Hesperian Health Guides

First action: Meet with clinic staff

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HealthWiki > Health Actions for Women > Chapter 2: Communities Organize for Women's Health > First action: Meet with clinic staff

Luz knew that Mario already had a good relationship with Doctor Mora, so she asked Mario if he would arrange the meeting. He agreed and 2 weeks later the committee representing Vilcas Women’s Voices met with Doctor Mora in his office at the health center. Doctor Mora had also invited Nurse Flores to the meeting. Paula began their presentation by asking Luz to briefly tell her story about trying to help Sonia. Then Paula explained why Vilcas Women’s Voices had formed. Alicia and Yesenia both spoke, and then Tomasa read aloud the group’s proposals to improve care.

Tomasa telling Doctor Mora the group's proposals.
Women in labor should be allowed to wear our traditional clothes and always have a companion who speaks Quechua. We should be allowed to walk and squat if we choose.

Doctor Mora and Nurse Flores grew more and more impatient as the women spoke. When Tomasa had finished, Doctor Mora said he was sorry they were dissatisfied with the services offered by the health center, but he did not have time to discuss all their concerns. Nurse Flores said that the real problem was the women who did not follow the rules, and she criticized Luz and the other midwives for bringing pregnant women to the health center when it was too late to give them proper care.

Paula stood up and said that the health center rules denied women their right to health care. Doctor Mora responded angrily that the real problem was not the health center rules. He told them that without supplies and support from the government, he had a hard time keeping the health center running at all. Then he ended the meeting.

Evaluate the action

Vilcas Women’s Voices felt that their first action was a failure. They had done well gathering information and undertanding the problems that indigenous women face. They felt they had a strong case, yet the meeting ended abruptly and they could not see a way forward. At their next meeting, Tomasa encouraged the group to evaluate their action in the same way they think about their own lives and how change happens.

2 women talking.
When there is a conflict in my family, I try to focus on what we have in common. At the meeting, I learned that we are not the only ones upset about the lack of health care resources. Doctor Mora is too!
We could join with the health center staff to demand that the government support our community’s right to health care.

evaluating the action.
1. Process: How did we work together as a group?
2. Goal: What did we want to achieve?
Who did we want to influence?
3. Results: What change did we achieve?
4. How do we know change happened?
5. What did not work? What barriers were there?
How could we help overcome these barriers?
6. What can we do to be more successful next time?

Revise the action plan

After evaluating the meeting with Doctor Mora and Nurse Flores, the group realized that perhaps it was not such a failure after all. They decided to revise their proposal to take into account Doctor Mora’s point of view and to focus more on the right to health care. Discussing this idea helped them decide their next step: to convince Doctor Mora that the changes they proposed would also help him meet the health center’s obligations toward the community. Vilcas Women’s Voices brainstormed the challenges they would face to do this and decided they would need more allies who could help convince Doctor Mora to meet with them again.

Work with allies to involve the community

In the following weeks, Vilcas Women’s Voices shared their ideas with the allies who had already helped them.

Luz speaking with Mario.
Can you talk with Doctor Mora and find out more about his problems as director of the health center?
Sure, and I can get more information about Peru’s right-to-health law and about government funding for community health centers and women’s health programs.
a woman speaking with a man.
Doctor Mora says the government does not meet its obligations to keep the health center operating.
I know the mayor. Once he sees how organized you are, he might support you.
a woman speaking with a man.
Julio, you lead the farmers' organization. Their families all would benefit if they joined our efforts to improve women's care at the health center.
They worry about their women speaking out in public, but they also want better care for them. I will talk to them.
a man in a group speaking to Doctor Mora.
We think you should consider the Vilcas Women’s Voices proposal. Here’s why....
Not everyone you approach will be an ally. That’s OK, you don’t need everyone to be an ally. Little by little, keep increasing the number of people who are on your side.
Paula speaking with Doctor Mora in front of a large group in a meeting room.

Organize a community conversation

With their allies’ help, Vilcas Women’s Voices started a community conversation about women’s health and the Vilcas health center. They invited health workers, midwives, health promoters, and community leaders from Vilcas and nearby villages to the meeting.
Doctor Mora, we want the same thing you do — to improve the health of our community. You have a chance to make such a big difference. How can we support you and work together towards this common goal?
I thought about your concerns, and I can see why women don’t want to come to the health center. I want to make people feel welcome here, because the health center belongs to the community. Let us find a way we can work together.

