Reproductive Resilience: Insights from Ipas Bangladesh

Posted on by Adriana Gaona

Working in public health on an international platform is no joke. My first two weeks at Ipas Bangladesh have already given me a wealth of perspective. The Bengali health system is complex, arguably more so than that of the U.S. (how could that even be possible?), and cultural stigma creates significant barriers for women and adolescents seeking proper education and access to MR (menstrual regulation/abortion) services, PAC (post-abortion care), and family planning (FP) services. With a staggering population of over 170 million people, a third of whom live in urban areas, Bangladesh is rapidly urbanizing. Yet, despite this shift, there is a noticeable lack of prioritization for urban health needs.

General practitioners (GPs) are tasked with providing MR, PAC, and FP education and services, but they are overwhelmed, under-resourced, and oftentimes not properly trained in these services. This unmet need has forced NGOs to step in and shoulder much of the responsibility in urban and humanitarian settings. Ipas Bangladesh is at the forefront, tirelessly forming collaborations and partnerships with local NGOs and government entities to champion sexual and reproductive health rights (SRHR), particularly for women and adolescents in urban slums and humanitarian settings.

I had the privilege of visiting and observing a Comprehensive Reproductive Health Care Center (CRHCC) in Dhaka. One GP and a team of dedicated mid-level providers—nurses, family welfare visitors (FWVs), and paramedics—manage all MR, PAC, and FP services and counseling. Ipas is instrumental in training these mid-level providers, ensuring they can deliver essential care with confidence. Without these clinics, many women do not have access to these vital services. I also witnessed an Ipas training session involving 34 paramedics for MR, PAC, and FP services. These trainings are crucial for enhancing reproductive care in Bangladesh.

Being part of Ipas Bangladesh has given me a firsthand look at public health programs and initiatives in action within a “developing” country. However, I feel “developing” is a misnomer; it’s not the people but the systems that need development. The resilience of the Bangladeshi people is inspiring. Accessibility to MR, PAC, and FP is limited, GPs and mid-level providers are stretched thin, and sexual and reproductive health (SRH) remains a taboo topic. Yet, amidst these challenges, the work being done is nothing short of extraordinary, and I am ecstatic to play a small role in understanding and promoting this ongoing work.

Haylee

 

The vibrant, city-life hustle of Dhaka streets.

Storytelling as public health practice: Initial reflections on working with trans women in Santo Domingo

Posted on by Adriana Gaona

Hello from Santo Domingo! My name is Gaby Sandor, and I am currently completing my practicum with the Instituto Dermatológico Dominicano y Cirugía de Piel “Dr. Huberto Bogaert Díaz.” This summer, I am working on the GAP (Gender-affirming Abriendo Puertas (Opening Doors)) project, which aims to reduce stigma and increase social cohesion among transgender women with HIV in Santo Domingo. One of my first tasks has been to review recorded interviews with GAP participants. In these interviews, participants share their experiences as trans women, including exploring their gender and sexual identities, finding out their HIV diagnosis, and identifying support networks. GAP participants have also told stories of being rejected by their family, of keeping their trans identity a secret, of the difficulties of navigating their health and wellbeing in a society that largely does not accept them for who they are. Though I have not met these women in person, I am deeply grateful to be able to hear their stories, to be invited into a world so different from my own.

Since arriving in Santo Domingo, I’ve also had the honor of meeting many of the clinical and community-based partners who are involved in the GAP project, some of whom who are central to the liberation movement for trans women in Santo Domingo and the Dominican Republic more broadly. One of these activists, Chris King, the executive director of TRANSSA, one of GAP’s community partners, was involved in the creation of Media Luna (Half Moon), a short documentary about trans women in the Dominican Republic. Media Luna reflects much of what I’ve been hearing while reviewing interviews with GAP participants, and I invite you, reader, to take a moment to watch this powerful film. I also implore you to hold present that though Media Luna shares stories that belong to many, these are ultimately not the stories of all. Just as there are stories of pain, violence, and rejection, there are also stories of joy, of sisterhood, of hope, and of resilience. The reality of trans women in the Dominican Republic is nuanced beyond what we, as outsiders, can comprehend. Media Luna allows us a brief view into these realities, plural. As Sabrina Moderno, a local trans activist and leader who has since passed, shares in the film, “All this darkness that they see in me, doesn’t exist. It’s just a light that many people aren’t able to see.”

Please note that Media Luna contains graphic stories of gender-based violence.

 

Gaby

Striving Towards Malaria Elimination in Zanzibar

Posted on by Adriana Gaona

As the summertime begins to settle in, my mind is already drifting to the tropical shores of Zanzibar, Tanzania. This summer, I am doing my practicum with The UNC Infectious Disease Epidemiology and Ecology Lab (IDEEL) joining their ZIM (Zanzibar Imported Malaria) Study. With a goal to contribute to the efforts of malaria elimination on the archipelago, I am eager to dive into the challenges and opportunities that lay ahead.

The UNC Infectious Disease Epidemiology and Ecology Lab (IDEEL) is focused on improving the understanding of infectious diseases around the world through interdisciplinary research. It is composed of a diverse team of investigators from UNC, Brown University, and Imperial College. Their areas of research include malaria, syphilis, diarrheal diseases, and hepatitis among others. The project I will be working on is the ZIM (Zanzibar Imported Malaria) Study. The project goal is to understand the main drivers of imported malaria cases from mainland Tanzania to Zanzibar. For my practicum, I will be focused on designing and conducting surveys aimed at assessing the knowledge, behaviors, and perceptions/acceptability of proposed malaria interventions among travelers in Zanzibar. This data will inform patterns of transmission, and risk behaviors and pave the way for future pilot intervention programs targeting the reduction of imported malaria cases.

For the past three weeks, I have been working on the design of the surveys by exploring ONA, a mobile data collection tool and survey software. I have been honing my coding skills to tailor traveler surveys specifically designed to gather valuable insights into the dynamics of imported malaria cases. We are still in the development stage as this process requires a lot of testing of the different technological features as well as assessing the feasibility and user-friendliness of the surveys through practice runs. As I am preparing to leave the US for Zanzibar, I look forward to being immersed in the Zanzibari culture and interacting with local public health experts from the Zanzibar Elimination Program and community members. I am also excited to see how the surveys will unfold as this study will provide important data which will be essential to implement a pilot intervention addressing imported malaria cases and striving towards eliminating malaria in Zanzibar.

Rokhaya