Family Planning Around a Campfire
To reach the village of Kitugutu, you must be prepared. “The road is not good. You have to move out of your car and walk. It can be terrible, and on a motorcycle—deadly.”
None of this stops Harriet Kengonzi, a registered midwife, from making the trip. Pathfinder regularly transports her and a team of providers to this remote area in western Uganda.
“Since April, I’ve been here five times. Whenever I have time off from the hospital, and there is outreach, I come. But today is different.”
For two days, with the help of Pathfinder and our local partners, Harriet and her team deliver critical services—family planning, maternal and newborn care, child immunization, and HIV—in a network of tents.
Then, at night, they build a campfire, relying on its magnetic glow to attract villagers. Groups of local men, who are key decision makers in their community, warm themselves beside it, while they engage in discussion about their sexual and reproductive health.
“We announced the mobilization very well,” Harriet says, her face glowing. “We got huge numbers. Tomorrow, we expect even more.”
Q&A with Harriet
This month, at an outreach clinic in one of the most remote parts of Uganda, Harriet sat down with Pathfinder Uganda staff for a Q&A about her important work.
Why are you here?
I’ve been here in this village five times. Whenever I have time off from the hospital, and there is an outreach, I come. I first came in April.
Today is unique. We are camping at the site. We are going to be with the villagers for two days.
Can you describe what it was like when you arrived this morning?
By the time we reached the site, it was around 9:30 AM. People were already waiting for us. In my department, I couldn’t even come out to take the number of people. I worked on around 50 mothers. My role in the camp is antenatal care, examining pregnant mothers, counseling mothers on hospital delivery (although it is very far).
It’s around 60 KM (~37 miles) to nearest hospital. If a woman has complications during labor, her life is in danger. She can die. The hospital is too far and there are no midwives here, in case a woman goes into labor in the middle of the night.
You talked with 50 women today. Did any woman’s story stand out?
One woman I talked with has been delivering kids here at her own home by herself. She is carrying her seventh pregnancy. She can die during that time, when she has nobody to attend to her.
How will today, and what these women experience, help them?
They are accessing services. Today, the women were happy. I examined them. Some don’t know how old the pregnancy is. They’d ask, “Am I almost delivering?” when the pregnancy is in a very early stage. Others, barely show, but the pregnancy is coming to term. I don’t think they have 2 weeks, and they didn’t have any idea.
I have encouraged most of them to go to the hospital. Said, “You have little time. Your baby will soon come. You better begin moving toward the health center.”
Was everyone receptive to what you were telling them?
Some still say they can make it at home, the way they used to. They need a lot of counseling and education. We are losing very many mothers.
Why is their need for family planning urgent?
The fertility rate here is very high. When parents bring their kids for immunization, I can see the birth spacing is very poor. The attention given to those small kids is not enough. The more babies a mother delivers, the weaker she becomes and the more complications. So family planning is very important.
Why don’t more couples use it then?
Some think implants, like Implanon, can reach their heart. Others fear that when they use it, it will destroy sexual pleasures. They need information. When we come out here, their anxieties are lessened. When you really educate people about family planning and how it works—they really USE it.
How do you educate them?
First, we point out all the methods we have. Then we talk about each, help a woman select the one that is right for her. We also give women our phone numbers. “Call on me and I will advise you,” we say. And we explain, “I personally have used that method.” They have developed trust in us.
What about services for young people?
I admit—before I had a negative view of a young person who comes for family planning, that they are too young. But my attitude has changed. Pathfinder has trained me in youth-friendly services. I know that if a young girl comes for services, and I don’t give her family planning, she will still have sex and possibly get pregnant. She may try to have an abortion and die. I have learned to counsel her and give the method.
Have you seen changes since coming here?
Yes. Take this one woman. Today, she said, “It was really terrible for me. I was pregnant every day, suffering.” But now, with family planning, “I’ve been able to do something for myself. I can dig. I have tried to construct a house. I am free. I can get up.’
What about the other services, like immunization, how are they helping?
Before we started, you’d meet a two year old who has never had any immunization. At two. Nowadays, since we’ve started doing outreach, it is flowing. They bring the child every month.
It’s important that villagers can get all the services close. Before, they couldn’t carry all of their children to the hospital; it was too far.
How has this village benefited from the program?
What I see—this program has promoted their health. Kids are being immunized. Mothers are offered services. They are treated before they ever reach complications. Also, people are treated for HIV and getting family planning. These services are improving their health and their standard of living.
If you had one message for Pathfinder’s supporters, what would it be?
It’s a request. Please help us get more supplies, so we can really be making something permanent. Maybe even train more providers who can stay here, until government takes up the work. People are suffering and really need services. Villagers ask me, “Can you stay at least for a week?” I really feel bad that we cannot do that right now.