June 24, 2019 - 11:56 AM

Care Beyond Borders: Care Beyond Borders: Centering Women and Girls in Humanitarian Response Efforts

On June 12, 2019, as a part of the Value of Sanctuary: Building a House Without Walls, the Cathedral presented a conversation with International Planned Parenthood Federation/Western Hemisphere Region on the impact of climate disasters and political upheaval on the healthcare of women of reproductive age in Latin America, the Caribbean, Venezuela, and Colombia.

Below is the audio and a transcript of the conversation.

Moderated by Alexander Sanger, chair of the International Planned Parenthood Council

Giselle Carino, CEO & Regional Director for IPPF/WHR
Mayra Díaz-Torres, MPH, head of the IELLA Profamilias Clinic, a community-based sexual and reproductive health services clinic in Puerto Rico
Belmar Franceschi, Executive Director of PLAFAM, IPPF/WHR’s local partner in Venezuela.
Olga del Mar Reyes, community social worker who has worked with survivors of Hurricanes Irma and Maria
Marta Royo, Executive Director of Profamilia, IPPF/WHR’s local partner in Colombia.
Dr. Luz Towns-Miranda, member of Board of the Planned Parenthood Action Fund

Lisa Schubert: Tonight’s program is part of an ongoing series we now have at the Cathedral that looks at sanctuary from many, many different perspectives. When we think about a sanctuary, we really come down to thinking about the safety of each individual and what it means to have a culture and a society that respects the dignity of everyone, no matter where they are, whoever they are, wherever they live.

And from our perspective, International Planned Parenthood is a natural partner for the Cathedral. So we’re very excited to think about having this very serious conversation tonight moderated by Alexander Sanger with our very special guests, who I'm looking forward to hearing from. So please welcome them, and [00:01:00] we hope that this will be the first of many conversations. Thank you.

Giselle: Welcome. Thank you so much for coming out to join us. Thank you so much to the Cathedral of St. John the Divine for hosting this important conversation here tonight. My name is Giselle Carino. I'm the CEO of the International Planned Parenthood Federation, Western Hemisphere Region. IPPF/WHR.

Yes, thank you.

We're a network, and it's such a privilege to lead this organization, a network of organizations that provide health care in almost every country in the Americas and the Caribbean. Last year alone we served about seven million clients, most of them women. The great majority of them poor and underserved. We also work, as you know, to really change restrictive laws related to reproductive rights [00:02:00] and are one of the largest sex education providers in the region for young people. We're here tonight in the context of the Cathedral’s Sanctuary exhibit.

And we'll be talking about the ways in which IPPF/WHR and our local partners provide sanctuary for health and safety for women and girls in crisis situation. We provide care to women who can't afford to go to a clinic, or those women who can't travel to one, or those who are in transit and have been forced to migrate. Many of them are survivors of gender-based violence and forced pregnancies. And as you know, we live in a region where about 97% of us live in countries where abortion is completely prohibited or highly restrictive.

This situation which is [00:03:00] pretty challenging is exacerbated by the magnitude that we're seeing of migration and displacement. We're seeing the largest amount of people on the move ever. And we know that women and girls bear the brunt of climate change and political turmoil. We know that women and girls are the backbone of our society. And when disaster hits, they are, of course, they feel the brunt of this crisis.

And on several different dimensions. Families and social structures become fractured, leaving women who are usually the caretakers of children very much without support. We know because evidence tells us, and the stories of the women we serve show that the well-being of women is very much linked to the wellbeing of [00:04:00] children.

So, when women can be empowered to lead full and productive lives, children and families prosper. It's kind of obvious, right? And we have to keep repeating that, especially during times of disaster where gender inequality is, of course, is exacerbated by leaving children and especially girls in very vulnerable conditions.

The lasted evidence shows that when girls are in a conflict setting, they are 2.5 times less likely to go to school than boys. So it is different. Sexual violence is very prevalent. We know and we have known first hand from the experience in Haiti after the earthquake. In other countries that have been impacted by natural disasters, sexual and physical violence against women spikes following disasters.

And on top of that, we know also through the stories of the women we serve [00:05:00] that many of them cannot continue their regular contraception routines because of the collapse of the health systems.

So, as a federation of really locally owned organizations, what we do is we have a network of health care providers that provide care and work to provide care to women and girls that are most in need under these circumstances. We're growing our capacity to respond, and we're not going to back down in our fight to make sure that women and girls remain at the center of any humanitarian response effort. For a number of reasons.

The most important one is that we will need help in health care. Access to health care is a human right, and human rights have no borders. I'm very thrilled to have with us such an impressive panel. So I'm going to be looking forward to really engaging in this conversation. And I'm going to introduce now Alex as the moderator. Alex Sanger is [00:06:00] a lawyer by trade, a women rights activist by heart. He is the chair of the International Planned Parenthood Council and also the grandson of one of the three very brave women that founded International Planned Parenthood, Margaret Sanger.

So Alex, the floor is yours.

Alex: Thank you.

Thank you, Giselle, and welcome, everyone.

Good evening.

