Dr Ratni Palullungan is a fearless doctor, mother, and selfless volunteer providing sexual and reproductive healthcare to marginalized groups in fragile humanitarian settings.  Currently she is deployed with the Indonesian Planned Parenthood Association’s (IPPA/PKBI) response team in Majene District, West Sulawesi, following a magnitude 6.2 earthquake which occurred in January 2021.   In an open diary, Dr Ratni shares what a day in the life looks like for a volunteer doctor providing care to those affected by the earthquake.   5.30 – 8.30am I get up quite early and have my quiet time (prayer), then I gather my dirty laundry. Currently, I live with other volunteer teams in a place called PKBI Post in Majene, and there is a cooking schedule for everyone. After prayers, chores and breakfast, I get my daughter ready for the day as she accompanies me to work temporarily. After that, the team and I prepare medical equipment and medicine for the day's humanitarian mission. 8.30 – 11am Today the first location is Maliaya Village Health Centre, in Malunda District, Majene. Here, I attend to and examine 25 pregnant women. The pregnant women, on average, get married at a fairly young age. There are definitely risks to their reproductive health. There is a 43-year-old mother who is currently pregnant with her 11th child. To limit health risks, we advise her on the various safe family planning options.   There is also a 38-year-old woman who is eight months pregnant. However, the size of her belly is very small for a woman in her third trimester. In fact, I initially thought that she was only four or five months pregnant. After I examined her, it turns out that she is categorized as a ‘malnourished’ pregnant woman. It is very unfortunate because she admitted that she eats food without paying attention to her nutrition intake. In fact, she tends to eat instant noodles. So I advised her to drink milk, eat only nutritious foods, and always taker her vitamins.  11am – 2pm After visiting Maliaya Village, I travelled to Kabiraan Village. This village was severely affected by the earthquake. Here, I walk around the evacuation camp, most of which is still occupied by displaced people in this post-earthquake period. Even under the evacuation tent, I continue to conduct health examinations for pregnant women.  Due to the large number of cases of young marriages in Kabiiran Village, the team and I decide to conduct counselling sessions for the teenagers here. I advise the teenagers to get to know the risks that might occur to their reproductive health if they marry too young.  2 – 4pm The health volunteer team and I are finally able to take the time for lunch. We have our lunch near the beach, and get to enjoy local seafood as our menu. Enjoying the seafood while looking at the beautiful sea view is a precious time. I certainly won't forget this moment. 4 – 6pm We continue our journey to East Lombong Village. We have many elderly patients here. Yet interestingly, during one of the patients’ examination, there is one mother who wants to get the contraceptive implant. For me, this is quite a shock, given that we rarely find women in this village who want to do family planning. The mother admitted that she did not know much about the family planning program and has many children. She is grateful that the PKBI volunteer team and I came to their shelter camp for the health examination. 6pm The team and I decide to return to the PKBI Post. Today’s journey is quite tiring but there is a sense of pride and emotion for having carried out a humanitarian mission for teenage girls, mothers, the elderly and even toddlers who still stay in the shelter camp. 7 – 8pm At the PKBI Post, after cleaning and tidying up the medical equipment again for the next day’s program, I  prepare dinner for the team and assist my child with her studies. I am so grateful for each and every day that I am involved in this program. I feel encouraged to continue to provide sexual and reproductive healthcare to marginalized groups

