This was first posted on the etr blog on October 4th, 2018.
By Jody Gan, MPH, CHES. Instructor, Department of Health Studies, American University
Three years ago, I became the first health educator to join a volunteer brigade providing medical and public health services to Honduras. For two decades, the Organization for Community Health Outreach (OCHO), based in Baltimore, Maryland, has sent a 40-person medical team to Atima, in the province of Santa Barbara. This is a mountain community of about 16,000 people in one of the most underserved and remote areas of the country.
In addition to providing direct medical care during its annual summer visit, OCHO assists the community with life-changing, sustainable programs that include providing clean-burning cooking stoves, supporting the construction of a water purification plant, and building a school for the many children with special needs who reside in the community.
Originally, I was unsure as to how I could best contribute to OCHO’s efforts in my role as a health educator. On the first day of my first visit, I learned of Atima’s alarming teen pregnancy rate of 67% (of the approximately 4,000 young women between the ages of 12-19 residing in the area). I quickly recognized where I could be of most assistance.
Starting Out: Building Condom Comfort
The very next day of our six-day visit, without much in the way of materials, I developed and delivered an impromptu training for teen leaders and concerned parents. Working with a supportive nurse from the clinic, I unearthed thousands of condoms that had been in storage.
We set out to increase comfort in using condoms with a spirited condom relay race, using bananas purchased from the produce stall in town. This was just a quick preview to a more intensive effort that would be planned for subsequent visits with the supportive, young nurse and the town’s community health workers.
The extraordinary teen pregnancy rate poses an obstacle for this highly motivated community’s journey to improved health and prosperity. Honduras has the second highest rate of teen pregnancy in the world. The effects on the country’s development are profound.
In fact, the First Lady of Honduras has made this issue one of her platforms. The country has set impressive national and local goals for reducing the teen pregnancy rate, increasing access to contraceptives, and involving parents in the effort.
Planning and Preparation
OCHO leaders were very supportive of my interest in leading brigade efforts to support these national and local goals. After conducting a needs assessment with the town medical director and other community leaders, I began planning a brief intervention I would deliver the following summer during the brigade’s next visit.
From my days as a college health educator, I remembered how wonderful ETR materials were. I ordered Spanish pamphlets, videos, and some models for condom demonstrations. I developed a training that could be adapted to fit the different needs of the key stakeholders with whom I’d be meeting—the teens, teen leaders, parents, and promotores de salud.
Promotores de salud are trusted community members trained to provide health information and support to their peers. These community health workers have a long history of delivering health promotion and disease prevention in Latin America.
Components of the Training
The components and activities of our training will sound familiar to health educators working in the sexual and reproductive health field. They included:
- Ice breaker that got participants up and moving, already exploring the topics we would be addressing in the training
Facts and statistics reinforcing the risks of early pregnancy
- Information about the Zika virus, which was a health threat at the time
- Interactive game that demonstrated the financial and social burdens placed on large families
- Strategies for safe and non-sexual ways to be close and have fun with a romantic partner
- Hallmarks of healthy relationships where partners are respectful and don’t pressure one another
- Presentation by Atima’s registered nurse about methods of contraception available at the clinic, including Depo Provera (known in Central America as “la inyeccion”), oral contraceptives and condoms, and how teens can access them
- Spanish video showing proper use of condom and demonstration by trainers
- Participant practice using condoms on a wooden model and then a spirited competition between two teams for speed and accuracy!
- Role play scenarios that gave participants the chance to practice new skills
I created a survey instrument to administer with each group before and after the training. This would yield information about the effectiveness of the training. It would also provide insight about the adolescent participants’ personal goals—what did they hope to attain before having a child? How did they think the clinic’s staff and community could help them postpone parenthood?
During our short week in Atima, we conducted trainings with 18 teen leaders, 33 teens from the high school, 8 promotores de salud, and 45 concerned parents and grandparents. From my analysis of the pre- and post-tests and the rich open-ended responses, I compiled a list of recommendations for the reduction of teen pregnancy in Atima.
During my analysis of the responses, I was struck by a comment from one of the promotores de salud in response to my question about how they felt they could contribute to reducing teen pregnancy in the community:
Talk to the teens about how beautiful life is and to enjoy their very special teenage years by waiting until after age 21 to become a parent…an early pregnancy robs them of enjoying this stage of life and reaching their goals.
This and other comments confirmed my speculation that the promotores could play a pivotal role in lowering the town’s teen pregnancy rate. So again, during the “off season,” I searched the ETR catalogue. In addition to ordering another batch of the materials I’d already used, I discovered the Cuidate curriculum, designed to reduce sexual risk behavior among Latino youth.
ETR’s Generous Donation
As a brigade volunteer without much of a budget, I could only afford to buy the curriculum in one language. I knew that the English kit would be a valuable resource for informing my efforts during the next trip, but I also wanted the promotores to have the Spanish version for their use. ETR was very understanding of my predicament and made it possible for me to obtain both the Spanish and English kits!
Here’s a photo taken at our planning meeting at the beginning of my most recent visit. This was shortly after I presented the town’s registered nurse and promotores with ETR’s generous donation of our health education materials. The focus of our week would be on training the promotores—three very hip and gregarious men in their 30’s—to lead the workshops during the week of my visit and beyond!
The workshops featured many of Cuidate’s active learning activities about the hallmarks of healthy relationships, instruction about how to use a condom (through an interactive game pictured in the photo below) and the other contraceptive methods available at the clinic, as well as role plays for negotiating condom use and non-risky ways to be close to a partner.
Reaching a Neighboring Town
This year, we also presented the workshop in a neighboring town called Enales. I was thrilled to see that the teachers had decked out their one room school house with all sorts of posters and positive imagery for the adolescents related to their sexual health and delaying parenthood.
Observing these classroom messages and the other efforts of the caring teachers—as well as the school’s community garden where parent volunteers used the vegetables to prepare healthy lunches for the students to eat before departing for their long walks home—gave me some nurturing visions about how we might better serve adolescents in the U.S.
I enjoyed being served a delicious arroz con leche after the workshop.
Celebrating and Building for the Future
This glorious and fulfilling week ended with a spirited party that the promotores organized for the teens of Atima and the brigade’s youngest members, complete with music, dancing, skits, snacks and prizes. The party was held in the clinic. This was in keeping with the community’s love for festivities and supported the continuing effort to get the resident teens more comfortable with Atima’s new medical clinic and it’s caring team of health workers.
This health care team is clearly committed to helping the youth enjoy their adolescence and delay the tremendous responsibilities that come with parenthood. They were very appreciative of the strategies, materials, and activities that I was able to share.
Jody Gan, MPH, CHES, is an Instructor in the Department of Health Studies at American University. She has over 25 years of experience planning, implementing and evaluating health programs for adolescents and young adults. She can be reached at email@example.com.