It is an irony that we're situated tonight at this piece of land at the former location of the Leake and Watts Orphanage, which was founded here in 1843 and was here until 1891. And this orphanage took care of indigent and abandoned boys and girls throughout New York City and were cared for [00:07:00] at then a bucolic setting. And here we are, the organizations that are represented here on the stage dealing with orphans, the poorest orphans in the countries that we represent. The panelists today, I’ll do a brief introduction.

Dr. Luz Towns-Miranda, psychologist and psychoanalyst, serves on the board for the Planned Parenthood Action Fund.

Marta Royo is the executive director of our local member association in Colombia called Profamilia.

Belmar Franceschi is the executive director of PLAFAM, our local member association in Venezuela.

Olga del Mar Reyes, a community social worker and student who has worked with survivors in Puerto Rico of the hurricanes. [00:08:00]

And Mayra Díaz-Torres is the clinic director from our local partner Profamilias in Puerto Rico.

Now, if you were listening carefully, I named three organizations that are the local partners of IPPF. None of which were named Parent Parenthood. My grandmother set it up that way because she wanted every country to create their own organization to do family planning and reproductive health and to call it whatever name resonated in their country. So, of the 162 organizations around the world that are members of the IPPF, there are five that have the name Planned Parenthood including the one in this country.

We're going to talk tonight about mostly Puerto Rico and Venezuela and the migration problems and refugee problems there. I want to start with our clinic director in Puerto Rico. Mayra, [00:09:00] give us a brief summary about yourself, because you've been on the job only a year. What were you doing before that?

Mayra: Well, before... Goodnight, thank you for being here. Thank you for having me.

I have always worked in the social arena, in the community-based initiatives. Before Profamilias, I was working in the Boys & Girls Clubs. They have 14 clubs in Puerto Rico. I was there for 16 years, and one day I said, “That's enough.”

And I moved to this amazing opportunity. Sometimes with the opportunity of a lifetime, you don't know you need it, but it arrives, and I'm so happy. It has been [00:10:00] only a year, but it has been the most rewarding and exciting year. Many hardships.

Alex: So you came to Profamilias after the hurricanes.

Mayra: Yes, I did.

Alex: So you leapt into the frying pan.

Mayra: Yes, I did.

Alex: With your eyes open.

Mayra: Yes, I did.

Alex: Tell us about the services that ProFamilias offers so that we can understand what we do in Puerto Rico.

Mayra: ProFamilias offer services in three areas. First, sexual education. It's important to children and youngsters to be properly educated in sexual health. It should be as normal as math and history. It's very important for them to have all the information they need to live [00:11:00] responsible lives.

Also, we work with contraceptions and with access to contraceptive options for the women, as Giselle was saying earlier; the time a woman decides to have a son or a daughter, the amount of sons and daughters that she wants to have is pivotal to her development as a woman.

And finally, we also work with sexual justice. We're very active in promoting the defense of those sexual and reproductive rights so that women can empower themselves [00:12:00] and live prosperous lives.

Alex: And then came two hurricanes.

Mayra: Yes, not one. Two.

Alex: And did everything you were doing stop?

Mayra: Yes.

Alex: So I understand you had no power, no water. Staff had no way to get there. Patients had no way to get to you. So tell us what it was like and the challenges of reaching the women and families who needed you.

Mayra: Well, we asked Puerto Ricans, we live in the Caribbean and we’re used to having these storms and these Hurricanes, but with Maria was completely different. It was a cyclone, super powerful. And nearly destroyed our island. But it passed, and the women needed access to their services. We were three months [00:13:00] without electrical power, but the women didn’t stop coming. So we needed to tend the needs as well as we could with the resources we had. But foremost, we were there.

We didn't have electricity, but we were there every single day to do what we were able to do with our conditions. Women were searching for the contraceptions, for the methods. Some of them were not available, some of them were. Some of them came with other necessities, so we tried as an organization of reproductive justice, we tended [00:14:00] to their needs.

Yes, we have here the staff to give you the service, but we also know that you need other type of things. You need water, you need food, you need counselling. So we were able to expand the reach in order to tend to their needs. We were, as I told earlier, three months without power. After three months, we have power some days.

And we’re still struggling as a country with that power issue. Obviously, there were problems before Maria that were exacerbated. Right now, we're much better [00:15:00]. We were able to bounce back. We're a very resilient organization, and we were there for our patients, which is very important to us. Even though we didn't have what we needed to give them, all they needed, but we were there, and we were able to tend their needs.

Alex: Before the hurricanes and after, was there a change in the methods of contraception that either you could get or that the women wanted? Did women change their behavior in how they were... ?

Marya: Yes, they need to because with the power outage some methods weren't available. The injections, we gave them the support they needed, we gave them alternatives. Some of them were able to adjust. Some of them [00:16:00] needed more time to adjust, but in all, all the needs were met as well as we could.

Alex: Right. And did you have trouble keeping your staff? Did your staff have trouble getting transportation to get to you? Have many staff left the island to come to New York or Miami?

Myra: Well, we were lucky. In our clinics the staff is very into their work and the organization, and they stayed. The majority of our staff we could retain. But the suppliers, the medical practitioners, some of them left. And it's very understandable.