Dr Ratni Palullungan is a fearless doctor, mother, and selfless volunteer providing sexual and reproductive healthcare to marginalized groups in fragile humanitarian settings.  Currently she is deployed with the Indonesian Planned Parenthood Association’s (IPPA/PKBI) response team in Majene District, West Sulawesi, following a magnitude 6.2 earthquake which occurred in January 2021.   In an open diary, Dr Ratni shares what a day in the life looks like for a volunteer doctor providing care to those affected by the earthquake.   5.30 – 8.30am I get up quite early and have my quiet time (prayer), then I gather my dirty laundry. Currently, I live with other volunteer teams in a place called PKBI Post in Majene, and there is a cooking schedule for everyone. After prayers, chores and breakfast, I get my daughter ready for the day as she accompanies me to work temporarily. After that, the team and I prepare medical equipment and medicine for the day's humanitarian mission. 8.30 – 11am Today the first location is Maliaya Village Health Centre, in Malunda District, Majene. Here, I attend to and examine 25 pregnant women. The pregnant women, on average, get married at a fairly young age. There are definitely risks to their reproductive health. There is a 43-year-old mother who is currently pregnant with her 11th child. To limit health risks, we advise her on the various safe family planning options.   There is also a 38-year-old woman who is eight months pregnant. However, the size of her belly is very small for a woman in her third trimester. In fact, I initially thought that she was only four or five months pregnant. After I examined her, it turns out that she is categorized as a ‘malnourished’ pregnant woman. It is very unfortunate because she admitted that she eats food without paying attention to her nutrition intake. In fact, she tends to eat instant noodles. So I advised her to drink milk, eat only nutritious foods, and always taker her vitamins.  11am – 2pm After visiting Maliaya Village, I travelled to Kabiraan Village. This village was severely affected by the earthquake. Here, I walk around the evacuation camp, most of which is still occupied by displaced people in this post-earthquake period. Even under the evacuation tent, I continue to conduct health examinations for pregnant women.  Due to the large number of cases of young marriages in Kabiiran Village, the team and I decide to conduct counselling sessions for the teenagers here. I advise the teenagers to get to know the risks that might occur to their reproductive health if they marry too young.  2 – 4pm The health volunteer team and I are finally able to take the time for lunch. We have our lunch near the beach, and get to enjoy local seafood as our menu. Enjoying the seafood while looking at the beautiful sea view is a precious time. I certainly won't forget this moment. 4 – 6pm We continue our journey to East Lombong Village. We have many elderly patients here. Yet interestingly, during one of the patients’ examination, there is one mother who wants to get the contraceptive implant. For me, this is quite a shock, given that we rarely find women in this village who want to do family planning. The mother admitted that she did not know much about the family planning program and has many children. She is grateful that the PKBI volunteer team and I came to their shelter camp for the health examination. 6pm The team and I decide to return to the PKBI Post. Today’s journey is quite tiring but there is a sense of pride and emotion for having carried out a humanitarian mission for teenage girls, mothers, the elderly and even toddlers who still stay in the shelter camp. 7 – 8pm At the PKBI Post, after cleaning and tidying up the medical equipment again for the next day’s program, I  prepare dinner for the team and assist my child with her studies. I am so grateful for each and every day that I am involved in this program. I feel encouraged to continue to provide sexual and reproductive healthcare to marginalized groups

Aminata Sonogo listened intently to the group of young volunteers as they explained different types of contraception, and raised her hand with questions. Sitting at a wooden school desk at 22, Aminata is older than most of her classmates, but she shrugs off the looks and comments. She has fought hard to be here. Aminata is studying in Bamako, the capital of Mali. Just a quarter of Malian girls complete secondary school, according to UNICEF. But even if she will graduate later than most, Aminata is conscious of how far she has come. “I wanted to go to high school but I needed to pass some exams to get here. In the end, it took me three years,” she said. At the start of her final