The mayor said the purpose of the meeting was not to blame anyone for problems, but to find ways the health center could better meet the needs of everyone, including the health workers. Despite the mayor’s attempt to unite everyone, people still disagreed. Because of past experiences, some people did not trust the mayor or Doctor Mora. Others were not used to hearing women speak up. Some people did not want women, especially young women, to have access to so much choice about whether and how to have babies. However, people did agree that saving pregnant women’s lives should be a priority. The mayor pledged to use more of the city budget to improve services. The farmers’ organization said that volunteers from each neighboring village were ready to help with building and maintenance projects. The teachers offered to help develop health education materials. An officer from a nearby military base promised to help with emergency transportation and creating a safe blood supply.

Organize for long-term changes

In the following weeks and months, Doctor Mora promoted a spirit of dialogue among the doctors and nurses at the health center. They had been resistant to change until Vilcas Women’s Voices helped them think about health as a human right. This led the health workers to reflect on their professional commitment to health care and to saving lives. They agreed that their work would improve if they had a better understanding of the Quechua women’s point of view. Nurse Flores suggested to Doctor Mora that he invite Vilcas Women’s Voices to the health center to discuss their proposed changes with all of the staff.

Through continued dialogue, Vilcas Women’s Voices and the health workers slowly gained mutual trust. They agreed on common goals and made small and lowcost changes at first, such as shifting clinic hours to fit community needs. They hired bilingual nurses and assistants and made sure someone was always on duty who could interpret Quechua and Spanish. They also worked with staff to help them learn how to make young people feel more welcomed and supported.

A welcoming and safe place to give birth

a woman using a birthing chair at the health center, with her birth companion and Luz the midwife.

Vilcas Women’s Voices and a group of community volunteers painted the delivery rooms at the health center, hung curtains for privacy, and made birthing chairs, so women could deliver in their traditional way of squatting. Doctor Mora changed the rules so women were allowed to wear their clothes, and to have their choice of food and drink. They could also have birth companions, including their partners and traditional midwives. Nurse Flores organized training for the doctors and nurses to help them be more comfortable with these changes

Soon Doctor Mora invited Luz and other midwives to deliver babies in the health center. He saw this as a way for the doctors and nurses to learn more about community traditions that help women have healthy births. He also knew this would encourage the midwives, doctors, and nurses to work together in emergencies, as well as provide midwives opportunities to learn new skills to make births safer.

The community health committee

families eating and sleeping at the safe motherhood house.

Soon after the big community meeting, Vilcas Women’s Voices helped form a community health committee that included young and older community members, health workers, and local leaders. The health committee worked with the health center to organize a community emergency plan and build a "safe motherhood house," so that women who lived far away could stay there with their families during the last weeks of pregnancy.

With the help of CARE, an international organization, the committee persuaded the government to send more doctors so that the health center could be open 24 hours a day, and to ensure that they had medical and blood supplies for emergencies.

Health for all

As relationships between community women and health workers improved, women brought their whole families for care. More women came with their partners for prenatal care and births, and also brought their children for vaccinations. As men became more involved in pregnancy care, they also learned about their own health. Men felt welcome at the health center and began to come for their own needs as well. As women’s rights, culture, and dignity were respected, more women chose to have their babies in the health center. Over time, by focusing on everyone’s right to health care, the health of pregnant women and their babies in Vilcas dramatically improved, but it also improved for women and men of all ages.

Women’s voices and leadership

The community of Vilcashuamán voted on the town’s budget so that every year a specific amount was guaranteed to support women’s health programs. The town government also created a permanent elected position for a woman to oversee women’s health affairs. This meant that women from Vilcas rotated positions of leadership and had a voice in how decisions were made about women’s health and their community’s development.

More challenges

Vilcas Women’s Voices had achieved a lot, but there were still many challenges. Poverty and displacement were still obstacles to women’s health care. Although the women had gained respect, some people still thought women should focus on raising children. Vilcas Women’s Voices knew these ongoing challenges would require ongoing organizing.