Alex: Have you seen a rise in sexually transmitted diseases after the hurricane?

Myra: Yes. [00:17:00] A rise in the sexually transmitted infections, especially HIV, and it's very worrisome because it's in the young people. We have teens and young adults having these kinds of infections and it made us worry.

Alex: We're going to get into this later with Dr. Miranda, but you saw PTS, post-traumatic stress syndrome, in your patients?

Myra: Yes.

Alex: So maybe we'll have a commentary about that in a few minutes. But you saw that definitely?

Myra: Yes. And trauma. We're still dealing with the trauma. And some people lost everything. Their houses, their jobs, their significant [00:18:00] others because families were displaced. Some kids left their friends, their families, their known land to venture into another place, and after the trauma of the hurricane, you add up another layer of stress to that family, to women who are the head of the family mostly.

Alex: Tell me what... I can safely predict there will be more hurricanes. Tell me what has Profamilias, what are you preparing? What are contingency plans for the next one?

Myra: ProFamilias is very conscious about this possibility. We're in the hurricane season right now. So every [00:19:00] week comes with the possibility of something happening, but we learned a few things. We learned to be sustainable. We learned to strengthen the ties with the community. We learned to build and foresee and plan on our own sustainability.

Because we knew with this crisis how important we are to the families that we serve, and they deserve to have the assurance that no matter what, we’re going to be there. And that's a huge responsibility, and we're assuming it. We're creatively ongoing in projects that are not traditional [00:20:00].

We're making collaborations with other organizations, community-based organizations. That is a learning and a value that came of this crisis. We strengthened our ties with the community, with other organizations that would complement our services. And after Maria, if we didn't have... We tried as much as we could but if we didn't have the means or the resources necessary, we could refer to other organizations and that woman got the service that she wanted.

Alex: That will be a relief to Olga, who is and was one of your patients. Olga's also a community [00:21:00] social worker and a student. Before we get to your patient experience, where were you during the hurricane? What happened to you? Is your house standing? How is your family? Your dog, your cat?

Olga: Okay, so my dog is fine. Also, my parents are fine, but my home is not safe. At this point, I lived in 11th floor, and the balcony door just went flying. That was in 2017. The insurance was supposed to pay for that, and we're still waiting. We don't have money. It's thousands of dollars to repair that. So right now, if another hurricane comes, we are completely vulnerable. There is no way that... We can't have anything [00:22:00] in the house. When the hurricane passed, I worked in the government in the office... What would you call it?

Alex: Senior citizen's office.

Olga: Our senior citizen's office. So I had to work during the aftermath of the hurricane with elderly people, with people that were bed ridden. They didn't have food, they didn't have water, they didn't have transportation and we didn't either, basically. The people helping, we didn't have a lot of... We were suffering too, but we were the ones that were supposed to be there working, so we still did it.

Alex: And you had no power in your building. So you walked up and down 11 floors.

Olga: Yeah, every single day I had to go [00:23:00] up and down. If I forgot something upstairs, it was a nightmare. And it was really hard, like sometimes you saw people, like, in the parking lot just, like, thinking about, “Oh my God. I have to go upstairs.” And through all of this, it was dark because there weren't lights. It was dangerous. There was a lot of sexual harassment.

Like, when I went to my home, it was a safe place before, but because of all of this, there was a lot of sexual harassment in the streets. I was always with the pepper spray, the taser in my hands because it was not safe. During the hurricane, I had to go to my grandma's sister's [00:24:00] home. It was the safest home in our family.

But she is a very conservative Catholic, and so is my grandmother. They don't like tattoos. I have ten. They don't know it, and they obviously don't know I use contraception. So at that point I was using the ring. That's one of the methods that has to be refrigerated. It was really hard because my method was floating around in the cooler with the bottled water, and I was, like, always guarding the cooler to make sure that no one grabbed to see what was in there. It was very stressful.

We were in the apartment, there wasn't a fan, there wasn't... We couldn't open windows. And I was with my long sleeves and my sweat pants [00:25:00], and it was really hard. So even though my home was not safe, I left because it was just... I felt so repressed being there. And they are loving people, but it would be like... I can't even imagine because it's not something that's acceptable, and even though from the outside Puerto Rico may seem like an open-minded place, it's not. It's really conservative.

After the hurricane, a few days later I decided that I couldn't go on with the same method because it was really stressful. I didn't know if I was going to be able to refrigerate it and if I was going to be in that situation again. So I decided to change methods. I called and called Profamilias, but they didn't answer. So [00:26:00] I had to go the office. Normally that's nothing. I live in San Juan, and the office is in San Juan, so that's nothing.

But in this context, there was no gas. The gas lines were 12 hours, and then you got to the gas station, and it was over. You didn't have any gas. So every single drop had to count. So in this context I finally decided to go to the office, and when I got there, they were closed because there wasn't any power. And then they told me to come back, and when I came back there wasn't any power. I know that that was the reality of every single service in the island, because I worked in the government.

And I had to turn back people too that needed our help because we couldn't be in that building because the windows didn't open. So it's understandable.