year of collège, or middle school, Aminata got pregnant. She is far from alone: 38% of Malian girls will be pregnant or a mother by the age of 18. Abortion is illegal in Mali except in cases of rape, incest or danger to the mother’s life, and even then it is difficult to obtain, according to medical professionals. Determined to take control of her life “I felt a lot of stigma from my classmates and even my teachers. I tried to ignore them and carry on going to school and studying. But I gave birth to my daughter just before my exams, so I couldn’t take them.” Aminata went through her pregnancy with little support, as the father of her daughter, Fatoumata, distanced himself from her after arguments about their situation. “I have had some problems with the father of the baby. We fought a lot and I didn’t see him for most of the pregnancy, right until the birth,” she recalled. The first year of her daughter’s life was a blur of doctors’ appointments, as Fatoumata was often ill. It seemed Aminata’s chances of finishing school were slipping away. But gradually her family began to take a more active role in caring for her daughter, and she began demanding more help from Fatoumata’s father too. She went back to school in the autumn, 18 months after Fatoumata’s birth and with more determination than ever. She no longer had time to hang out with friends after school, but attended classes, took care of her daughter and then studied more. At the end of the academic year, it paid off. “I did it. I passed my exams and now I am in high school,” Aminata said, smiling and relaxing her shoulders.  "Family planning protects girls" Aminata’s next goal is her high school diploma, and obtaining it while trying to navigate the difficult world of relationships and sex. “It’s something you can talk about with your close friends. I would be too ashamed to talk about this with my parents,” she said. She is guided by visits from the young volunteers of the Association Malienne pour la Protection et Promotion de la Famille (AMPPF), and shares her own story with classmates who she sees at risk. “The guys come up to you and tell you that you are beautiful, but if you don’t want to sleep with them they will rape you. That’s the choice. You can accept or you can refuse and they will rape you anyway,” she said. “Girls have to know their rights”. After listening to the volunteers talk about all the different options for contraception, she is reviewing her own choices. “Family planning protects girls,” Aminata said. “It means we can protect ourselves from pregnancies that we don’t want”.

My name is Mariame Doumbia, I am a midwife with the Association Malienne pour la Protection et la Promotion de la Famille (AMPPF), providing family planning and sexual health services to Malians in and around the capital, Bamako. I have worked with AMPPF for almost six years in total, but there was a break two years ago when American funding stopped due to the Global Gag Rule. I was able to come back to work with Canadian funding for the project SheDecides, and they have paid my salary for the last two years. I work at fixed and mobile clinics in Bamako. In the neighbourhood of Kalabancoro, which is on the outskirts of the capital, I receive clients at the clinic who would not be able to afford travel to somewhere farther away. It’s a poor neighbourhood. Providing the correct information The women come with their ideas about sex, sometimes with lots of rumours, but we go through it all with them to explain what sexual health is and how to maintain it. We clarify things for them. More and more they come with their mothers, or their boyfriends or husbands. The youngest ones come to ask about their periods and how they can count their menstrual cycle. Then they start to ask about sex. These days the price of sanitary pads is going down, so they are using bits of fabric less often, which is what I used to see.  Seeing the impact of our work  We see cases of early pregnancy here in Kalabancoro, but the numbers are definitely going down. Most are from 14 years old upwards, though occasionally they are younger. SheDecides has brought so much to this clinic, starting with the fact that before the project’s arrival there was no one here at all for a prolonged period of time. Now the community has the right to information and I try my best to answer all their questions.

