volunteer when I was little, because I saw how my mother did it", Alicia recalls.  The community spent some years without a volunteer health promoter after Alicia’s mother left. During that time, women came to Alicia to encourage her to contact the Asociación Demográfica Salvadoreña’s (ADS/Pro-Familia)to bring back the programme to the Santo Domingo village, 90 minutes outside of San Salvador. In the absence of a local public health facility, Alicia decided to become a Pro-Familia volunteer to support her community.  "When my mother left, I agreed to collaborate just to promote the cervical screening clinic, but Pro-Familia suggested that I be a volunteer, like my mother, and I accepted. Today, it’s been two years. They have trained me at home on sexual and reproductive health issues, counselling, home visits and the use of brochures, and I also learned to inject." Changing people’s lives   Alicia is an entrepreneur with a strong spirit of care towards her family and community. Every day she attends her small business that provides the community with basic products.   "I help change people's lives; the women are happy and grateful, because they no longer go to Guazapa to buy contraceptive methods. Pro-Familia trains me and I coordinate with other institutions in the community – such as the church – to help people", she says.   Alicia says that counselling is a crucial part of her work: "Counselling is very important, women learn to use [contraceptive] methods and stop thinking that it is a sin. I help them to understand that family planning is a right. I had a case of a client where the husband was the one who decided which method to use and make her change it very often. One day I explained to him about the benefits of using only one family planning method, the effects of changing very often on her menstruation and that she had the right to decide whether or not to change. He understood and thanked me for taking the time to speak to him; from that day on the client keeps one family planning method and the husband respects her decision." Alicia dreams of having a larger place for her clients, or to have a table to administer the injectable, but despite the limited space she enjoys her work. "I like it and I am happy to know that I can help. Many users come at night to pick up their methods because they work out of house and I take care of them with great pleasure, when they miss their appointment, I look after them, I speak to them by phone or I send them a WhatsApp message."  Ensuring trust and confidence       Ruth Séfora Manzano has known Alicia for several years before she had children."I like Alicia because she is a respectful person, she likes to help people, she gives me confidence, and you can trust your personal things to her because she doesn't tell anyone. She looked after me when I got pregnant and she also cares about my daughter. She guides me on how taking care of myself and the baby – she is a kind person, that's why I plan with her, and if I need other medicines I also buy them from her. I also like it because it is close to my house. She gives me the shots, and I don't have to go elsewhere – I am grateful for her help and Pro-Familia's." 

When Blanca started volunteering with the Asociación Demográfica Salvadoreña’s (ADS/Pro-Familia), she committed to her new role with enthusiasm. Her thoughts were about how the women of La Loma village would benefit from being able to access contraceptive methods close to home.  "Many women walk up to an hour-and-a-half from the villages of the Guazapa Hill to receive family planning services, or to receive counselling," 61-year-old Blanca Edith Mendoza Ramos says proudly.   Her house is a cosy and special place for the clients. "I have been a Pro-Familia volunteer for 29 years. When I started, I had already had my five children. I was busy at home, but when the Pro-Familia staff explained to me about working in my community, I trusted it was important to support women. I have learned a lot and I continue to do so. I have received training that helps me to be a better person, to have knowledge and to give good advice; I have received many people from Pro-Familia in these years, and always with great responsibility", she says.  A confidential and cosy place    To ensure her clients’ confidentiality, Blanca has created a private room with a sofa where she provides counselling and administers injectable contraceptive methods. By creating a private space, Blanca has built up trust in the community and women prefer to go to her for contraception and advice.  "I am proud to help in my community. I visit clients to see if they have any side effects, when they do not come to receive their method, to know if they are well, or to recruit new clients who are encouraged to use a family planning method, because their families are already very large." Although the public health facility provides free healthcare, women from other local communities prefer to see Blanca because she is closer and offers confidential personalized care.   "The Health Unit is not close, so women prefer to plan with me. They come with confidence to apply their method. On their first visit, I ask them a few questions about their health, and if everything is okay, they plan with me. I think that family planning is important for the spacing of the children and that it is not only the use of methods, but also communication with the couple", reflects Blanca. 