Alex: So how long did it take you to get an appointment at ProFamilias?

Olga: Well, finally about... [00:27:00] I had to go about two or three months without any method. When they were finally able to... With all of this situation, they were finally able to give me the IUD, in January. So this was in September, and in January was when I was actually able to get this. And my decision was completely based on the hurricane because before I was super happy with my method. But then my body rejected the IUD, so they had to remove it, and that solution wasn't a reality for me.

Alex: Right. And you've had to change methods since, multiple times?

Oga: Yes. Since March, I've had to change methods three times [00:28:00] to see which one my body accepts. Definitely with the NuvaRing I never had any problem but it's really stressful to think that it won't be available in the clinic or that I won't be able to store it in my home.

Alex: All right. And Mayra, just to turn to you for a minute. Are you now able to get all the contraceptive methods in stock?

Mayra: Yes.

Alex: And available for the young people?

Mayra: Yes.

Alex: So for a young person, if I may call Olga young, comes in, she gets it with reduced and subsidized services?

Did you have to pay, Olga, when you came?

Olga: At that moment, I was qualified in a program, and I didn't have to pay anything. And I didn't have to pay anything for the IUD either.

Alex: And so tell me, it's now two years after the hurricanes. Have a lot of your friends left the country and come here? Tell me about [00:29:00] your plans.

Olga: Okay. So a lot of my friends have left Puerto Rico. Some looked for university programs to come study here because their situation in the university is also really hard. After the hurricane, my plan is to stay in Puerto Rico because I really have like... I love my island, and I believe that I have to stay and work for everyone and try to make everything better.

But I know that it's not easy. It hasn't been easy. For women, it's really hard in this context. The rights of women are in danger because they lose autonomy. When they cannot have access to contraception, when they can't have access to safe abortions to just [00:30:00]... Women that are in gender-based violence situations and relationships, they need a lot of support.

And Profamilias, they give that support. And in this context, it's really important that we have access to all of that.

Alex: That's a perfect segue to Dr. Towns-Miranda, who has been to Puerto Rico many times, including on a visit with us last fall. Tell me about the psychological impact of living through what our first two guests have lived through.

Dr. Towns-Miranda: As they've referenced, from the visits I've had in Puerto Rico and with experiences here, my impression is that the traumatic impact came in waves. So on September 6th [00:31:00], a million people were left without electricity when the category 5 Hurricane Irma went by. So already one third of the island was blacked out.

And then on September 20th, Hurricane Maria devastated the island. Many of the residents had already been without electricity for two weeks and would go on without it for another four to twelve months. The complexity of the traumatic event was and is layered and persists. It's not over.

The initial trauma was surviving Maria. It ravaged the island for hours, causing acute fear and destruction and deadly flooding. In the immediate aftermath, material losses were massive. Thousands of homes were destroyed, and cars, as you mentioned, which are vital in Puerto Rico, were drowned. Loss of communication with the island was wide, as well as with the outside world. [00:32:00] Multiple insecurities, as you've mentioned, were quickly evident.

Food insecurity, water insecurity, gasoline scarcity, cash scarcity to do with the banks being closed and no functioning ATMs because of the massive blackouts. The blackout would persistent for a year in some places.

Medical facilities, hospitals, acute care clinics, and any residential facilities was rendered inoperable and struggled to secure diesel for their emergency generators. And many failed. Many residents who relied on electrical equipment like oxygen died. The ability for staff to travel to their jobs was nearly impossible. Without communication, uncertainty prevailed for days, especially deeper in the island where the residents resided. Medical supplies and services most critical for chronic medical conditions [00:33:00] were unavailable.

Pharmacies did not open. In small towns, some pharmacists were at hand, but resupplies did not arrive for weeks, for months at times. Within days without electricity, deaths began to mount in medical institutions such as hospitals, nursing homes, and rehabilitation centers. One of our aunts, I have several relatives here, my cousin's grandmother died in a nursing home because she required oxygen. They just couldn't sustain it.

With the lack of electricity, vital for refrigeration for medication for chronic conditions such as diabetes, which is rampant in Puerto Rico, more deaths ensued. Dialysis patients were also impacted. There was no capacity to do any dialysis. In this desperate and chaotic scenario, women experienced a spike in domestic violence, sexual harassment, and the [00:34:00] accumulation of stress set off a wide range of symptoms in response to the chronic stress for aftermath. When we say chronic, we're talking months and months of stress.

There was a quick need for adaptation of survival mode, as most had to try and meet their needs during daylight hours. Once the sun set, they were plunged into darkness without the comforts of electric fans or air conditioners, and temperatures soared. And there were rainstorms as well. Daily activities that had previously been supported by electricity were now having to be executed in pre-electricity mode, from cooking to washing oneself, one’s clothes, one’s dishes.

And securing food and keeping food edible. Clusters of individuals could be found in pockets of locations where internet signal could be picked up. Notifying the family of your status was difficult on the island [00:35:00], as getting information was as well to the mainland.

