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Most Significant Change: Importance of Training

Ena leading a training session

Ena leading a training session

Story Teller: Ena del Carmen Balarezo Ramirez
Role: A midwife working in sexual and reproductive health division of DISA Jaén, the sub-regional health authority
Date of Recording: July 4, 2013
Location: A restaurant in Jaén, Cajamarca, Peru

My name is Ena del Carmen Balarezo Ramirez. I am a midwife and have worked for the local Ministry of Health for the Jaén and San Ignacio Provinces (DISA Jaén) for more than 18 years.

I first got to know Grounds for Health during their first visit to Peru in June 2012, when they came to do a site assessment. I also had the opportunity to participate in the first campaign in February 2013. For me, this was something new that was going to serve me well because I felt that training me would give me the ability to train my colleagues in the importance of doing quality work for women. For me, Grounds for Health is an opportunity, something positive. It is a privilege to have such wonderful professionals come here to train us. Above all, it has been a benefit for the women of the area.

There are approximately 80,000 women between the ages of 30 and 50 in the area of Jaén and San Ignacio. At the local ministry of health, we had a goal of reaching 7,000 women per year over three years. To date we have only facilitated access for approximately 2,500-3,000 women. We still have a lot of work to do.

For me, Grounds for Health is an opportunity, something positive. It is a privilege to have such wonderful professionals come here to train us. Above all, it has been a benefit for the women of the area.

While we knew that VIA existed, we had no trained personnel. It is a joy to have begun to working with Grounds for Health. This has been something very positive for us because since February of this year we have started training professionals in what is really a simple and rapid screening test that allows us to detect pre-cancerous lesions that can be treated on the same day. The professionals that attended the Grounds for Health training in February are very satisfied, and we feel the same at DISA Jaén.

When we did Pap, it was always difficult to receive the results. The goal was for the woman to receive her results within a maximum of 30 days. But we often did not even reach this standard. Often the woman’s results were lost or she received her results after six months or after one year. Suddenly, the lesion would advance to another state and we felt horrible and dissatisfied because we had done nothing for that woman. Also, we had problems because we did not know where to refer patients. When women have a positive test or a lesion that needs treatment, they become stressed or worried. We cannot allow that woman to suffer like that in her house. We must facilitate access to treatment at the earliest opportunity. For this woman, she has great need for treatment because she has children. Thus, we must focus on her.

Checking out a new cryo unit

Checking out a new cryo unit

In relation to Grounds for Health, there are many positive aspects, and we have learned many lessons. I appreciate how they work in a team with great discipline. The planning of the activities is well done. The organization of the trainings is great. The facilitators are experts, and we greatly appreciate the methods used to teach us. Grounds for Health has fantastic training materials and, above all, the participants feel great. Grounds for Health has given us confidence that we can learn quickly and progress with a great deal of practice.

There are no negative impacts. To the contrary, it has strengthened us. We would like Grounds for Health to always be here. Everything that we have learned has helped us to be sustainable. We can institute all that we have learned. I believe that the personnel that have been trained by Grounds for Health helps us achieve the goal that all women in Jaén and San Ignacio have access to cervical cancer prevention programming.

Grounds for Health will highlight a series of Most Significant Change stories from all program sites. Many accounts consist of excerpts from longer interviews. For full transcripts, please contact Justin Mool at:

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