Aunties Project
????Encadrer, soutenir les Adolescents
German-Cameroon Health and AIDS Programme
Strenghtening of Self help Groups Component
(PGCSS-REGA)
January 2007 (edition)
INTRODUCTION
In line with the activities of the German Cameroonian Health and AIDS Programme, a series of training workshops of Aunties on adolescent counselling were organised with the financial support and technical collaboration of InWEnt. InWEnt is a German Development Organisation that intervenes in the domain of human resources development, training and dialogue in various countries in the world. These workshops were motivated by the fact that the basic training received by these Aunties on adolescent reproductive health could not help in solving specific cases of adolescents in difficulties in their communities. The training was therefore aimed at building the capacity of these Aunties to better follow-up adolescents who come up with specific problems (rape, incest, pregnancy, STI, harassment, etc) and from there, to establish a standard procedure to help the different associations of Aunties in Cameroon to act in a methodical and systematic manner.
This document contains a series of charts on counselling adolescents in difficulties, followed by comments for each chart. In the course of time, these charts shall be revised and updated in order to render them simpler and more efficient.
All these ideas were developed in the course of workshops on adolescent counselling by Aunties and Uncles with guidance from various facilitators. We cannot thank individually the more than 200 Aunties from about 33 associations who participated very actively in all of these workshops, and their commitment and voluntary intervention in their respective communities which has been a key to the success of this approach on guiding adolescents in the domain of sexual and reproductive health. We wish to express our acknowledgement and thanks to Edith Dawaya, Agar Mbianda, Césaire Tankoua, Evelyn Chuigwe, Victorine Ngalle, Marquise Kouo Ngambi, Margaret Nyuydzewira, Chantal Njomou Wandji, Albert Mbanfu who facilitated the various sessions during the training of both the English and the French speaking Associations. We also express our gratitude to Halima Mohamadou who in addition to facilitating the different sessions, conceived the module on rights and obligations of a child and served all along as a resource person in legal matters, as well as Guy Bertrand Temgpe, Psychologist, who developed the initial module on the introduction to counselling. We want to equally thank the following Aunties who provided support in the organisation of the workshops or who animated case studies as well as the session on the testimony of Aunties: Mercy Ngandicho, Chimène Batchou, Jeannette Lonne, Florence Mouafo, Madeleine Ngo Songo, Rugiatu Mohamed, Lisette Jumven, Anne Elock Matanga, Fanny Etong and Maureen Obi Mbu.
We also appreciate all the nannies or babysitters who spent their time taking care of children during workshops so as to enable the Aunties concentrate better.
We cannot cease to express our gratitude to the personnel of GTZ and InWEnt who at various levels contributed to the smooth progress of the workshops. Our special thanks go particularly to Seynabou Fachinger of InWEnt, Dr. Regina Goergen, Consultant for InWEnt who supported us all along the process, and at the level of GTZ, Mrs Aka Amuam, Katrin Merabet, Germaine Ngo’o, Schneider-Owono, for providing the logistics, and also Jean Bernard Teteu, Philippe Pokam and Joseph Nguimatio who facilitated movements in the field.
Dr. Gerd EppelMme Ursula SchochDr. Flavien T. Ndonko
ABUSIVE CHECKUP
A good number of aunties have testified and have equally recorded complaints from adolescents on the mean behaviour of some health workers notably men. They have the tendency of asking young girls who come to them for a medical check up to undress and climb on the table indiscriminate of the kind of test they came for. Then they start touching the girl everywhere. “When I was 14”, an aunty reports. “I went to the GeneralHospital of my area to do a Medical Certificate for the registration of an examination. The Doctor asked me to undress and climb on the table. That I did ignorantly, and he touched my breasts and other parts…”In such situations, adolescents have reacted in different ways. Some accept believing that they have no other option, others refuse and leave. This is becoming a serious problem in our communities. We should sensitise adolescents on this issue properly. We should not wait till it happens. Adolescents should know that if a health personnel wants to touch them abusively under the guise of a medical check up, they have the right to stop that worker first, and take steps after because changing the nurse or hospital would be a kind of individual solution. The same thing will be done to the next adolescent who comes to that health worker. Next try to mobilize other victims or aunties of that area to prevent and lobby for a stop to such practices.
For prevention, aunties could invite a senior health worker to organise a public conference, lecture on medical check ups and specify in which cases that girls are touched and how.
For follow up, go personally to that health personnel and sensitisehim. Make him understand that adolescents feel so traumatised by such acts.
For negotiation, complain to the head of Health centre to call his staff to order. If it is him who is involved in such acts, talk to the village head or the Administrative Authority of that locality. After all these have been done, you should follow up with the adolescents of the community to know if the practice has stopped completely.