Social media conveyed information, Facebook and most notably David Begnaud Twitter account provided a lot of information. He's like an honorary Latino man. Residents with some means soon departed the island, having camped at the airport desperate for flights to the mainland. Ill residents sought to leave for fear of health deterioration. The ones that could make it out. And slowly over months, they did. Some parents began to realize that the excruciatingly slow response would have an impact on their children’s school year and relocated.

The uncertainty of whether the move was temporary or permanent contributed to the anguish of entire families. Those that relocated faced adaptation uncertainty as well as the loss of their community employment and family on the island. [00:36:00] As the dire situation continued, the migration to the mainland mushroomed and the deaths directly attributable to the aftermath of Maria continued to mount with a surge of suicides.

Economic anxiety mounted. Many professionals were noted to leave the island. There was a crisis and the loss of medical staff. A particular concern that I heard on the national news was the departure of many OBGYN specialists and a lack of adequate prenatal care for pregnant women and reproductive services for women.

Alex: We were lucky at Profamilias not to lose staff.

Dr. Towns-Miranda: Absolutely. And one of the other agencies that the Hispanic Federation funded is‘Women Helping Mothers,’ which was at the core of midwives that travel with bicycles through the country and provide prenatal care and provide the service for free. [00:37:00]

Alex: So women ad girls are going through all this trauma. You're a psychologist. What do you as a professional offer them? What kind of help do they need professionally?

Dr. Towns-Miranda: They need to be able to find agencies and resources that they are familiar with. Like people started coming. They knew if Profamilias is opened, they could receive the help there. So getting that kind of help was critical. So it's important to appreciate that the impact went on for months. How many of you can imagine living in these horrible conditions for months?

Leaving your iPhone at home can cause significant stress for the day, never mind having to figure out how to live in this new reality without electricity and with no predictable end. Profamilias strove to open quickly to [00:38:00] address the needs of the women who were familiar with their services and were able to reach their offices. With the increasing austerity measures being imposed by the oversight board in Puerto Rico, the specter of the dramatic reduction in funding of medical care and the reduction of quality of education through the closing of hundreds of schools, it is raising the likelihood that Puerto Rico would resemble the post-Katrina phenomenon.

For the traumatization of the vulnerable, low-income residents who make up much portion of the island. I forget what the high percentage is, of low-income families—57% of the people in Puerto Rico live below the poverty line. In Puerto Rico, the poor did not return to New Orleans. With their homes destroyed, they remained or they went for refuge and did not have the means to rebuild. In Puerto Rico, many will not return, and more will leave due to the basic needs [00:39:00] of basic health care and quality education for their children.

Many also lacked the means to rebuild. On the island everyone has a Maria story. There is palpable anxiety with the advent of each hurricane season. Uncertainty prevails for many families due to the slow recovery.

Alex: The families forced to flee their homes or come to New York, you treat families as a professional...

Dr. Towns-Miranda: I volunteered at the Red Cross because there was such a need, and they kept asking for Spanish speaking mental health providers, and I'd never joined Red Cross, but I finally responded to the appeal... When I was working with the Red Cross between September and January, each day brought a wide variety of individuals and families with varying degrees of shock and distress. The center was well set up [00:40:00] to provide a wide range of resources and services.

As you might imagine, most difficult was housing. Most were being put up by low-income families and over credit conditions, and restrictions such as section eight. Consequently, a portion or a house in shelters. Those who had prescriptions from national chains such Walgreens or CVS faired better, as their information could be accessed from the national database.

Others are required to receive medical evaluations and were referred to HFC facilities in order to renew prescriptions if they knew exactly what they were being prescribed. Many individuals had been without both medical and psychiatric medications and supplies since September. And we were seeing people in November, December, and January who had gone without their medications.

Uncertainty prevailed in all areas of their lives. How long would they remain with their host family? Could they return [00:41:00]? Should they return? When should they return? Also palpable was their sense of loss. Friends from school, family members, some came because they were ill and had to leave others behind. Each story was distressing and pain filled.

And very often when they started talking about the event, or if you've ever seen someone who's gone through a significant trauma, they could be talking about something not difficult, and suddenly their whole demeanor changes because they were back in the event.

Uncertainty has continued with many of these Maria refugees since the recovery has been so slow and the means to rebuild escapes many of them. And with the impeding austerity cuts, more maybe fleeing.

Alex: I want to move ahead to talk about Venezuela, but [00:42:00] before I leave Puerto Rico, you and your family have done a lot to raise awareness there. So what is your suggestion for the audience?

Dr. Towns-Miranda: Well, for Puerto Rico, I think we all clearly early realized that the government’s response is very slow. So with the help of the Hispanic Federation our family worked very hard to get many, many donations through that particular agency. And then worked with local municipalities to distribute a lot of resources.

In particular I wanted to announce, with respect to this… Because of my visits to Profamilas in particular, the Miranda family and the Hispanic Federation Unidos is launching a five-year fund for reproductive health in Puerto Rico to fund sex education and health services for marginalized women. [00:43:00] It's going to be a million dollars over five years, and it's going to have three pillars.

One is to provide funding for sex education, which is so important and needed on the island. The second will be for training of young medical staff. Half of the abortion providers in Puerto Rico are 70 and older, and it's very difficult to attract new medical staff. We're looking at loan forgiveness as an underserved place as well as subsidizing rotations through and training Puerto Rico through medical residency programs.

