Friday, November 16, 2012

Pumped about Finishing RUMPS

Apologies about my lack of posts!  The last months have been busy with all kinds of things: finishing up my RUMPS program at my site, planning for Camp GLOW, getting sick on and off, celebrating Halloween, etc.  Below is a summary and final report about my RUMPS project that took a whole year to complete (from grant writing to evaluation).  I thought some of you might be interested in what we accomplished and our evaluation results.  The final report will be sent to all government schools in my center.  (It's in British English)!



RUMPS Final Report
Chelsea Roberts, CCT/PCV Butaleja Coordinating Centre
Peace Corps Uganda
2012

Introduction

In Uganda, primary school girl children are given equal opportunities to pursue their education, but they face more challenges than their male peers.  Upon reaching puberty, many are not adequately informed about the bodily changes to expect and possible ways of managing their menstrual periods.  The lack of resources causes many girls to stay at home during their menstrual period.  Absences lead to poor academic performance, which ultimately resulting in dropouts.

Reusable Menstrual Pads (RUMPS) is a sustainable program that helps a girl appropriately manage her menstruation periods.  RUMPS is a program that has been established and used throughout Uganda since 2008.  RUMPS are made from local materials: the pad is sewed from cotton material, and the liners are layers of cotton towels.  A RUMPS kit is not thrown away after just one use.  It is washed daily during a menstrual cycle and should last for one year before it needs to be replaced.  In the future, she will be able to make these pads on her own using cheap locally available materials.


Project Implementation: RUMPS Teacher Training

In Butaleja CC, we have successfully executed a RUMPS program for our 15 government schools.  Our program first trained the Senior Women Teachers and Head Teachers of each school. 

The workshop took place on 11 April, 2012 at the Butaleja Coordinating Centre.  The workshop was facilitated by Chelsea Roberts, and visiting Peace Corps Volunteers, Audrey Denton and Bethany Miota.  At the workshop, all participants received a manual about reproductive health and HIV/AIDS, as well as a RUMPS kit.  Each school worked in pairs to create long lasting instructional materials.  During the workshop, the following topics were covered:
  •  Importance of RUMPS
  •   Female Reproductive System
  •   Menstrual Cycle
  •   Family Planning
  •   HIV/AIDS
  •   RUMPS kit construction
  •   Instructional Material construction
  •   Roll out for Term II 2012
Of the 29 participants, the following government schools were represented in the workshop: Butaleja Integrated, Butaleja P/S, Namulemu P/S, Leresi P/S, Nakwasi P/S, Mulandu P/S, Mabale P/S, Namutima P/S, Namulo P/S, Bugosa P/S, Butesa P/S, Hisega P/S, Lunghule P/S and Bunghaji P/S.   BUPA Nursery & P/S was the only private school to attend the workshop.


Project Implementation: RUMPS Roll Out

In Term II 2012, the RUMPS program was rolled out to the P5-P7 girls of all 15 government schools.  The Peace Corps Volunteer travelled to the schools to provide the RUMPS kits and supervise the Senior Women Teachers’ presentations.

At most schools, Senior Women Teacher gave a presentation to the girls concerning the female reproductive system, the menstrual cycle, HIV/AIDS and RUMPS.  At few schools, the Senior Women Teacher was not prepared, absent or had been transferred, so Chelsea gave the presentation with assistance of a female teacher.

RUMPS Roll Out Attendance
P5 Girls
582
P6 Girls
396
P7 Girls
217
Total Girls Attendance of Presentations
1195


RUMPS Roll Out Kit Distribution
Total Girls with RUMPS Kits
1008
Total RUMPS Kits Distributed (including extras and kits for teachers)
1105


Our program reached at least 1,200 girls and beyond because many of the schools included mature girls from P4 at the RUMPS presentation.  Additionally, we have empowered at least 1,000 girls with RUMPS kits; a tool to help improved their self-esteem, their school attendance and hygiene.


Project Implementation: Family Planning and HIV/AIDS with Primary Teachers

As the Peace Corps Volunteer visited the primary schools for the roll out, she met with the teachers at lunch for a short survey about family planning and HIV/AIDS.  Each teacher filled the survey individually, which had 17 questions.  The best performers were rewarded with soda or airtime.
Primary Teachers Participation
 in Family Planning and HIV/AIDS Activity
Male Teachers
72
Female Teachers
42
Total Teachers
114


Project Evaluation: Senior Woman Teachers and Head Teachers

In Term III, we evaluated the program on several levels.  First, the Senior Women Teachers and Head Teachers were asked to fill surveys to assess the retention of knowledge from the workshop and an evaluation of the program.  These results have been compared to the pre-survey from the RUMPS Workshop.
Question
Pre-survey
Percentage
Post-survey Percentage
Percent Increase
Identify the five reproductive organs of the female reproductive system:



Uterus
83%
96%
15%
Fallopian Tubes
83%
100%
20%
Ovary
75%
92%
22%
Cervix
58%
83%
43%
Vagina
75%
100%
33%
Where does a woman’s body store her eggs?
In her ovaries
83%
100%
20%
Where does fertilization of the take place?
In the fallopian tubes
50%
58%
17%
What do the letters HIV stand for?
Human Immunodeficiency Virus
25%
25%
0%
Name the four bodily fluids that transmit HIV:



Blood
96%
100%
4%
Vaginal fluids
63%
96%
53%
Semen/sperm
83%
96%
15%
Breast milk
13%
58%
367%
What are the ABCs of HIV prevention?



