Let's talk COVID-19: Protecting women and girls from the worst effects of the pandemic

Avril Benoît:

Hello and welcome, I'm Avril Benoît, I'm the executive director of Doctors Without Borders in the United States. Doctors Without Borders known internationally by our French name, Médecins Sans Frontières, and the acronym MSF will come up over the course of this discussion. So when you hear MSF, you know it's Doctors Without Borders. Today as part of our series, Let's Talk COVID-19, where we're bringing you into our operations, our medical work around the world and giving you a lens through which we are looking at this pandemic. 

Today we're talking with a couple of MSF physicians about how the pandemic is affecting access to critical sexual and reproductive healthcare for women and girls. Since the start of the pandemic, there have been even more barriers to accessing antenatal, postnatal, emergency obstetrics, contraception, safe abortion care, treatment for sexual violence and other sexual and reproductive health care, and we will be explaining all of these terms for you today. The key part for us, and the big worry is that, without access to these essential lifesaving services, we at MSF, Doctors Without Borders, fear an increase in preventable deaths, maternal and child deaths in the coming months.

From our experience in past outbreaks, such as with Ebola, several times we have seen that deaths can be caused by cutting women off, women and girls off, from access to the healthcare that they need in this realm, and can be even more deadly at the end of the line than the coronavirus itself, that's our big fear right now. We're going to have this webcast for around 45 minutes, a chance for you to ask many questions, wherever you're joining from today, you can submit your questions to us. If you're watching on Zoom, send your questions into the Q and A option. If you're joining on YouTube Live or Twitch, you can send your questions in the comments or the chat section, we will prioritize questions that are relevant to COVID-19 and sexual reproductive health and how the pandemic is affecting all these areas.

So, we are here with a couple of doctors. I mentioned Dr. Manisha Kumar is a family medicine physician, and she heads MSF taskforce on safe abortion care. Also, joining us, Dr. Maura Lainez, is a community doctor working with MSF in Cortés, in the Cortés Department of Honduras. So welcome to you both. It's so great to have you with us. If I could just, by way of introductions, yesterday we were a little worried about your internet access Maura, have we got you okay? Maybe you can describe a little bit where you are today.

Dr. Maura Emelina Lainez Vaquiz:

Well, actually I'm at home right now. I have been doing tele-health consults because I'm pregnant and I can't be in the frontline of the COVID epidemic right now, but I hope the internet is going to be stable today.

Avril Benoît:

We're also hoping that, and we also have Dr. Manisha Kumar. Manisha, where are you joining us from today?

Dr. Manisha Kumar:

Hi everybody. Yeah, I'm joining you from my apartment in Amsterdam. It's 7:00 PM here, so evening and a gray rainy Amsterdam evening.

Avril Benoît:

All right. Well, we're all safely indoors away from the rain. Manisha maybe you could just start by explaining some of these concepts because for those who are unfamiliar with SRH, which is the medical jargon that we toss around, but sexual reproductive health, why is it so vital? Explain the full package of what we mean when we talk about this?

Dr. Manisha Kumar:

Sure. So, sexual and reproductive health services are so vital because they are lifesaving. So just to take a step back to say, what are sexual reproductive health services, it's really a full package of care. It ranges from everything such as providing antenatal care, so care during pregnancy, care during delivery and postpartum care as well as contraception and safe abortion care services. It includes treatment of sexually transmitted infections or STIs, and it also includes treatment for survivors of sexual violence. So really that phrase, sexual and reproductive health encompasses this really broad range of healthcare services that are vital for women and girls, and then also their families and communities. So, the healthier that women and girls are, the healthier that their children and their families are as well.

Avril Benoît:

And Maura, can you describe then what did all of this look like before the pandemic and now after in Honduras where you're working?

Dr. Maura Emelina Lainez Vaquiz:

Well, in Honduras actually before the pandemic we're having troubles always with family planning, especially in the sexual health area, because it's like really limited and it's like people don’t want all these young girls have access to it because it's a taboo theme in here. It feels like something that you don't want to go to the doctor and ask for a pill. If you want to go into the pill or as for any other method of family planning, because you're going to be seen bad at that point.

Right now we have more limited access to it because it's not an emergency and all of our health centers, at least the majority are working just for the epidemic right now. So it's like taking the power of the women to decide into her body when to plan to have a family or not having a planned family at all. You're putting this girls behind a wall and a sword in deciding to have a baby or not.

Avril Benoît:

In Honduras, to what extent is the lockdown complete over what are considered these non-essential health services of all kinds?

Dr. Maura Emelina Lainez Vaquiz:

Non-necessary health services are locked down. If you need an emergency service, you can go and there will be assistance in there. But for example, if you need the pill, because you're in the pill and you want to go to your health center to take your medicine, you can't go because it's no longer an emergency, it's no longer considered that you need it. It's like, "Oh, you are in it but you can wait or you can go and buy it." Most people doesn't have the money to go and buy this kind of stuff. So they go to your health center that is from the government because it's the only way to go and get it without spending that much money.

Avril Benoît:

Yeah, and we must be seeing this in many other parts of the world. Manisha you've got a bit of the view of the whole, can you give us an idea of how the pandemic is affecting other parts of the world with these services that are essential but have fallen into the basket for some governments of being cut off?