And I forget what the third one was…

And then because poverty is so prevalent, although [00:44:00] a lot of people have some basic insurance, many of them can't even afford to get reproductive services. So a portion of that, the third pillar, will be to provide funds for women with no means to be able to get services including termination. It would be too costly for them.

Alex: Thank you. Fantastic.

We're going to hear more about the effect of trauma on the patients and clients we serve. I want to turn to Marta, the director of Profamilia Colombia. And I must say that Profamilia in Colombia is the most amazing clinic I've been in on the planet for the following reason.

When you go to the front desk, they have across the front, they have the photographs of five women [00:45:00] who have changed history, or that they think are emblematic in some way of feminism or reproductive rights.

And the five women are Marilyn Monroe, Bettie Page, Madonna, Frida Kahlo, and Margaret Sanger. So my grandmother made it to Bogotá.

So Colombia can't catch a break. It's had a civil war for 40 years and now has Venezuelan migrants coming in. And you're caught in the middle trying to provide health care. Tell me first about the civil war, the conflict. There is a peace accord mostly, but talk about the effect of this war on women and girls and how [00:46:00] they're coping.

Marta: First, I have to say you have a very good memory and eye, because it's not easy to remember those five women that we choose as representative of the advances that the world has regarding sexual reproductive rights. And thank you so much IPPF team and Alex and Giselle for putting this together. And a special thanks to all of you for taking the time and coming all the way here to hear to our stories and the challenges that each one of us faces when it comes to advancing our mission, which is the defense of the sexual reproductive rights of all people.

And yes, you’re right. It's more than 50 years. Colombia is an amazing country. I have a saying, a personal saying that goes that 'Everything that is good in Colombia is amazingly good.' People, [00:47:00] what we do, the way we live, but at the same time when things are bad, people can be really, really bad. So we have been suffering for more than 50 years in an extreme, extreme violent context.

And as you all share, you know different reasons would at the end, the fact, the true fact is that women and girls suffer disproportionately the consequences. Not only of humanitarian crisis or natural disasters, but of internal conflicts like the ones that we've seen for more than 50 years. And sadly, most of those consequences are closely related to sexual-based gender violence.

I mean, rape. Who gets raped? Mostly women.

Who are forced to [00:48:00] carry out a pregnancy? Women.

Who are forced to have abortions? We have seen cases of girls 18 and 19 years old who had had nine abortions, forced abortions under the armed conflict of Colombia.

Who are forced from their homes?

Who are still searching for their children, for their families, for their husbands and still do not know where they are because even though—you are right, Alex—even though we have a signed peace treaty for the past two years, the truth is that, what does it take for a whole country to leave behind 50 years of internal armed conflict and finally reconcile with a foreign story?

It takes truth. We need the truth to come forward. [00:49:00] And that has not happened. Even though, and I have to recognize that the efforts our government, our past government, have made trying to find and create spaces through which we can finally reconcile with everything that has happened. They have created the historical memorial center.

They have victim units, they have even appointed a very important lawyer in Colombia as the high commissioner for the stabilization and Consolidation of Peace processes. And all of these are spaces through which a safe place has to be created in order for victims, survivors, and aggressors to come and put the truth and speak about it. That has not happened.

For the past two years on the contrary, what we're experiencing locally [00:50:00], and I have to say that maybe the image that we're sending is that we're moving ahead with the peace process, but the truth is that for Afro-descended women, for the indigenous population, for rural women, that peace has not arrived yet.

We have not seen it. Why? Because we're still suffering from a huge amount of communities that are being displaced. In this year only, only in these three months of the year, 21,000 families have been displaced from their homes. Why? Because the drug trafficking business is still going on. Because there are a lot of those guerrilla soldiers that dropped their arms who are going back to those rural spaces. And why is all this happening?

Because we do not want to face the truth of what had happened in our country. And again, when it comes to the truth [00:51:00], what we have seen in the spaces, and when I was listening to you how important it is, it's not only having accesses to services, it's not only being able to recognize your rights, but it has to do with all the stereotypes regarding women in Latin American countries. Because the truth is that we still live in a very machista environment, very patriarchal.

They are still the ones who are deciding all our lives. They are still the ones that are deciding in our autonomy.

Alex: And that will be our next program at the Cathedral. About how to deal with the men in Latin America.

Marta: That definitely has to be a purpose.

Alex: So, Marta, I want to move on to the border between Venezuela and Colombia, several hundred miles long, varied terrain, and you were operating clinics there. Tell me what you were seeing and how are [00:52:00] your clinics coping? How do you get supplies? How do you get staff? And what are you seeing with the patients and the families?