My name is Fatoumata Yehiya Maiga. I’m 23-years-old, and I’m an IT specialist. I joined the Youth Action Movement at the end of 2018. The head of the movement in Mali is a friend of mine, and I met her before I knew she was the president. She invited me to their events and over time persuaded me to join. I watched them raising awareness about sexual and reproductive health, using sketches and speeches. I learnt a lot. Overcoming taboos I went home and talked about what I had seen and learnt with my family. In Africa, and even more so in the village where I come from in Gao, northern Mali, people don’t talk about these things. I wanted to take my sisters to the events, but every time I spoke about them my relatives would just say it was to teach girls to have sex, and that it’s taboo. That’s not what I believe. I think the movement helps girls, most of all, to know their sexual rights, their bodies, what to do and what not to do to stay healthy and safe. They don’t understand this concept. My family would say it was just a smokescreen to convince girls to get involved in something dirty.  I have had to tell my younger cousins about their periods, for example, when they came from the village to live in the city. One of my cousins was so scared, and told me she was bleeding from her vagina and didn’t know why. We talk about managing periods in the Youth Action Movement, as well as how to manage cramps and feel better. The devastating impact of FGM But there was a much more important reason for me to join the movement. My parents are educated, so me and my sisters were never cut. I learned about female genital mutilation at a conference I attended in 2016. I didn’t know that there were different types of severity and ways that girls could be cut. I hadn’t understood quite how dangerous this practice is. Then, two years ago, I lost my friend Aïssata. She got married young, at 17. She struggled to conceive until she was 23. The day she gave birth, there were complications and she died. The doctors said that the excision was botched and that’s what killed her. From that day on, I decided I needed to teach all the girls in my community about how harmful this practice is for their health. I was so horrified by the way she died. Normally, girls in Mali are cut when they are three or four years old, though for some it’s done at birth. When they are older and get pregnant, I know they face the same challenges as every woman does giving birth, but they also live with the dangerous consequences of this unhealthy practice.  The importance of talking openly  The problem lies with the families. I want us, as a movement, to talk with the parents and explain to them how they can contribute to their children’s sexual health. I wish it were no longer a taboo between parents and their girls. But if we talk in such direct terms, they only see disobedience, and say that we are encouraging promiscuity. We need to talk to teenagers because they are already parents in many cases. They are the ones who decide to go through with cutting their daughters, or not. A lot of Mali is hard to reach though. We need travelling groups to go to those isolated rural areas and talk to people about sexual health. Pregnancy is the girl’s decision, and girls have a right to be healthy, and to choose their future.

In early April 2020, the all too familiar destruction of a Tropical Cyclone (TC) – Harold – hit the Solomon Islands, Vanuatu, Fiji and Tonga. One of the worst affected areas was the Eastern part of Fiji. Through support by Department of Foreign Affairs and Trade (DFAT), our Member Association, Reproductive and Family Health Association of Fiji (RFHAF), was quick to respond ensuring access to essential sexual and reproductive healthcare for Kadavu’s women, girls, and vulnerable groups. Fiji's vulnerable coastline Fiji’s worst affected area was the Eastern part, with TC Harold bringing destructive storm force winds and storm surge. RFHAF focused its humanitarian response on the local Kadavu population. This remote area proves a challenge to reach for the team with supplies. Share on Twitter Share on Facebook Share via WhatsApp Share via Email RFHAF's humanitarian response team tackle rough terrain National travel restrictions - due to the current COVID-19 pandemic - on all inter island transfers has slowed the response in some areas, including Kadavu. The island of Kadavu is one of the least developed areas of Fiji, the main source of income is substance living (Yaqona). Transport around the island is difficult, with very few roads, no public water system or electricity. The humanitarian team from RFHAF travels by boat and then on foot. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Asenaca, client Kadavu, the biggest island in the Eastern division has the greatest population (10,897). 197 evacuation centres were activated in total, initially hosting over 6,240 people. Many are women of reproductive age, with an estimated 150 currently pregnant. Asenaca learns about breast cancer self-checks from RFHAF’s healthcare provider, Karo. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nasi, RFHAF healthcare provider The medical mobile team deliver a broad range of healthcare including contraception, information and counselling on sexual health, pregnancy, HIV and STI care and testing. RFHAF Team in Kadavu performing general health checks after TC Harold. Nasi administers a HPV shot to a client. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Kate, client Young women and girls are at the heart of RFHAF’s healthcare provision. Kate walks home with her dignity kit after a health check at the mobile clinic. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Karo, RFHAF healthcare worker RFHAF offers sexual and reproductive healthcare as well as counselling, and referrals for follow up care. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Alidi, RFHAF healthcare worker The team ensures young people in the community are not forgotten and provide information and education on relationships and sexual health and rights. Alidi conducting a session with a local group of young people at Gasele, Kadavu.Photos ©IPPF/Rob Rickman/Fiji Share on Twitter Share on Facebook Share via WhatsApp Share via Email