If there are still complains coming up, therefore the negotiation did not work. You could now seek the intervention of the village elite or the Parliamentarian of that area who could use his powers to influence the health staff concerned. If this does not work still, don’t give up. Continue by writing a memo to the Minster of Public Health also send a copy to the Ministers of Women and Social Affairs with an attached list containing the names and signatures of victims of such practices. Also increase pressure by mobilising the media and as a last resort, engage a legal procedure by filing a case in court. Aunties should constitute a pressure group in their various localities, take decisions, and make choices that benefit the community by thinking of safeguarding the interest of adolescents in general, and that of young girls in particular.
BOYFRIEND REFUSES TO USE CONDOM
Many adolescents boys nowadays have the notion that condoms make sex unpleasant thereby neglect the use of condom. Consequently pushing their girlfriends to unprotected sex against their wish. Most of them will accept thinking they have no choice. But then some will always run back to look for Aunties and lay their complains. Tell the adolescent to insist because condoms are very important during sex not only to prevent unwanted pregnancies but also STI and HIV/AIDS. The adolescent should know that they have to use it systematically (for each sexual intercourse) she should also constantly bring up discussions on HIV/AIDS with her partner and avoid taking for granted the longevity of their relationship as reason for an unprotected sex. If the adolescent cannot convince the boyfriend to use condoms, then let her suggest that they both go for a medical check up. If he still refuses, then the adolescent should put an end to that relationship. That kind of a partner should be a someone who is already aware of his HIV positive status and he is hiding it. Do your best to convince that adolescent to quit that relationship. But then if the partner is understanding and accepts to go for the HIV test, the results will be negative or positive. If the results are negative, then the adolescent can accept to have unprotected sex with her partner while using a modern contraceptive method like pills to avoid unwanted pregnancy. They should equally know that, they are not risk free and none of them should have an unprotected sex with other partners. They should be faithful to each other
FEAR OF BEING PREGNANT
Many adolescents would conclude that they are pregnant immediately they miss their period. Thus, they thus rush to one closed person or another.
Aunties have always advised adolescents to keep their pregnancies to no avail. Adolescents refuse to take to this advise, prefer to meet their friends in the quarters who will only help them with terrible substances to provoke an abortion. Although the law of the country prohibits abortion when the mother’s life is not in danger, a good number of adolescents still carry out clandestine abortion and die or sustain profound injuries. This is so because no adolescent will gladly accept a pregnancy. She will do everything within her reach to abort in order to avoid so many consequences like conflict with the parents, school dropout, loss of partner, giving birth to a child without a father, generalised poverty, possibility of being exposed to prostitution, etc. If an adolescent complains to you that she is afraid she is pregnant, it is always important to have an effective dialogue with her first. Know her age, her dates of last menses and last sexual intercourse. You can then administer emergency contraceptive pills in a case where she had an unprotected sex in less than 72hours or three days. But if on the contrary, it is more than three days, advice her to go and do a pregnancy test. If results are negative, then sensitise her on the dangers of unprotected sex. If results are positive, advice her to go for an ecography test to determine the duration of pregnancy. If pregnancy is less than three months, the adolescent has the choice between aborting or keeping the pregnancy but if more than three months, she has no option but to keep the pregnancy. Then her case is now treated as the pregnancy case.
PREGNANCY
It should be noted that an adolescent pregnancy is always a very risky one particularly when she is below 16years. Generally adolescents hide their pregnancy and would attend antenatal care just for a short period before delivery. Some even try to abort on their own because of various reasons like school dropout, denial of pregnancy by author, conflicts at home, lack of means to take care of the child, mockery from friends and mates, etc. It is therefore very important to follow-up with a lot of attention an adolescents who present pregnancy problems. The role of the Aunty is not to encourage abortion but to prevent more adolescents from loosing their lives due to induced abortion in the quarter. Again they help to protect adolescents from getting involved in early sexual intercourse and also to avoid pregnancy if already sexually active.
So if an adolescents presents to you a pregnancy problem, you should first find out how old the pregnancy is, ?????????????????.
If pregnancy is less than three months and she desires to abort, refer to the chart on abortion and follow the steps indicated. If the adolescent desires to keep the pregnancy, turn to pregnancy chart and follow the steps indicated. But if pregnancy is more than three months and she wishes to abort, do your best to make her keep the pregnancy because abortion at this stage is very dangerous. If her parents are not aware, encourage the adolescent to tell them or seek her permission to tell her parents if she is afraid to do so.