Marta: And getting together with what I was sharing with you is we started seeing these huge massive movement of migrants coming into a hostile, already hostile country. We share 2,200 kilometers, Venezuela and Colombia. And you can cross between both countries throughout all those 2,200 kilometers. There are three official entry points, but the rest of the passes are through mountains, rivers, deserts. And we have 35 clinics in the country. And we provide in a year around 1,600 mobile brigades. And it is through these two models through which we are reaching women. [00:53:00]

I think it's very important to mention something: that when the crisis started, when the migrant crisis started, we were invited to most of the technical tables that we created around the country from the government and the local governments. And I can tell you that in none of those spaces sexual and reproductive rights were there. We were invited because we were a provider of services but not because we were a specialist in sexual and reproductive services.

And this is very important. Because the whole country rushes to provide clothes and blankets, food, but when it comes to contraceptives, “Mmmm, you know, we're not sure if we want to really help about that.” When it comes to delivering something as simple as sanitary napkins, “Mmmm, you know. It's not very nice, it's not nice. We don't want to really donate that.”

That was one of the first points that I want to make [00:54:00] because it is very hard to get in those spaces sexual and reproductive service. It's not easy, it's not fashionable, to put it in some way. Why do the woman started coming to our clinics? They came in such big amounts that some of our clinics collapse? The [inaudible] had to be closed. The police will arrive to some of the clinics asking us, What are you doing here? What are you giving for free? Because why are there so many women? And they think the main reason is that in Profamilia they found all of our staff are people who hear them without judgement.

Almost all of the women that have managed to arrive to our clinics, or the ones that we have served through our mobile brigades, have suffered some type of sexual gender-based violence event. And I can share with you [00:55:00] two of the last stories that we've had.

Marcella, 19 years old. She was approached by three men crossing the border. These three men told her, “We can help you pass undetected by the police forces.” They hold her almost for a week, abuse her for a whole week. When she finally managed to escape, she found work in a house, and she found out she was pregnant. Her employer knew about Profamilia. She helped her get to one of our clinics, where she had an abortion.

She did not want to announce what had happened to her because of her fear of being deported back to Venezuela.

The other one is a case that you [Giselle] were able to share with us when you visited our clinic in Riohacha. Sylvia, 16 years old. She was captured by one of the many sex trafficking groups [00:56:00] that have a booth all around the border. She was held captive for 15 days. She was forced to perform sexual labor for many, many men. She again managed to escape. She arrived at one of our clinics, and she found out that she was pregnant. She was there for a visit, she just wanted a contraceptive. During the visit right there she found out that she was pregnant. We were able to provide her with a safe abortion service right there.

These are many of the stories. The truth is that they keep coming to our clinics, and I think that the biggest difference, as I told you at the beginning, is that we truly hear. We don't judge them. And we try to accompany them through the whole process because it's not only that they have to suffer being displaced from their homes without nothing left, many times leaving [00:57:00] their children. As a woman, most of them already have children in Venezuela.

Leaving their children behind, being abused trying to cross the border, and reaching a country where we already have a lot of things going on. These are the lives of girls and women. Also, we have seen some cases of men, small boys that have also suffered from sexual violence. And this is the reality that we're facing right now.

Alex: And in the middle of all this and the need for increased clinics and staffing, you lost over a million dollars in USAID funding because of the global gaggle, which is a US government policy that denies US foreign aid for family screening services to organizations that perform legal abortions in their country or advocate for legal abortions. So the US government [00:58:00] has not been your friend in this.

How do you make that up?

Marta: Quite a challenge because it's not only that they stopped the funding that we usually used to get through the USAID around $1.2 million, through which we would carry out comprehensive sexual and reproductive rights and health delivery. And this is very important because it's not only that the funding stopped because we advocate and provide abortion services.

But it expanded with also an expansion and also affecting everything that has to do with HIV programs and Zika, which was an epidemic that started affecting many of the countries in Latin America. And at the end, the message that something like they got wrong is sending the countries that have been affected is [00:59:00] that it doesn't really matter the loss that you have locally.

It doesn't really matter the poverty conditions that affect our countries, abortion and safe abortion is a matter of public health in all of our countries because many women die because of unsafe abortion or the consequences of going to a clandestine clinic, which is not even attended by a professional. Those effects can accompany the life of a woman forever. It's not only that. It is a message that that loss does not matter.

That women’s lives do not really matter because they are in this crusade of righteousness and imposing their own way of thinking. What we have been able to do is again, thanks to IPPF, we have gathered some resources, and through them we're attending subsidizing [01:00:00] the processes that we provide the migrant population that is coming into Colombia.

But also, the complete impact was that we have to close four of our clinics in four of the poorest communities in Colombia mainly on the pacific coast which is an Afro-descended and indigenous community. We have to fire 110 people from our staff. And the way we have been trying to keep on providing services to these places is through the mobile brigades.

Again, it's a huge difference when you are able to carry a comprehensive program through which you can empower a whole community by just delivering a brigade through which you just provide services, very concrete assistive services. So even though we try to do our best, at least it's something at the end we know that it is of huge difference for those communities [01:01:00], especially regarding the possibility of having a different future and developing, believing that they have a different future.

Alex: I want to turn now to the other side of the border in Venezuela and Belmar. We’re going to have a semi-simultaneous translation. Unless someone wants to try out their high school Spanish translation with Belmar.

