By Shilpa Darivemula
Current Partner for Bena Jema Women’s Health Initiative
Founder of Aseemkala Initiative
Changing the history of a community requires changing the story of one woman. In the Shipibo communities surrounding Yarinacocha and up the Ucayali River of Peru, women are central to the households, to caring for their families, to working, and to improving the community with traditional medicines and knowledge. This often results in self sacrifice, usually related to taking care of oneself. The Shipibo community has one of the highest rates of HPV and HTLV-1 co-infections and a high index of cervical cancer occurrence. While some notes higher incidence of smoking, multiple partners, younger age of initiating sex to be major causes, the most notable cause is the lack of health literacy on the topic of their reproductive systems. After 5 years away, I returned to Pucallpa, Peru to work again with the wonderful organization of Alianza Arkana to change this by offering three days of workshops to touch on four topics: 1) STDs, 2) cervical cancer, 3) menopause, 4) menstrual cycle.
Inga Stege was thrilled to set up the workshops in Bena Jema, the community in which she had been teaching English for the past few months. We designed the workshops with the help of Charlotte Biren and Maca Arias and used their contacts to build an amazing team. We were grateful to have Silveria, a Shipibo nurse, Shirley, our Shipibo translator, and Luzmila, our Bena Jema leader give their ideas on design and ways to share the information in an interactive manner. Inga and I walked with Luzmila to as many houses as possible to invite the women to attend.
We were so thrilled to have about 20 women join us for the three workshops. At first, it was difficult to figure out a system to communicate so it was not overwhelming. We found that small groups are the best way to make sure everyone has a chance to participate. We also learned that discussing the material and having them teach back what we shared was a simple and fun way to get everyone involved. What we didn’t expect was how much STDs and cervical cancer impacted the community. The women would often ask specific questions about the cases of their sisters, cousins, daughters, and mothers. One woman asked over and over again about the reasoning behind the copious amounts of blood loss that her niece with cervical cancer had before she died. This workshop series became intensely personal and as facilitators, we started to allow the women to take control and steer the workshop on their own. Silveria and Shirley would take turns explaining the reproductive systems to the women while Inga and I would support them, holding posters, and acting like patients. Over three days, we could see how much joy and pride our Shipibo facilitators had as they explained and answered every question patiently to each woman. Trust developed through this exchange of power and women shared their own personal stories of IUDs, of tricking their husbands to use condoms, of menarche stories, and of being a mother.
At the end of the workshops, we asked the women, over cake and Cebada, a drink made by Inga, what they wanted to do next. The women asked for a Pap smear campaign to happen in their own community. They also wanted the HPV vaccine. They also wanted to have insurance. They also wanted to learn more, with more workshops, and more sharing. They also wanted to teach their girls everything they learned. We wanted to inspire them and instead, they humbled us with their innate strength and power. Inga, Silveria, and I decided to find out what we could truly offer them. We spoke to the Jefa of CIS, the insurance program for indigenous people, at Hospital Amazonico and we discovered that they would indeed be able to help get everyone insured. We also found out that all contraception, including implants, IUDS, and pills, are all free with insurance, as well as pap smears and other women’s health needs. She also told us to meet Dr. Zarela of INMED to help us develop a Peruvian based community health workers program with the women and told us that any campaign we want can be secured through working with the doctors at each regional health post. We found our local physician, an OBGYN, who was thrilled to do a campaign in Bena Jema. Our meeting with INMED went very well as well and we returned to Bena Jema with the plan to start with our first local pap smear campaign, led by the women of the workshop.
While there were challenges, the overall outcomes of these workshops was more than anyone imagined. Inga, Charlotte, Shirley, Silveria, Maca, and Luzmila are excited to continue this amazing work they created and I look forward to the changes they make. All it took was a new idea and the community grew stronger.
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