Abstain
88%
100%
14%
Be Faithful
92%
92%
0%
Condom Use
92%
100%
9%

From these results, we can determine that teachers have learned something significant about to these topics.  The most phenomenal result is the 367% percent increase regarding breast milk as a bodily fluid that can transmit HIV.  However, it is obvious that some things remain troublesome, such as HIV in full.  For further questions about these issues, refer to the manual.
In the post evaluation process, the teachers were also asked to answer free response questions regarding their advice to young girls.  All teachers answered correctly about how to properly wash RUMPS pads. 

Only 61% of teachers correctly answered the question regarding young girls’ safe days for sex.  Young girls do not have safe days.  Her cycle is still unpredictable and is prone all kinds of changes.  Her body is still practicing the menstrual cycle; therefore her MP can jump months at a time or come twice in one month.  All teachers need to understand this very clearly: Young girls do not have safe days, and this method will not work for them!  The best method for young girls is to abstain; however, some girls will have sex even if they are advised to abstain.  If girls are asking about their family planning options, it is important to advise them to use condoms because it is the only method besides abstinence that protects them from pregnancy, HIV/AIDS and STDs.

Additionally, only 78% of teachers correctly answered the question regarding young girls’ MPs skipping or jumping months.  It is very normal for girls to miss their MP for months at a time for several reasons.  Their bodies are just starting this process and their hormones are unpredictable, which can cause them to miss their MP or even have their MP twice in one month.  A women’s menstrual cycle can also change if her diet changes or is not balance, if she is not getting enough sleep, if she starts or stops exercising and if she is stressed.  If a young girl has not had sex, she does not need to worry if she has missed her MP; however, if she has had sex, she should get a pregnancy test at the health clinic.

In the evaluation, most teachers have expressed satisfaction with the RUMPS program, as well as plan to continue the program with the help of their School Management Committee.  Many schools have noticed a positive change in their girls’ attitudes, as well as their attendance. 


Project Evaluation: P7 Girls

In order to evaluate the effectiveness of the RUMPS roll out, the first schools were given written surveys for the girls to fill.  Unfortunately, the girls did not understand the surveys well enough to fill them out properly.  Therefore, the final evaluation of the girls was more of a discussion with the P7 girls.  From 15 schools, 190 girls were interviewed in groups.  P7 girls were chosen because they were able to understand the Peace Corps Volunteer. At some schools, the P7 girls were very eager to participate and ask questions.  However, at other schools, the girls were shy and unwilling to answer questions, which made the evaluation process very difficult.

In the oral evaluation, the girls were asked to identify the parts of the reproductive system and its functions.  Then, they were asked questions regarding the topics covered in the RUMPS presentation.  The girls performed well regarding the following topics:
  •   Identifying the organs of the female reproductive system
  •   Site of fertilization
  •   Site of implantation of the egg and development of a baby
  •   The ABCs of HIV prevention
  •   The bodily fluids that transmit HIV
  •   Local materials used to make RUMPS
  •   Washing and drying of RUMPS
The following topics were difficult for at least 60% of the schools:
  •   The cause of menstruation periods: the egg was not fertilized, the woman is not pregnant
  •   The purpose of the menstrual cycle: to prepare a women’s body for pregnancy
  •   The cause of skipping or jumping MPs: see above
  •   The purpose of vaginal fluid: to clean the vagina 
Note: in Lunyole, vagina stands for vagina and the surrounding area (in English- vulva).  It is important to explain to girls that when bathing, they wash their vulva.  Some girls think they are supposed to put soap in their vagina, which is very dangerous and likely to cause infections.  The vaginal fluid is there to clean the vagina- no soap needed!
  •   The signs or symptoms of Candida: white, thick vaginal discharge; itching; irritation

These topics are important for girls so they can understand their bodies and make important health decisions.  Senior Woman Teachers should continue with further sensitization so these matters are clear to the girls.

Of the P7 girls, 92% purchased RUMPS, and over half claimed to use their RUMPS kits.  After the RUMPS presentation, at least 90% of the girls shared their new RUMPS knowledge with someone at home (mother, father, sister, aunt, friend, etc).