You're the director of our member association in Venezuela. You operate four clinics there. You're about to open the fifth you tell me. Four million people have left Venezuela in this current crisis. Give us a quick overview about what's happening in the country. What's a typical day like? Is there power? Is there transportation? Is there safety on the streets? So, if you can give us a [01:02:00] view of that, thank you.

Belmar, translated by Giselle: Thank you Alex for the invitation and to me [Giselle] for the translation.

So, she's going to share about the situation in Venezuela and how today looks like, not just for health care providers, but for women and girls in the country.

She feels very privileged because she lives in the capital.

She feels very privileged [01:03:00] because in the capital city the situation is slightly better. The shut downs of water and electricity are less frequent than in the rest of the country. And there is some sort of public transportation, limited but still existent.

In the country side, the situation is very different. There can be blackout for 24, 48 hours, very often.

And there is really no water, no public transportation, so people can’t go to work or take their kids can go to school in any way.

I think that extends the irony of a country that is [01:04:00] one of the main producers of oil and right now doesn't have any gasoline.

And while the country has advanced in the past 20 years, about access to water right now, it doesn’t have the capacity to really get water for people.

About 50% of health care provider doctors have left the country.

Alex: Let me ask you about, have you lost health care providers at your clinics?

Belmar: So, yes. They have lost a lot of health care providers, but also of other professions as well.

Alex: And so, talk about the difficulties every day of [01:05:00] getting contraceptives in your clinics, of getting ultrasound machines to work if there is no electricity. Talk about the day to day operation of your clinics.

Belmar: What is really difficult is that all of our providers, all of our staff working in the clinics are not different; they have the same exposure to the same challenges that anyone else living in the country.

So, in addition to not having water, electricity, and all of it, which poses a lot of challenges for running a health care services, the institution also has a lot of challenges in accessing basic commodities to run the centers.

I don't even want to tell you about when a piece of medical equipment gets damaged, and you simply have to spend months trying to find a way to repair it because the technicians are not there, or trying to ship some of the pieces from out of the country, or take the equipment out of the country to have it repaired.

And they have been able [01:07:01] to bring contraception. They have been able to keep some sort of dialogue with the government for them to allow contraceptives to enter the country both through donation, through our IPPF work, and that's the way they have been able to function.

She's pretty sure that the reason that the government still didn’t close them down or attack them has to do with the fact that they know that they are the only place for women to access contraception in the country today in a consistent way.

But we have to be very careful, and constantly live on the edge [01:08:00], and we have to be very careful about how we engage and what we say, what we don't say so the government doesn't close down our clinics and just exacerbate them [the problems].

Alex: In the last few years, you've had the combination of the government malfeasance and disorganization combined with the Zika crisis, which Venezuela faced. And I'm interested in how women and girls have reacted to these twin crises, and what are they doing about their sexual and reproductive lives, and how they are changing their behavior and their contraception and their child bearing.

Belmar: Zika has been an invisible problem for the country.

[01:09:00] In 2015 they had projected about 70,000 cases of Zika.

But for 2016 the public association of Venezuela had projected about 700,000 cases of Zika.

So, for the government Zika doesn’t exist in Venezuela. They completely ignore the fact that it is there.

She cannot begin to explain the consequences for women. Not only in that Zika [01:10:00] is a sexually transmitted infection but also the likely result of having microcephaly, a pregnancy with microcephaly, and the more than 200 conditions associated with the disease when children are born with microcephaly.

So, PLAFAM conducted some research on the effect on women, and they clearly found that the state had abdicated them, abandoned them when they found out they had Zika.

Health providers didn't have much information.

And, as always, women sought help [01:11:00] with other women.

I'm trying to create support groups seeking information from other countries like Colombia where more information was available.

And we don't have in the country providers that are prepared to both help children with disabilities as a result of Zika or women who have gone through this experience.

Alex: So, with this picture, let me ask of a final question. You get up in the morning, what gives you hope [01:12:00] to carry on?

Lady: When she gets up in the morning and goes out, she sees lines of women, very young women, that are lined up for sexual and reproductive health services.

When she opens the door of the clinic, she sees and greets women who have traveled very long distances to get there and during [01:13:00] very difficult circumstances, and many of them have, that come from the countryside, have camped in front of our clinic for 24 hours for them to be able to be seen by a doctor.

And so that gives me hope along with the team of very competent health care providers who also get up every morning to go and help women who need protection against sexual and reproductive health, sexually transmitted diseases, forced pregnancy, or anything else that they need [01:14:00].

Alex: I've been involved with Planned Parenthood for most of my life. And I've been surrounded by extraordinary women. But what a group today we've had the honor of listening to. I thank you all for sharing your stories and your work with us. The challenges that we and you face are ongoing. I can predict there's going to be more climate disasters and political disasters in this hemisphere and worldwide, but we at Planned Parenthood and our local organizations are the first responders for women and girls in crisis.

And we know you and you know after having heard these stories from the local providers, the local organizations are the best. They are on the ground, they know the communities, their staff know the patients and [01:15:00] the women and girls that need us.

And we know what community is needing, communities trust us to deliver the services that they need. So I just would like to ask our audience, to thank all of you.

Thank you.


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