Furthermore, advice and encourage the adolescent to go for prenatal consultations and take all her vaccines like the anti tetanus vaccine and others. Above all motivate her to do the STI and HIV test to avoid transmitting the virus to the unborn baby in case she is HIV positive. In hospitals, they do propose the HIV test for pregnant women but some adolescents at times are scared to do it and as a result will go to another health centre that does not request for an HIV test for delivery. Whereas if the you had taken pains before to prepare adolescents in the community, she would feel more motivated to go in for the test because she knows the importance of the test. You should make it a duty to visit the adolescent from time to time during this period especially within the first six months. After delivery you should also follow up the adolescent to make sure the child is issued a birth certificate, that other complimentary vaccines are taken and to make sure she takes a balanced diet and maintain her body hygiene and that of her child. As follow up, the adolescent should be encouraged to go back to school or get involved in some income generating activity to help her take care of herself and child. It is also necessary to encourage the adolescent not to stay idle because being idle could lead her to another unwanted pregnancy.
RAPE
Reports on rape usually come up in our various communities and adolescents are the common victims. If a case is reported to you, it is very necessary to follow rapidly all the steps on the chart. Firstly take the adolescent to a health unit(hospital or health centre) for a medical check-up. Make sure the medical personnel issues a report confirming rape. If delayed, it would be difficult to have prove. After that, a pregnancy test should be conducted. If the test is positive then refer to the pregnancy chart to know which steps to take. If the test is negative, then propose and encourage the adolescent to go in for an HIV test. She will be counselled before and after the test. If the results are negative, then the adolescent did not have the virus before the rape. In that case, the adolescent is put on a preventive treatment known as Post Exposure Prophylaxes(PEP). If the test comes out positive, then she was positive before the rape. You should then refer the adolescent to a Certified Treatment Centre or a health unit for people living with HIV/AIDS. For follow up, encourage the adolescent to join associations for people living with HIV/AIDS. Each Association of Aunties has a list of these associations of people living with HIV/AIDS, and their phone numbers.
If the rape occurred during the adolescent’s fertile period and within the last 72hours, then administer immediately the morning after pills(emergency pills). Refer to the chart on morning after pills to see the method of administration.
After all these have been done, you are now faced with the most difficult part of it, tracking down the rapist. You should never, never for no reason negotiate with a rapist because he will never hesitate to resume his old practice. He should be punished severely. Rape destroys adolescents mentally and physically, and can cause all sorts of problem to her future. That’s why we should mobilise the whole village, forces of law and order, social services to put to an end such practices by punishing the rapist severely. Everyone in the village is supposed to know such a person so that adolescents would be more careful with them. In a case where the rapist is a parent or a close relative, refer to the chart on incest to know what actions to take.
However you should think of carrying out further actions by organising conferences, and sensitisation sessions. To make it more effective, you should invite specialists (Doctors, Lawyers, Magistrates, Teachers, Brigade Commander, Commissioner of police, etc.) to explain the problem of rape and its consequences. In a locality where these people are not available, the association can use another channel through the elite to solicit the son and daughters to join in the fight against sexual violence faced by the adolescents.
???????????
INCEST
Incest at times occur in some of our communities. This is when an adolescent is being raped by a member of her family. There are two types of incest: absolute and relative incest. Absolute incest is when the father of the adolescent committed the act while relative incest is when the person involved in the act is a family member. In any case, it is always important to find out two things: if the incest occurred during the adolescent’s unsafe period and within the last 72hours. If that is the case, then administer the emergency pills immediately before any other step. You can turn to the chart on Morning After Pills to be more accurate.
Secondly, the victim should be encouraged to do the HIV screening test. Refer to the chart on rape for details. In the case of a relative incest, seek victims opinion to inform her parents. If victim becomes pregnant and wants to do an abortion, direct her to a hospital or refer on the abortion chart. Abortion is authorised by the law in case of incest. But if the victim is interested in keeping the pregnancy, then refer to the chart on Pregnancy and follow it carefully. In the case of an absolute incest, where it is the father who has committed the act, it is certain that he can not collaborate to seek for a solution. So guide the adolescent equally following the above steps. For all cases of incest, treat it fast and consider it serious. Contact the Social Welfare, influential people in the community, for example the Notables, the President of the village association, the Forces of Law and Order, the quarter or compound head. All these personalities will help to mount pressure on the author and punish him severely so as to stop such an act from occurring again.
For follow up, initiate preventive actions by organising advocacy campaigns at the level of the authorities, sensitisation sessions with the wider public, conferences or legal clinicsfor other youths and adolescents in the community. This strong mobilisation will push people to be careful with the kind of things they do as they will know that there is a pressure group that protect adolescents against such abuses.