Many of us probably remember the sometimes awkward sexual education lessons during school when we were children. Regardless of how we felt at the time, or how much we might have laughed, a substantial amount of information was presented to us and to some extent helped us to navigate various decisions relating to our sexual health.
But what if you were never taught about sexual and reproductive health? What if the causes and symptoms of sexually transmitted infections (STIs) were unknown to you or inaccurately explained? Without accurate information, you might be unaware of the negative effects that certain behaviours can have on your health and the health of those close to you.
In rural Madagascar, very few people are exposed to information or discussions about sex or STIs. Often people learn through informal conversations and story sharing, but this can contribute to common misconceptions. With limited access to health services, many people might never have the opportunity to speak with a health worker and those whose symptoms fade might never seek treatment.
Some rural communities in Madagascar are very isolated | Photo: Garth Cripps
“What if you were never taught about sexual and reproductive health”
In response to this issue, the Blue Ventures outreach team alongside community volunteers from coastal southwest Madagascar recently completed their second Village Outreach Tour (VOT) of 2016.
VOTs can be likened to the glue that binds Blue Ventures’ various community health, coastal livelihood and marine resource management initiatives together. As such, the tours represent a core component of Blue Ventures’ community health programme, known locally as Safidy (a word that means “the freedom to choose” in Malagasy).
Responding to the needs and interests of rural communities, the Safidy programme trains and supports local women to offer community-based family planning and other health services in isolated areas. These Community Health Workers (CHWs) help empower couples to make their own reproductive health choices, tackle issues concerning maternal and child health, support management of common illnesses for children under five, and help promote positive behaviours related to water, sanitation and hygiene.
The Safidy programme trains and supports local women to offer health services | Photo: Garth Cripps
Photo: Garth Cripps
Training community health workers
Safidy is an integral part of Blue Ventures’ holistic approach, as empowering couples to plan and better provide for their families helps improve food security, and allows women to play a more active role in fisheries management or alternative livelihoods. A higher standard of community health also increases the ability of men and women to engage in community conservation efforts. That’s where the VOTs come in.
The recent VOT visited 32 communities over the course of November and early December to engage communities in discussions about health issues. Each session started with discussions stimulated by STI posters, with separate groups for men and women to enable people to ask questions and exchange ideas openly.
The women of a coastal community are engaged in discussions about an STI poster during the VOT
A group of men discuss STIs during the VOT
A group of men discuss STIs during the VOT
Many people are unaware of the symptoms or causes of STIs, and it is often very difficult to tell whether someone has contracted an STI or whether you yourself are carrying an infection. After the initial discussion, the VOT team therefore shared pictures of unknown individuals alongside pictures of various STIs and potential symptoms in order to open up discussions about the difficulty of knowing someone’s health status and the importance of preventive behaviours.
After covering the biological basics of STIs, further pictures were presented that depicted different behaviours such as using condoms and having one trusted partner. With limited health workers or facilities in many of these communities, the VOT team facilitated discussions about the importance of using condoms every time one has sex and potential barriers to achieving this. They also highlighted the work of the CHWs in terms of offering condoms and referring people to health centres where they can get tested and access treatment if necessary. The poster discussion sessions ended with condom demonstrations that provided an opportunity for people to become confident in how to use a condom correctly.
The community health workers offer condoms and can refer people to health centres
Condom demonstrations help increase knowledge
Condom demonstrations help increase knowledge
To keep community members engaged and lighten the mood after these serious discussions, the second half of the VOT used entertainment to further explore the topics raised in the poster sessions. A theatre performance followed the lives of a few couples learning about healthy life choices. Pertinent lessons were raised through a dialogue that mirrored life in rural communities, and the performance gave everyone the opportunity to reflect on the poster discussions and how different decisions can impact on their health. The performance also reinforced knowledge of the services offered by CHWs, and one of the scenes was followed by a song (written and composed by a Blue Ventures staff member) about condoms and how they can protect against STIs.
The second half of the VOT used entertainment to explore health topics
A theatre sketch with an integrated message | Photo: Njaka Raveloson
The last few scenes of the play focused on another health theme: purifying water. Although it was a slight theme shift from condom use and preventing STIs, the message still supported healthy behaviours and there was another catchy song to go along with it!
As many rural communities in the region have limited access to safe drinking water, treating water with a simple chlorine solution can help to prevent water-borne diseases. The most common water disinfectant provided in Madagascar is sold under the name “Sur’Eau” (which means “safe water” in French) and just recently transitioned from a liquid solution to a pill. The catchy song emphasised the importance of stirring the water to ensure that the capsule dissolves properly.
The most common water disinfectant in Madagascar
There was another catchy song to go along with it!
The poster discussions and theatre performance were followed by screenings of conservation and health videos highlighting local initiatives supported by Blue Ventures, recent community exchange visits and opportunities to become involved in natural resource management efforts. These videos explored the importance of addressing human and ecosystem health together, and showcased the ways that healthy individuals are better equipped to manage their natural resources.
It’s through these VOTs and ongoing community health promotion efforts that we hope to ensure that individuals living in Madagascar’s rural coastal communities are informed and inspired to adopt healthy behaviours. When provided with accurate information in an interesting and interactive way, and given the opportunity to discuss and debate openly different behavioural options, we can all make informed decisions for a healthy life.
Find out more about Blue Ventures’ community health work.
All photos in this blog were provided by Community Health Programme Coordinator Njaka Raveloson unless otherwise specified in the caption.