Finally, the girls were given a chance to ask questions.  The most frequent questions are below with answers:

Why do we have menstrual pains?
The uterus is a muscular organ.  Before and during menstruation, the uterus is working very hard to push out the uterine lining- tissue and blood that would become the placenta if the woman became pregnant.  When the uterus is contracting and working, it is going to get tired and cause us pains.  The pains are very normal.  To help relieve them, she should drink plenty of water.  She can also take Panadol, place something warm over her stomach (such as bottle of hot water) and go for light exercise.
What is fertilization?
Fertilization is when the man’s sperm meets the woman’s egg, and it can now develop into a baby.
What days am I safe to go with a boy?
            Young girls do not have safe days.  Further explanation above.
What is sex?
Sex is when the man’s penis enters the woman’s vagina.  We talk a lot about avoiding sex at school, but some of our pupils may not know exactly what they are avoiding.
If I go for sex, will my breasts grow?
No.  A woman’s hormones determine the size of her breasts.  Every girl and woman is different.  Her breasts will grow to the right size for her.  Boys try to deceive girls by telling them this.
If I have feelings for boys, how do I avoid having sex?
As an adolescent, having feelings for boys is very normal.  It comes from the increase in hormones.  However, having feelings does not mean you need to act on them.  One of the best ways to avoid having sex is to avoid being alone with a boy.  If you want to spend time with your friends, stay in groups.  Also, be friends with other girls or boys who want to abstain from sex too.
How is Candida spread?
Candida is generally not spread from one person to another.  Candida is caused by a warm and moist environment or a change in vaginal bacteria.  Therefore, a girl or woman may develop Candida if she wears wet knickers or wears knickers that do not dry quickly (cotton is the best).  She may also get Candida from lack of bathing or washing her knickers.  It is possible to get Candida from sharing towels that are not dry.  Finally, taking antibiotics (treatment for various illness, including Malaria) will kill the bacteria in her body and may lead to growth of Candida.  Treatment for Candida is very simple: a tablet or cream.
If I throw my pads down the latrine, does it mean I can’t produce?
No.  Throwing pads down the latrine will not affect her ovaries, fallopian tubes or uterus, all things that affect her ability to produce.
If I have sex with a man that is 50, can I get pregnant?
Yes.  Men continue to produce sperm until late in life.  This question is very troublesome.  Girls need to know that sex with adults is considered rape.  Adult men should not be asking or having sex with minors (children under 18 years old).  If this happens, the man should be taken to the police.
Why do I get pimples before my MP?
Girls and women get pimples before their MP because their hormones have changed.  Before their MP, their hormones increase the oil production in their skin, which cause pimples.  The best way to avoid pimples is to wash your face every day with soap.  Additionally, avoid smearing Samona on the oily parts of your face (or where you get pimples).
Why are some women barren?
Women can be barren for many reasons.  It may be biological: her ovaries are not releasing eggs, her uterus is not producing good tissue to support a baby, the structure of her fallopian tubes make it difficult for the egg to reach the uterus.  For these reasons, it is not the woman’s fault, and they are completely unavoidable.  Some women may have suffered from an infection or STD that has caused damage to her uterus or fallopian tubes.  Some women may not be eating well enough, therefore her body is not producing tissue in her uterus to support a baby.  It is important to stress: if a couple cannot get pregnant, 30% of the time, there is a problem with the man’s sperm, not the woman.
If I use withdraw methods, can I get pregnant?
Yes.  This method is only 70% effective because men release pre-ejaculate fluid.  Pre-ejaculate fluid are small droplets of semen that are released when a man is sexually aroused, but prior to ejaculation.  These droplets can also contain HIV/AIDS.  Some experts believe that the effectiveness is further decreased because men may fail to withdraw in time or may release semen on the vulva.  As a young girl, you have no control over the proper usage of this method because you cannot control if the boy or man removes his penis in time.
Is it good for me to pull my privates parts?
When a girl or woman pulls on her private parts, she pulls her labia.  This is a cultural practice, and it is her decision whether she wants to pull her labia.  The labia’s major function is to protect the woman’s urethra and vagina from infection.  The labia is designed to stretch during childbirth.  Pulling the labia does not help a woman produce because it does not affect her eggs, ovaries, fallopian tubes or uterus.  It also does not help her push the baby because the labia will stretch. 


Summary

The RUMPS program has directly affected over 1,300 girls and teachers in the Butaleja community through the sensitization about reproductive health and HIV/AIDS.  It has indirectly impacted many parents, siblings and relatives.  Hopefully, our community is now more aware of the issues that affect our girl children.  Through the use of RUMPS, girls will be able to afford a method of menstruation management, which will improve her school attendance, sanitation and confidence.  Schools should continue the RUMPS program by mobilizing the SMC to budget for materials or asking girls to contribute materials from home.

Chelsea Roberts still has RUMPS kits available for 300 UGX at her home.  If girls or teachers can organize funds, they can arrange to pick RUMPS kits.

AFRIPads are pre-made reusable menstrual pads kits that are produced by Ugandan women in Masindi.  They are sold at Biyizika Drug shop at Hirya House in Butaleja directly across from the police station.  Agness sells them at 5,000 UGX.  These pads will last for about one year.

Although Chelsea is a Peace Corps Volunteer for the Butaleja Coordinating Centre, she has had the opportunity to bring RUMPS to many more teachers and girls.  Following the success in the RUMPS program in Butaleja, Chelsea has co-facilitated RUMPS workshops for Busaba CC, Butebo CC, Busabi CC, Hasahya CC, Mukuju Core PTC, Save the Children of Fort Portal, A little bit of HOPE Charity of Busolwe, Camp GLOW East in Iganga, National Camp GLOW in Kisubi and Peace Corps Uganda.

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