Reproductive health education for men in rural Peru, continued

A week or so back, I interviewed Joe Steffens, a medical student from the University of Washington, who was interning with SVH/Ayni Wasi through the Global Health Immersion Program (GHIP). Joe (sadly) returned to the States last Thursday, but he left behind the blueprints for a comprehensive sexual education plan, targeted at men in the Sacred Valley. The undertaking was substantial: in just eight weeks, Joe was able to research prior reproductive health knowledge among local populations; conduct a Community Needs Assessment to hone the focus of his project; develop sexual education curricula for three different age groups; and pilot one of his lessons with a group of men in the upper Andean community of Huilloc. Because of his work, SVH/Ayni Wasi now has the tools to implement male-oriented reproductive health campaigns in the areas where we work.

I write this post both to tip my hat to Joe and to provide a sense of the work he completed during his short tenure volunteering with us.

Fast forward to July 16. Joe has already formulated the sexual education pre- and post-tests, designed the lesson, and collected some props to accompany him, namely posters and samples of contraceptives. After the lunch hour here in Ollantaytambo, Joe heads up to Huilloc with Porfirio, a local confidant who speaks Quechua and can therefore facilitate Joe’s interaction with the men. Upon their arrival, they rally a small group of men 18 and older, the intended audience for this specific pilot curriculum. While the attendees snack on bananas and bread, Joe and Porfirio administer pre-tests to gauge the prior knowledge of this sample of men on issues related to reproductive health; Porfirio reads the test aloud in Quechua to ensure the greater understanding of the men, some of whom may not have received formal education. Once everyone has finished the pre-test, Joe begins his lesson by reviewing condom use. To accelerate the group’s ease with what might be a sensitive subject, Joe uses a carrot to demonstrate how to put on a condom. “The men giggled,” Joe admitted to me later, “but they seemed very comfortable throughout the entirety of the lesson.”

Medical intern Joe discusses family planning techniques with a group of men in Huilloc.
Medical intern, Joe, discussing family planning techniques with a group of men in Huilloc.

Joe then teaches the group about other contraceptive methods that are available at their local health clinic. For each, he discusses their proper uses and effectiveness with respect to STD-prevention. He even passes out samples. “I wanted the men to have a tactile experience of the contraceptives,” Joe explains. “It was a highly interactive lesson, which was important, especially considering that we were uncertain about literacy rates among the participants.”

When the main lesson is over, Joe opens the floor for questions. A few themes recur in this segment of the conversation, including the treatment of STDs and certain misconceptions related to when a woman can (and cannot) get pregnant. Most of the men actively participate throughout the discussion, but Joe notices that the younger participants are especially engaged; he said, “I saw a big disparity in knowledge of the subject matter between the younger men in the group and the older men. The younger ones performed much better on the pre- and post-tests and knew more about contraceptives in general.” Joe’s observation is unsurprising, given that the barriers to learning are typically lower for younger generations in communities like Huilloc. Older men have generally been out of school longer and are more encumbered by the responsibilities of daily life, like tending to their chakras (family farms) or working at other posts.

Other obstacles affect all the men equally. In his preliminary research, Joe discovered that sexual health education is largely deficient in the communities that comprise the Sacred Valley. It is unclear how much students are taught about sexual anatomy, contraceptive options, and the responsibilities associated with having sex. The curricula Joe developed will hopefully lay the groundwork for a more systematic sexual education program in the Sacred Valley region. As for Joe’s pilot lesson, he was impressed with the progress he’d made in just a few short hours. “I can’t say it was perfect, but I do think we made a difference in the men’s lives,” he reported. “We got the ball rolling, but there’s still a lot of work to do.”

 

After the main lesson, Joe responds to questions from the participants.
After the main lesson, Joe responds to questions from the participants.

In the coming months, SVH/Ayni Wasi staff will review Joe’s project analysis and begin training others to continue the work he started. Joe suggests that the new sexual health educator(s) be male, and he specifically references Anastacio, our lone male promotor, who lives high up in the mountains in T’astayoc. Having a male educator teaching the male-centered curricula makes for a more comfortable space, one in which participants are more likely to be transparent about their health concerns and questions.

Joe’s other tips for doing related fieldwork in the public health domain?

  • Be mindful that your target audience probably adheres to a different set of norms related to time and scheduling than those to which you’re accustomed. You shouldn’t expect to advance your project as quickly as you might be able to in your home country; in fact, it’s best to expect that things won’t always go as you’ve planned.
  • That being said, be persistent. Don’t lose faith in your project just because of a few scheduling-related setbacks.

 -Written by Courtney Weintraub

 

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