MPH, Research Specialist | Axum, Tigray, Ethiopia | November 2012
“…participants were so excited to demonstrate their skills with recruiting clients and provide family planning counseling that we actually had to interrupt their role play to move on to the next activity…”
At the beginning of November, just as everyone in the US was starting to prepare for Thanksgiving, I returned to Ethiopia for a fourth time as part of our project to increase rural access to injectable contraceptives. While I made it back to California in time to celebrate the holiday with friends and family, the visit to our project made me even more mindful of all the opportunities and gifts for which I am thankful.
The journey to Ethiopia is never simple. And after three flights, I arrived in Axum, a small town in the Tigray region. There is a great deal of historical significance associated with Axum, including UNESCO World Heritage Site, but my colleagues and I were there to conduct a training of 100+ Community Based Reproductive Health Agents (CBRHAs), as part of our project to scale up community based distribution (CBD) of the injectable contraceptive depot medroxyprogesterone acetate (Depo Provera) in Tigray, Ethiopia. The goal of the training was to teach CBRHAs how to provide Depo Provera in their villages, where women often face challenges in receiving family planning services at health facilities, due to distance to facility, stock-outs and often privacy issues. By training CBRHAs to provide Depo Provera, we hope to reduce some of the barriers that women face and increase their access to Depo Provera, which is the modern method of choice among rural women in Ethiopia. In a previous pilot study, we had demonstrated that CBRHAs were safe, effective and acceptable distributors of Depo Provera. The focus now was to go beyond the pilot study and scale up the successful findings. We had already trained 137 CBRHAs in three districts. Those CBRHAs had gone on to provide 2540 injections of Depo Provera in their communities, a vast majority to women who were new to family planning or Depo Provera.
This was our second training since the project commenced a year prior and we were excited and nervous as we made final preparations. As with prior trainings, until the morning of the first day, it is impossible to know how many CBRHAs will in fact arrive for the training. Since they are widely-dispersed, often without formal means of communication, we are left wondering if our invitation to join the training was delivered. As always, I was amazed as they arrived, many from villages that required a full day of travel. In the end, we had 101 CBRHAs complete the 4 day training. There were several highlights to the training. We introduced more role play activities and the participants were so excited to demonstrate their skills with recruiting clients and provide family planning counseling that we actually had to interrupt their role play to move on to the next activity. We also invited high performers from the first training to share their experiences and give advice to the new trainees. As they shared their experiences with the participants, they also spoke about how the project positively impacted them and their community. During one of the afternoon breaks, the CBRHAs broke out into song and dance – an impromptu refresher. The energy of the groups was contagious and I couldn’t help but join the dancing and singing. I am sure I looked ridiculous, but at that moment, my smile and laughter were unstoppable.
As the CBRHAs left the training, beginning their journey back to their respective villages, carrying new blue bags with a supply of Depo Provera, I thought about how even though the training was a success, the work was far from done. In fact, we will train an additional 700 CBRHAs in the next two years. As I sat around the table with my family and friends at Thanksgiving, I also reflected on our work in Ethiopia. We are providing an important and necessary service to the women of Tigray, yet on Thanksgiving, I only thought about dancing in the circle with training participants and realized that they are also giving me a very important gift.