Family Planning

 Brigit Teaching Family Planning

In the evening of Monday we were starting to have a clear idea of what other teaching needed to happen through the week. As we sat down to another delicious meal of potatoes, coconut milk soup, rice and greens that had been so lovingly prepared by Gina, Lyn and I shared with Mike what some of our thoughts were: stages of normal pregnancy, stages of labour, positions for labour and birth, breastfeeding, major problems in pregnancy and birth, family planning and general first aid. As we ate, with Gina sitting with us, her husband John joined us. We didn’t know it at the time but John had been our boat skipper. Gina told us she had grown up and been educated in Madang, then married John who was from Yamen. They had been married for 7yrs and sadly had not been able to have any children. John had a 9yr old son from a previous relationship and he lived with them in Yamen now. Gina was also caring for her 3yr old brother. They are such a beautiful couple and we just had the sense that the fact they were unable to have children together was a very difficult thing for them. Amazingly, Mike knew exactly how they felt because he and his wife had experienced infertility for 12 years. Mike shared that after many years of praying to God asking for children, his wife one day woke up after having a dream. She said she was going to have a baby. And 9 months later along came their first child. They now have 3 children. It was such an amazing story and I know it really encouraged John and Gina. Mike then prayed for them both. There’s something powerful  when a person prays for someone having had a similar experience; it adds depth and they know what to pray. I’d like to think that Gina will fall pregnant soon because of our prayers for her and John…

After John and Gina, came Philip and Maria. Philip is the Merisen Man from Yamen and Maria, his wife, the Village Birth Attendant. Our first meeting with Philip had been quite awkward. It was earlier that day at the first session which we had tentatively called ‘womens business’, a time to hear from the women what they felt the problems were in relation to deaths in pregnancy and childbirth. Village life is very paternalistic and we were aware that this opportunity was rare for the women to have a voice with ‘people in power’. We had already asked Matteu, the Health worker to come back in the afternoon and he very graciously went to Mike’s session on leadership instead. He seemed to understand and get the idea that it was women only for the morning. But Philip, well he wasn’t going to budge. He sat at the back of the church with a folder of information and a look of distrust and offense. ‘Oh no’, I thought at the time. ‘This guy is unhappy and probably been offended by our intrusion onto his turf’. I remember saying to Lyn that we were going to have to just go on as if he was not there, and then really butter him up to get him on side.

Lyn was awesome! She did such a great job talking to Philip, listening to him, sharing ideas with him and including him in everything we did from then on. I have to say that if it wasn’t for Lyn, our experience may have been very different because to be perfectly honest I didn’t have the time or patience to deal with this guy and his ego. I really felt I had a job to do with the women and couldn’t be bothered stroking ego’s while there were lives to be saved and traumatised women to be supported and equipped. I don’t mean to be rude and flippant because I’m very good at stroking egos when it is needed to achieve trust and respect and get a job done, but in this case I felt very single-minded about doing what I came to do: teach the women. It was another example of the fact that God knew what was needed and He provided for every need, even supplying Lyn to attend to the Merisen Man, opening the way for me to have unobstructed access to the women.

 Maria, VBA from Yamen

Back to the reason Philip and Maria came to visit. I think it’s because Lyn had paved the way! She had included him, acknowledged his status in the community and invited him to partner with us in teaching the whole community. He then felt comfortable to approach us, with his wife. Again I have to say that I felt a bit afraid of Maria. She wasn’t like a lot of the other women who had a very warm and friendly face. In the whole week I never saw her smile and I didn’t feel comfortable in her presence. But I knew we had to work with her because this was after all her village and she was the VBA. ‘Be open and gentle Sara’ I kept reminding myself, ‘she may be feeling afraid of you. It’s your job to put her at ease.’

It was great having Mike with us for this conversation – such a wise, gentle guy. A man of few words, but each word carries such depth and insight that it moves through space with its own momentum and carries meaning that transcends the actual conversation. Little is actually spoken and yet a whole lot is said.

Lyn and Mike initiated the conversation, asking about them and their family, then about their roles and responsibilities in the community. We were starting to get a clearer picture about all the different health roles: Merisen Men and Meri (Medicine Men and Women) are volunteers who run the first Aid posts, they too have had a little bit of training. They dispense medicine, provide first aid and can refer people to other health services or the hospital. Volunteers are people who help and have had no training. A Health Worker is a paid person who has had more training, they are not a nurse or a paramedic. I’d put them on a par with a volunteer ambulance officer here in Perth, but the Health Workers are paid by the government. They service a huge area and are based in their village with a health centre. It was hard to understand the difference between a health centre and first aid post, but it appeared that each village had a first aid post which was run by a MM, some had a health centre that had a bit more equipment and was run by trained paid Health Worker, but we’d also heard from the women that many of the health centres were closed because of no trained person to run it. Village Birth Attendants are volunteers who assist with births, some of whom have had training, but mostly untrained. Maria told us there was no antenatal care, the VBAs didn’t form a relationship with the mother before the baby was born; they were actually only ever called when there was difficulty in labour and the mother was nearly dead anyway: what an awful job. Really they were female undertakers. No wonder she didn’t have a smile on her face!

