I (Courtney) recently had the pleasure of sitting down with Joe Steffens, a University of Washington medical student who is spending the summer in Ollantaytambo with SVH/ Ayni Wasi. His independent project is a reproductive health program geared towards men in the Sacred Valley.
Courtney: Tell me a little about your trajectory, how you found SVH/Ayni Wasi.
Joe: I recently finished my first year of medical school at the University of Washington in Seattle, and I applied for the Global Health Immersion Program (GHIP) for this summer. Those accepted get to go to a foreign country, work on a public health intervention there, and promote health in that community. I was accepted, and I went to the orientation to learn about the possibilities of my project. There I met with Erica Gadzik, a student a year ahead of me who did [GHIP] last year. She worked at SVH/Ayni Wasi last summer and had nothing but good things to say about her experience. It sounded like a really good fit for me, especially with regard to the area and the population. Ollantaytambo looked pretty mountainous, pretty rural. Similar to where I’m from.
C: The Latin American Montana, then.
J: (Laughs.) Yeah. I also have a bit of a Spanish language background, so I really wanted to apply and improve that, so I decided that working with SVH/Ayni Wasi would be a really good fit for me.
C: Did you have a good understanding of what your project would be?
J: What [SVH/Ayni Wasi] really needed was a male reproductive health curriculum. Erica had worked on female reproductive health when she was down here last year. It was explained to me that there’s a lot of information available to women on contraception, while the men in Ollantaytambo and surrounding communities don’t really have much at all. So I immediately thought that would be a good project for me. It’s a topic I’m comfortable talking about and teaching. And the challenge was appealing, you know. Being asked to teach sexual health in Spanish can be a little intimidating. You know, one or the other is hard enough, right? (Laughs.) Additionally, when I was talking to some of the women in the office here [at SVH/Ayni Wasi], I discovered that many hadn’t had much experience teaching men or reaching out to men in the community. So I wanted to bridge that gap.
C: How did you start digging into the information about what’s already known and what may have been lacking in male reproductive health education here in Ollanta? How did you find all that out?
J: I did a lot of background research. I looked at what Erica had done and a lot of the resources SVH/Ayni Wasi had on the topic, looking at results from pretests given to women on the topics of anatomy and contraception for example. The vast majority of the promotoras [community health workers] are women. So I did a Community Needs Assessment, where I interviewed mainly men from Ollantaytambo and the surrounding communities to figure out what they knew about reproductive health, STDs, et cetera, to be able to identify gaps in knowledge and decide where to focus.
C: What were some of the specific questions that you asked on the Community Needs Assessment?
J: I asked nine open-ended questions. Among them were: What’s the role of the promotora in the community? What’s the role of the posta (government health clinic) in your community? What’s the most-often used form of contraception in your community? What’s an effective way to prevent STDs? Questions of that nature.
C: What were the mode responses to the questions dealing with reproductive health?
J: Most of the respondents said that the main form of contraception is the 3-month Depo [Provera] shot. But, of course, you know that the Depo shot doesn’t prevent STDs. Many of them recognized that condoms do prevent STDs, but there were some that didn’t mention condoms at all during the interview. Some respondents from the outer communities said that there were no condoms available in their area. Others said that they don’t like to use condoms or don’t know how to use them. So I decided that condom use would have to figure prominently in the curriculum I’d be teaching.
C: Can you speak about how you built off the gaps that you found to exist in respondents’ understanding when you crafted the curriculum?
J: I identified three goals that I’d like to achieve with my program. One is to teach men about contraceptive methods, not only so they have a better understanding of what it is, but also so they can take more ownership in their intimate relationships with regard to contraception. Make it more of a team effort, right? A second goal was to educate about STDs, make sure men know what to do if they’re presenting symptoms. And obviously how to avoid STDs. The third is to really make sure that men understand proper condom use. I’d like to go through that with them and have them demonstrate, put some condoms on some carrots, that type of thing. Also, to make sure they know where to look for the expiration date on a condom package, how to dispose of a condom, understand that condoms can only be used once per sexual encounter, and that they then must be disposed of. That last thing is something that stood out: it wasn’t always known that condoms should only be used once per sexual encounter.
C: And how have you selected the groups you’ll be presenting to?
J: I’m going to start out with a group of adult males, around 30 years old. I’m hoping to teach a group of 5-6 of them. I have a contact in town that’s helping me to select the men to participate. But it will be on a volunteer basis; I’m not pulling from a random sample or anything.
C: What do you hope the group takes away from the curriculum?
J: Fundamentally, I hope they walk away understanding proper condom use: what to look for on a condom package, when to use a condom and when not to, like if the package is sealed and has air in it or if the condom has expired, for example. Also, I’d like them to understand female contraceptive methods better. Those are the fundamentals. And ideally, I’d love them to come out of it saying, Hey, I do care about this, I do want to take more responsibility for family planning. That’s going to be a little more difficult to garnish during an hour-and-a-half lesson, but it’s the hope, right?
C: Like transferring some of the onus away from the females?
J: Absolutely. Working towards that, yes.
C: Do you anticipate any type of resistance to the program from the men you’ll be teaching?
J: I don’t know that I’d say I’m expecting that. I guess it could happen, but I’m hoping it doesn’t. But I start teaching groups in a few days so I guess I’ll learn and adapt as I go.
C: How will your project continue after you’re gone, when you’ve returned to the States?
J: First, I’m going to leave my materials here at SVH/Ayni Wasi. I’m going to have different materials for distinct age groups. There will be an 11-14 age group, a 15-18 group, and then one for 19 years old and above. There’ll be different curricula for each age group. SVH/Ayni Wasi will have those materials after I’m gone and also the lesson plans I’ve devised for teaching the material. Eventually, I’d hope the curricula get used in capacitaciones or with other male groups.
C: Would you like to see these curricula be taught in the school systems?
J: Yeah, actually that’s another goal, too. I’m meeting with one of the directors of the colegios—secondary schools—here in Ollantaytambo to run curricula by him for the age groups that are in his school and to see what he thinks. Should he want to modify some of the information, I’d be willing to work with him to make sure content is optimal for the age group. That’s another thing I really want to emphasize: this isn’t just my project, it’s a collaborative effort. For the project to be effective and sustainable, it’s really important to get input from the parties involved and to work in their best interests.
C: For those who may be unfamiliar with the Ollantina context, can you speak to some of the obstacles that exist to men having a robust understanding of reproductive health and safe sexual practices?
J: I think there are a few [obstacles]. One of the things I learned is there’s not really a structured or formal national program for teaching sexual education. That’s not to say that sexual education doesn’t occur at all; it does. But many don’t have access to it, neither education nor contraceptive methods. For example, in Ollanta you can purchase condoms in drugstores, but they’re actually not displayed or made easily visible. I’ve had to ask storeowners a few times where they are.
Also, as I said earlier, typically women know more about reproductive health than men. Machismo is a factor here—men may or may not be interested in learning about contraception or STDs and what they can do about them. From what I’ve seen, there is this attitude among men of, that’s not my responsibility. I’m really hoping to change that.
C: Thanks, Joe. This is a really exciting project.
J: Thanks. I’m looking forward to getting it off the ground in a couple days.
Stay tuned as we report on Joe’s progress in the coming weeks!
– Written by Courtney Weintraub