MSF has been working in Choloma for several years, providing sexual and reproductive health care. Earlier this year, we launched medical and psychological care and community education on sexual and reproductive health issues in Choloma and nearby San Pedro Sula, the capital of Cortés. The team of doctors, nurses, psychologists and community educators travel to various communities to provide prenatal and postnatal counselling, mental health care, contraception, community education and health promotion. MSF teams find that needs are greatest in low-income communities, those with many pregnant women and adolescent girls, or those with high rates of sexual violence.
The MSF health promotion team has also launched a program in health centres, schools and other educational centres, and through MSF mobile clinics to educate adolescents on sexual health issues and reproductive. Through this program, the team offers psychoeducation, a therapeutic intervention where psychologists provide mental health education and information to those seeking or receiving services. They also run group therapy sessions for teens to answer their questions about sexual and reproductive health issues and address mental health needs.
Women and girls face multiple vulnerabilities
“When I was 12, my maternal grandfather assaulted me twice,” said María [patient name changed] during a visit to a health center in La Bueso, a village not far from Choloma. “I decided to leave home at the age of 14. At 17, I had two children. I am currently 33 years old and I already have seven children.
María came across the MSF mobile clinic at the health center while trying to get registration documents for her five-month-old daughter. Last year María became pregnant after being raped. “I did not go to the doctor after the rape. I was surprised to learn that I was pregnant. I had to give birth at home, with the help of a neighbor who is a nurse. Where I live there is no access to a health center and I have no money to pay for transportation, let alone go to a private clinic.
María’s experience resonates with the stories of many other women who have been sexually abused or raped since childhood. Over the past 10 years, MSF teams in Honduras have treated 3,500 people who have suffered sexual and gender-based violence. Many survivors do not seek medical attention; this is often due to stigma, not knowing what help can be provided, or not having access to health care.
The treatment of sexual violence is time sensitive. If rape victims seek care within 72 hours, they can be provided with drugs to prevent STIs, including post-exposure prophylaxis to protect against HIV. Emergency contraception must also be given within five days to be effective. Emergency contraception is illegal in Honduras and MSF is calling for this ban to be lifted. Early psychological care and social support are also important, however, mental health care and certain other health services may be provided after the 72 hour window.
While María was waiting for her daughter’s registration papers, one of the MSF educators from the community team approached her to tell her about the services offered by MSF. Concerned about her economic needs and how difficult it can be to provide for a family, María decided to start contraception. “In the past I had to go through a lot,” María said. “I had sex for money. Now I have a lot of children. Just being able to apply a family planning method for free gives me peace of mind.
Over the past 10 months, the MSF team in Choloma has provided contraceptives to 690 people in 15 different communities.
During the conversation with the educator, María also recognized the emotional load she brings from her childhood and how this affects her work and her relationship with her children. “I really need psychological help,” she said. “I have no money to pay a psychologist. With my current job, I earn 1,400 lempiras [about $58] and most of it goes to baby food. I am aware that I need this support because I dragged a lot of things [with me] the past.”
Since the start of the program, MSF has provided more than 739 mental health consultations. Major symptoms include depression, anxiety, grief, acute stress reaction, chronic psychosis, epilepsy, bipolar disorder, post-traumatic stress, and behavioral problems in children.
The people MSF teams have interacted with are eager to learn more about sexual and reproductive health. In addition to talking about the importance of prevention, planning and self-care, MSF community teams also prioritize destigmatizing sexual and reproductive health care and reducing prejudice against people who treat it. are looking for.