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Women Leading Us Through the Pandemic

Cesaltina Mungue has a way of putting Pathfinder’s challenges during the COVID-19 pandemic succinctly: “It is not enough just to have COVID information,” she says. “Regardless of COVID, sexual relations happen without protection, so it is necessary to prevent both COVID-19 as well as unwanted pregnancy.”

The heart of Pathfinder’s challenge in the last eight months was just that – continuing our critical sexual and reproductive health work in an era where COVID-19 complicated nearly every decision. Lockdowns, supply shortages, and at times, a fear of going to health facilities due to COVID-19 have challenged the continued provision of sexual and reproductive health care.

But our staff, and the communities they work alongside, are more than up to the challenge.

Cesaltina works as part of Pathfinder’s MAIS project, which encourages the use of modern contraception to prevent unintended pregnancies in six districts of Mozambique.

Abelarda da Silva, a nurse affiliated with a MAIS-supported public health facility, administers medication to Jessica Adelaide in the maternity ward.

It hasn’t been easy. Gildo Américo, a Monitoring and Evaluation Officer, felt the impacts of COVID-19 firsthand. Gildo’s job is to review data, report on the health center’s outcomes, and support health providers in data collection. In an era of COVID-19, this work is even more critical. “Because everything we produce,” says Gildo, “ends up going to the Ministry of Health and serves to inform decisions – and this ends up changing what is government policy and people’s lives in general… It’s a big challenge.”

But they are up to it. While meetings used to be pretty large, staff have had to adapt both numbers and priorities.

“We used to hold meetings with 20 and 30 participants,” said Gildo, “but now with the pandemic we have reduced the number to 10-12 and the meetings are more to discuss issues that are challenges and needs of each health unit.”

Gildo Américo, Monitoring and Evaluation Officer, health center at Nlhamanculo

Across Mozambique, Pathfinder staff are working to reach women, girls, and their communities with continued care. Our RARE project operates in Gaza, Manica, and Sofala provinces, bringing critical care to tuberculosis patients, and antiretroviral (ARV) treatment and support to people living with HIV.

In this work, Pathfinder staff face a constant challenge – destigmatizing HIV, while ensuring consistent adherence to medication to keep patients and their families healthy.

“My job makes people’s lives change,” said Carmelia Mucachua, an activista with the RARE project. “The patients I have visited, they learn through counseling, they understand, and sometimes ask questions and ask for clarification of things they do not understand.”

Carmelia Mucachua, “activista”, working on her visit to Rogério Salomão. Home visits have taken place outside for COVID-19 safety.

Pathfinder’s Carmelia Mucachua conducts counseling session with Rogério Salomão outdoors.

Rogério Salomão, a community member served by the RARE project.

“I like activists and supervisors because they actually visit me and advise me,” said Rogério. “I feel good because I suffered a lot from wounds, not knowing where they were coming from, but as soon as I got into the treatment, I’m fine. I live here with my wife, two nephews, and two daughters.”

Quica Chilundzo, a field supervisor with RARE, understands the challenges well. “It is an honor to be in the community to help people living with HIV, who have at times suffered discrimination and stigma in their communities,” she said.

Quica Chilundzo, field supervisor with the RARE project.

Like our RARE project, Pathfinder’s MAIS project has continued its core work despite COVID-19. MAIS routinely provides trainings, mentorship, and technical support to community health workers, increasing the quality and reach of contraceptive services. In recent months, trainings have meant more physical distance, more personal protective equipment, and moving some trainings and assistance online – but the work hasn’t stopped.

MAIS project staff receive a training at the Malhangalene health center.

MAIS project staff participate in a training at the Malhangalene health center.

After all, women’s reproductive health needs don’t end during the pandemic. One of Pathfinder’s key approaches has been giving women and girls the option to choose long-acting reversible contraceptives (LARCS), proven to be some of the most effective methods at preventing unintended pregnancies. Because supply chains were challenged and routine visits less likely, LARCS have given women the consistency of contraceptive protection for a sustained period of time when access to care is more limited.

Bebina Cuamba, a new mother in Xipamanine, had a follow-up appointment with nurse Eugenia Nota.

Use of long-acting reversible contraceptives – pictured here, an implant - is an option for post-partum mothers to maintain contraception during COVID-19.

Bebina Cuamba leaves the Xipamanine health center after receiving care.

Since the start of the COVID-19 pandemic, we have adapted each step of our work to keep staff and communities safe. “The activistas walk protected with all the right materials,” said Program Officer Jonas Maunde. “Gel alcohol, masks, and two bars of soap to promote the process of hand washing in the community. We also have a poster produced by Pathfinder that shows the process of hand washing step-by-step, and in addition to personal masks, activists always carry with them two extra masks in their backpack to ensure if someone without a mask appears in the community meeting, we can offer one.”

Jonas Maunde, Muleide Association Program Officer.

MAIS staff, alongside local leaders, worked hard to mitigate the initial challenges. “In terms of difficulties or challenges because of the situation of COVID-19,” said Jonas, “there were certain families who hardly accepted the entry of health agents. But as we have the national community engagement strategy adopted in May of this year, which explains the standards of work in the community within the framework of COVID-19, the strategy has helped to explain to the community (our safety protocols) and we have the support of community leaders and district services that lead – so we always rely on the local leaders who support us and we have excellent experiences there in the community.”

Alice Manjate, an activista, counsels 18-year-old Leticia Laximidas at the Matola Gare health center outdoors.

Because Pathfinder continued to make outdoor house visits to people living with HIV during this time, their lives can remain healthy and stable. “I’m 22 years old and I felt sick – I went to the hospital, and am now getting treatment,” said Maria Wate. “My life is changed. The pills are working on me. I feel comfortable. My dream is to continue studying, to do my thing, and to continue living with my mother-in-law, sister-in-law, husband and daughter.”

Maria Wate is a recipient of Pathfinder’s services for people living with HIV.

Crécia Sambo walks towards Maria’s home for a visit.

Crécia Sambo, an activista, gives ARV treatment to Maria.

“I am honored to work as an activist and to be working with different people, and we have become friends,” said Selma Monteiro, a case manager at the Chaimite health unit working with the RARE project.

Selma Monteiro, case manager with the RARE project.

Adds Cesaltina, “It is with sympathy and understanding that a good result is achieved. If you’re not nice, you won’t have anything good!” We agree. Through the continued challenges brought on by COVID-19, Pathfinder’s values – respect, courage, collaboration, innovation and integrity – will stay at the heart of our work.

Teresa Belezarda, district supervisor, coordinates an outdoor meeting of activistas.

Fátima Mazoio, a case manager for activistas in Chibuto.

You can support Pathfinder’s ongoing work in Mozambique, and worldwide, here.