With three children to raise on her own, Liljana’s health was the last thing on her mind but she could no longer ignore the feeling that something was wrong. Through speaking to her friends, she learnt about the  Albanian Centre of Population and Development (ACDP) clinic. “First, I had the gynaecological visit and after that, for 1 minute, the doctor did the VIA test. The response was immediate, but positive. I was so scared. The doctor was able to calm me down by explaining everything very simply. Everything was going to be all right because this disease was 100% curable.” Liljana underwent treatment for pre-cancerous lesions for two weeks, but the results of the test were still positive. The doctor suggested cryotherapy. “I decided to do cryotherapy, which is very simple and very comfortable. It was the best decision I have made in my life. After two years, I am completely recovered. I am very grateful to the ACDP clinic, they saved my life.” What is VIA & Cryotherapy? Show more + Visual inspection of the cervix with acetic acid (VIA) is a process of screening and examining the cervix. Pre-cancerous lesions on the cervix will turn white when the acid is applied.  This simple procedure can be done in a clinic setting without the use of a laboratory and allows for immediate treatment of any pre-cancerous lesions with cryotherapy. Cryotherapy is a gynaecological treatment that freezes and destroys abnormal, pre-cancerous cervical cells. Cryotherapy is not a treatment for cervical cancer. VIA has the potential to revolutionize cervical cancer prevention efforts, particularly in low resource settings, because it eliminates the need for laboratories, transportation of specimens and provides immediate test results.   VIA needs less equipment and fewer specialists than traditional cervical cancer screening methods like Pap tests. Results from VIA are available immediately so women can be screened and treated in one single visit.  A happier & healthier life Now Liljana is having routine checks following the advice of the doctor and maintains regular contact with the clinic. “I know that whenever I need advice, I can call the doctor or the nurse and always get a response.” Liljana told all her friends about the VIA procedure and recommended many of them to the clinic in Tirana. Since her successful treatment, Liljana has noticed the relationship with her children has also improved. “My 15 years daughter says that now I smile more than before. She has noticed that before the test I was sad, because I was thinking bad things about my life. This experience has helped me also to talk openly with my daughter about the reproductive and sexual life and teach her to take care of herself. The other two are boys, 13 and 10 years old, but I promise I will talk to them about the importance of having a healthy reproductive and sexual life.”

Eleanor* is a mother of three children, she lives in Vlora, a city in south Albania. Eleanor and her children rely on her husband's modest income to survive. She is only too aware that her economic situation is a major barrier for her to access healthcare. Most treatments are referred to the capital, Tirana, or are at private clinics; incurring costs she simply cannot afford. When she heard about the Aulona Centre offering free PAP tests, she booked an appointment. “I have always admired women who take care of their health. Taking care of ourselves is decisive for our family wellbeing, children and relatives. But in our areas, it is difficult to get proper services, especially for reproductive health”, she says. Eleanor’s first pap smear was in 2012, the results came back negative. The doctor informed her that she had to come back in 3 years for another test.  In 2015 she returned to the center, convinced that the results would again be negative. The results came back positive. “I remember the doctor underlining my name with red pen. She said to go to Tirana for further treatment because they had better equipment and staff there.” The encouragement from the staff of Aulona center helped Eleanor decide on her next steps.  “While making my decision, I had this vision of my name underlined with red colour, which was an alert sign. So I contacted a doctor in Tirana and had the surgery in 2016. Nowadays I feel much better and I am clean from signs of cancer.” From a client to an activist  Her experience with Aulona center has made Eleanor an ardent activist of reproductive health for women. “Every cousin in my family knows about my case. I encourage them to have a PAP screening although they don’t have any concern. For some of them is a matter of shame, because they think if you don’t have any problem, why you should expose intimate parts of your body to the doctor? I challenge them asking what it is more difficult: when the doctor says: Madam, you have few years to live left or just booking a visit? They listen to me more now because they see I recovered.” Through her activism, Eleanor has recently become aware of the VIA testing method and is enthusiastic about it. “The most wonderful thing about this new method [VIA] is that I don’t have to wait 3 weeks for the response. I recall the waiting period for the second test with my eyes attached to the telephone screen. Why are they not calling? Is there anything wrong with my results? VIA avoid all this anxiety, and you can start the therapy immediately.”   Eleanor feels confident about her knowledge on sexual and reproductive health. Her own experiences allows her speak more openly with her 20-year-old old daughter, reminding her of the importance of regular screening. “The disease does not ask if you are rich or poor. I could have let myself at risk, but when interventions are at the right time, they save lives.” What is VIA & Cryotherapy? Show more + Visual inspection of the cervix with acetic acid (VIA) is a process of screening and examining the cervix. Pre-cancerous lesions on the cervix will turn white when the acid is applied.  This simple procedure can be done in a clinic setting without the use of a laboratory and allows for immediate treatment of any pre-cancerous lesions with cryotherapy. Cryotherapy is a gynaecological treatment that freezes and destroys abnormal, pre-cancerous cervical cells. Cryotherapy is not a treatment for cervical cancer. VIA has the potential to revolutionize cervical cancer prevention efforts, particularly in low resource settings, because it eliminates the need for laboratories, transportation of specimens and provides immediate test results.   VIA needs less equipment and fewer specialists than traditional cervical cancer screening methods like Pap tests. Results from VIA are available immediately so women can be screened and treated in one single visit.  *Name has been changed

