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Success Stories

Educated Women Change for the Better

Dr. Paul Sevastian Dandu has been a family doctor for 10 years in Sacele municipality of Romania. He has approximately 1,800 patients, half of whom are of Roma ethnicity and come from Gircini, one of the biggest and poorest communities in Sacele. Dr. Dandu is one of the few primary healthcare providers in this is poor and overcrowded area. Dr. Dandu also works at at a centre for institutionalised children in Brasov.

Steluta Batar, the Roma health mediator from Gircini, talking about pregnancyDr. Dandu knew there was a need for family planning (FP) services for two particularly disadvantaged groups of his patients; those of Roma ethnicity and young adults who had been institutionalized as children and who "were not ready for life." He was able to start fulfilling this need for FP services in 2006, after he took a course offered by the Society for Contraception and Sexuality Education (SECS), a partner in the Romanian Family Health Initiative (RFHI) program. After completing the course, Dr. Dandu immediately began to work with the youth at the Brasov centre. He found that while many of the young people had heard of Protex condoms, they did not know how, when, or why to use them. Dr. Dandu had some initial difficulties talking to the girls, so he called upon Steluta Batar, the Roma health mediator from Gircini. Steluta, with her training in FP and reproductive health (RH) and the informational materials developed within the RFHI program, was able to break the girls' "shield of shyness."

The situation with the clients in the Roma community was more precarious. One of the biggest obstacles in providing FP services to Roma women was that they were often too embarrassed to enter the FP office because "the whole village sees (us) enter and will laugh." The family doctor (FD) and the family planning doctor (FPD) came up with the solution of making 'visits': with the patient's consent, the FPD would visit the FD's office and provide FP counseling there, while the FD provided his/her regular consultation services in a separate treatment room. In this way, the Roma women were able to receive FP services in a safe environment, offering both confidentiality and privacy.

There were other difficulties, however. Dr. Dandu also found that, for some couples, the use of the contraceptive pill was seen as a sign of infidelity. He began to call both partners into the offices for counseling services so that he could explain how contraception benefits the couple and their family.

Dr. Dandu's team consisted of the nurse from his office and the Roma health mediator. Both were trained in FP/RH through RFHI, and both were excellent communicators. Experience soon taught them that small groups of mothers and daughters were the best way to provide early education on FP/RH.

In order to ensure that his patients were well-attended and would follow-up, Dr. Dandu offered a free analysis for every pregnant patient. Upon return for the first prenatal consultation, he gave the patient encouraging advice on how the pregnancy was developing and how to take good care of herself. This helped Dr. Dandu to gain women's trust and ensured that they come back for subsequent check-ups.

In the absence of correct information and prenatal care, many young women in Gircini had given birth to children with serious health problems. With the help of the health mediators, information about birth spacing began to reach the community. And Dr. Dandu was not at all surprised when, after discussing "natural and artificial barriers" with the health mediator, many women developed an interest in family planning and came to him requesting more information. "In Gircini, information has reached the women!" said Dr. Dandu.

Evidence of this was seen in the records of pregnancies, which showed that fewer girls under the age of 17 were getting pregnant. Other RH problems in the Roma community were also resolved, such as the large number of pregnancies during breastfeeding. Once the women had the correct knowledge about the value of breastfeeding and its required frequency to avoid fertility, they understood how to avoid future pregnancies and that it was a myth that young mothers cannot become pregnant while lactating. The number of abortions also fell, as confirmed by the reduction in referrals to medical units that provided the service.

"An educated woman changes her life, her health and her appearance," said Dr. Dandu. That is what gave him the most satisfaction, assuring him that "My work hasn't been in vain."

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The Romanian Family Health Initiative (RFHI) is implemented by JSI Research & Training Institute, Inc.
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