We started to talk about a few more issues that they as the health carers in the village felt needed addressing. And so as we talked, the ideas that Lyn and I had about the teaching sessions became even clearer. Together with Philip and Maria we formulated a plan: a class outline for each day. We discussed running a clinic, but mainly to teach the MMs, VBAs and volunteers. Lyn liaised with Philip when the best time for that would be and the logistics of where to hold the clinic. She arranged with him to meet the next day and see his first aid centre. He seemed to be more relaxed and was happy to be included and regarded as an important link with the community.

So, Tuesday morning we awoke to the sounds of a drum beat alerting the villagers to get up and prepare for the day. Devotion at 8am, teaching starting at 9.30am. For breakfast we generally just had a few wheatbix, warm powdered milk and chopped banana on top. It was delicious and probably a good food to begin the day with to sustain us through a busy morning.

On a personal note, the thing I had dreaded the most had started the previous day. My monthlies! But thankfully it wasn’t as bad as I had imagined. We had our own longdrop toilet (liklik haus), complete with spiders and raised box to sit on (quite comfortable really as long as the previous person had aimed straight!). Thank goodness for sanitizing gel! I don’t know how we would have survived without the stuff because it was a tricky walk to the river as it was quite low. We had to walk down a steep sided bank to get to the water. We had our own supply of rainwater which we had brought from Wewak, but its difficult pouring water over your hands to wash them. Good old sanitizer worked well. Lyn and I had a small bottle in our pocket for all occasions and then we had the mega bottle for stocking up and when we ran the clinic. So, toileting was a little more complicated than usual, but not as bad as I’d expected. Fortunately my monthlies were not as bad as they usually are and thankfully I didn’t experience the pain and dragging feeling that women often have at this time either. Thank you Lord!

 Liklik Haus

Our first session for the morning was Family Planning. Many women had asked me how to ‘space’ the babies. I was a little rusty on the topic and so asked Brigit, the woman from the Catholic village of Kambot, to teach. I identified Brigit on the Monday as she spoke very good English and had obviously been well trained. She has been teaching Natural Family Planning in her village for 20 years and had recently had some teaching from the Australian AIDS council on AIDS prevention. She said that in her village the women only have 3-4 children, whereas in Yamen and many of the other villages the women were having 10 – 15 babies each!

The sticky point about the presentation for me was the Catholic teaching. Condoms were ok to stop the spread of AIDS, but they were a definite no, no to prevent pregnancy. I found this intriguing. There were a few moments when I gulped hard and wondered whether I should intervene, but then when I balanced what she said which was controversial against the practical factual information which was good, I sat back down again and waited my turn. When she said that the minute the sperm fertilises the egg (while pointing to a chalk drawing of the fallopian tubes) the Spirit of God enters and so if that is deliberately prevented from growing into a person, then it is an unforgiveable sin. Firstly, ‘unforgiveable sin’ is not a biblical teaching. There is no grading of sins in the bible. That is a manmade concept to make some things people do appear worse than others, therefore they need more forgiving. Jesus died once for the sins of all. All sins. That’s what I find so beautiful about Jesus, and it is so simple. He died for all. No matter what you have done in your life it is forgiven. And he goes on to say, ‘sin no more’. So receive the forgiveness for something and then don’t do it again.

I had to let that one slip, to allow the relationship to remain good and respectful so that all the other teaching would be well received. I didn’t want to undermine her in front of the other women.

I think the women really got a lot out of that session. The teaching was totally new to them. There was a lot of interest in trying to ‘make a man or meri’ baby. One woman asked whether boys came from one ovary and girls from another. And there was interest about twins – because so many women have so many babies, there are lots of twins…

Once Brigit had finished and we’d answered all questions stemming from her presentation, Lyn spoke about AIDS and the use of condoms. What a great way to finish the morning. AIDS is a real problem in PNG, but particularly in the main towns ans cities. In the villages it’s not such a problem, but if the men are travelling to the towns to sell goods, the potential for them to have a ‘rod bel’ (make a pregnancy along the road!) was high and thus the risk of passing HIV to their wives back in the village also very real. I did see a couple of women who had the HIV AIDS look about them, but otherwise we had no idea how many women were infected with the virus – principally because there is not the antenatal screening like there is in Australia because there is NO antenatal care. Anyway, Lyn did a fantastic job giving an overview of HIV, how it is transmitted, how it is NOT transmitted as there are many rumours circulating that are based on fear and misinformation. She then went on to give a demonstration about the safe use of condoms using a lovely big banana. Due to the heat and humidity, the banana ripened rather quickly and by the end of the visual demonstration of how to safely put on a condom, the end of the banana was drooping and coming apart!! Lyn and I just laughed and laughed. She then finished the session with an interactive condom game which she got from Family Planning Association WA. There were a series of pictures with drawings aimed at Aboriginal people. Lyn put the pictures down on the ground in jumbled order and then the women had to place them in order. There was much discussion which was wonderful to see and they really took the activity seriously. After about 10 minutes the task was finished and then Lyn ran through the proper order. They had done well.

It was now time for lunch and a well earned rest.

 Playing the Condom Game