Scrolling through her social media page, 21-year-old Artemisa Seraj stumbled across a post from the Aulona Center offering seminars and workshops on sexual and reproductive healthcare for young people and students. Feeling like she had the opportunity to learn something about a subject that she and her friends rarely discuss, she decided to attend one of the seminars. “I found the information very interesting because we don’t talk very much about these things with my friends. It is still a taboo. On the other hand, we know that the sexually transmitted infections are being spread among youngsters, but we don’t know how to protect ourselves.” The first seminar went so well, Artemisa decided that she wanted to become a volunteer. “I like very much to pass the information on to others. So, I discussed with the Enela, the director of the center, to become a volunteer and here I am today.” Empowering women & girls Since becoming an activist Artemisa is now even more passionate about the importance of comprehensive sexuality education (CSE) for young people, gender equality and women’s rights. “I have known many other girls and women in our outreach activities that have no information about their reproductive and sexual life. Especially, girls from rural areas are the most deprived of this kind of information. The health centers have no staff or adequate equipment for gynaecological visits. Aulona center has high standards of friendly services for teenagers and youngsters, so you feel safe and not prejudiced against. Confidentiality is very high here and the doctors are very qualified. In the young groups, you feel like a community, you can speak openly about your concerns.”  Artemisa hopes that by distributing information to women and girls, it is empowering them as well giving them an opportunity to fight for their own rights. “I do think that even a single person can contribute to the improvement of the situation regarding CSE. It is an instinct now, whenever I meet a woman, I talk about the center.  My greatest satisfaction as an activist is seeing them coming to the center for a [health] visit or for counselling, because this means that my work has paid off. I do this work because I believe every girl and woman’s life counts.”

Hatixhe Gorenca is a nurse at the Albanian Centre of Population and Development (ACPD) clinic in Tirana. She joined the center in 2013 with 39 years of experience working in gynaecology. During her time as a nurse, she has seen vast improvements in access and services for cervical cancer screenings. However, she says that there is a considerable number of women in rural areas that face difficulties in accessing healthcare, and some that cannot access it at all. Rural women & access “The ACPD clinic is crucial for these [rural] women, because the healthcare we offer through gynaecological visits, includes counselling, pap smears, colposcopies and recently VIA tests and cryotherapy. Services that are totally missing in their areas. What they appreciate most is the mobile clinic in the outskirts of Tirana, because they have an opportunity to meet with doctors and to get information about their health status. We do approximately 17-18 visits per day and the number is always increasing”, Hatixhe says.  The clinic has developed a reputation for offering youth-friendly healthcare and information. The confidential and open approach of the clinic is providing access for girls to comprehensive sexual education at an early age, without fear of discrimination or embarrassment. When the clinic first introduced VIA testing in 2017, as an alternative way for the screening of cervical cancer, it was welcomed by the women. “The reason is that compared to pap smears, VIA gives an immediate response on the health of the cervical cells,”  Hatixhe explains. “The other reason is economical. Many of the women we work with have no health insurance, as such they cannot benefit from the free tests at maternity hospitals. Furthermore, some of them are vulnerable women and they feel safe when they can get free information and healthcare at our clinic.” What is VIA & Cryotherapy? Show more + Visual inspection of the cervix with acetic acid (VIA) is a process of screening and examining the cervix. Pre-cancerous lesions on the cervix will turn white when the acid is applied.  This simple procedure can be done in a clinic setting without the use of a laboratory and allows for immediate treatment of any pre-cancerous lesions with cryotherapy. Cryotherapy is a gynaecological treatment that freezes and destroys abnormal, pre-cancerous cervical cells. Cryotherapy is not a treatment for cervical cancer. VIA has the potential to revolutionize cervical cancer prevention efforts, particularly in low resource settings, because it eliminates the need for laboratories, transportation of specimens and provides immediate test results.   VIA needs less equipment and fewer specialists than traditional cervical cancer screening methods like Pap smears. Results from VIA are available immediately so women can be screened and treated in one single visit.    ACDP outreach activities enable the staff to give the information where the women are: in the streets, in their workplace, in their homes. Hatixhe has witnessed a growing interest in women regarding their reproductive health in recent years. The number of women that walk through the clinic doors is proof of that. During the 2016-2017 over 3,000 women received healthcare services from the clinic.  Encouraging other women  “I myself am learning a lot in the clinic”, Hatixhe says. “VIA test was a new technique even for me, but it is so simple, I can now train the staff at the health centers. I can tell you that they are very enthusiastic and responsive because VIA is very easy to apply. Since many health centers have no gynaecological bed for their visits or low capacities to apply PAP tests which require specialized personnel, VIA is much more suitable for their conditions, because it can be done by the nurses or midwifes themselves.” Hatixhe is impressed by the reaction of women taking VIA tests. “As a nurse with long experience in the health sector, I have received many thanks from patients, but the hugs we get from these women are heartfelt. After 2-3 years of coming and going to different institutions, finally, they have found a method which can detect pre-cancer cells, get treatment for it and now they are totally healthy.”  Hatixhe says that many women have been encouraged to book a VIA test through hearing about it from a friend or relative who had a positive experience at the clinic. “After the first visit, the women return with other women who are interested to do the tests. This is wonderful.”