Dr. Manisha Kumar:

Yeah. So what happened at the start of this pandemic is basically ... all governments, countries, institutions were forced to make decisions about what is essential versus not essential care. For a lot of people, essential more means current emergency, right? Without thinking about what could be the potential indirect effects if people do not have access to this care. So what we saw is that different countries and different agencies responded differently, but what the trend was, was that already to begin with, a lot of SRH services are not necessarily seen as essential or emergency. The way that we would typically imagine like if someone that needs emergent surgery, yeah, because they have an acute physical injury.

So services like contraception and safe abortion care have historically not been seen as essential or lifesaving services, and that's what made them even more vulnerable to becoming deprioritized. So what we saw was during the pandemic, a lot of resources got pulled away from a lot of routine services and care, and those resources got diverted to more direct coronavirus response activities, which in some ways we could think would be a logical response, right? We have a virus, we have a new emergency, we absolutely need to invest resources into addressing that. But what we've seen in history, as you mentioned earlier, such as in the Ebola epidemic, is that some of the indirect consequences are the collateral damage of taking that type of approach is that when we shut down these routine services, we actually saw an increase in maternal and child deaths from preventable causes.

So there are certain things that we know we can do to prevent death and suffering. We know that treating malaria will prevent death and suffering. We know that treating malnutrition, routine vaccination campaigns. So even though a routine vaccine today isn't necessarily seen as an emergency, it's still lifesaving. Similarly, for contraception or family planning like Maura was talking about, today she's not having an emergency, but if she is unable to access her family planning method today, it can start a cascade of events. Yeah? That can ultimately lead to her death. So if she makes the decision to continue the pregnancy, it's more likely to be a high risk pregnancy because it was a mistimed pregnancy.

So maybe she already has and recently gave birth, maybe she has a lot of children already. We know that these pregnancies, if they're continued and to have more complications, or if she decides not to continue the pregnancy and she does not have access to safe abortion. What we know in MSF is that women are then more likely to resort to unsafe abortion methods that put their life and their health at risk. So, this one event, this one blockade, right? Really can set off a domino effect or a cascade of events that really have long-term impacts on women in their communities.

Avril Benoît:

You've mentioned the diversion of resources from all the kinds of SRH care, sexual reproductive health care toward COVID-19 focused efforts. Maura, in Honduras, we have a question here from Zainab, and you are here giving us the example from one country, but we know that it's also something that is being experienced by MSF teams elsewhere. To what extent did MSF divert resources from sexual reproductive health toward the COVID-19 intervention in Honduras?

Dr. Maura Emelina Lainez Vaquiz:

Actually, we don't have any problems like taking this medicines to the other communities, but is the health centers that are not getting it from the government right now, especially, but MSF have been really responsive in this emergency, in the COVID-19 not just as the disease itself, but it's also as the sexual reproductive health that it had been responding. We have the family planning in our clinic, we have a clinic here that we work 50/50 with the health secretary here in Honduras, and we have to bring this access to the women in here. So they don't fall in this cascade as Dr. Manisha was talking about.

This cascade of events that actually will be falling if they get pregnant and they don't want the baby and they try to get ... and not safe abortion or anything other events that we're going to be. For example, here in Honduras, in Tegucigalpa, the MSF community is in charge of one of the branch of the resources for the COVID-19 in a national stadium in here. So we're in front of the lines trying to protect our communities bringing health, bringing attentions, bringing all this support that Honduran people need right now.

Avril Benoît:

You are listening and watching a special webcast series that we're doing here at Doctors Without Borders, Médicos Sin Fronteras, and Médecins Sans Frontières or MSF about COVID-19 and various other aspects of healthcare. Today we're talking about sexual reproductive health with two physicians. So, Dr. Maura Lainez who's a community doctor working in Honduras and Dr. Manisha Kumar, family medicine physician, who is the head of our task force on safe abortion care globally. We have a question here from Ruth, and by the way, I should mention again that you are more than welcome to ask your questions in Zoom in the Q and A option, or on YouTube Live or Twitch in the comments or the chat function. Manisha, this one's for you, and it's from Ruth. How are we working with closed borders during the pandemic?

Dr. Manisha Kumar:

Oh, that's a great question. So the closure of a lot of borders has really been a challenge for our teams. So, the two most obvious ways that come to mind are one, in terms of moving our staff, and the second one is in terms of moving our supplies and being able to get the medical supplies where we need them. So for a lot of our programming, it's been really challenging to be able to send our international staff to a lot of our project locations where we're working because of these travel restrictions and closed borders.

So what that has meant was an increased reliance on our teams who are already the ground and maybe can't leave, who are probably, who are, working really hard. So they're not getting the relief that they need, but at the same time, we work in collaboration of course, with a really amazing national staff or a local staff on the ground who have really been working hard to make sure that the populations we serve still get the care that we need. Then in terms of the supplies, a lot of our projects across the world, we send supplies to them from Europe, which is where most of our headquarters are based. We have a very strict quality assurance for our materials because we take our responsibility to provide high quality medicines and supplies very seriously.

Dr. Manisha Kumar:

So that has been a huge challenge, and specifically for SRH services when it comes to contraceptive methods, a lot of them or a lot of the precursors were made in China. And so being able to get the contraceptive methods into the hands of our patients is really dependent on this whole global system. I think it's really revealed how interconnected our world is because the closed borders have really impacted our projects.

Avril Benoît:

Yeah, and that's been the case for other medicines as well, hasn't it? I've heard of, especially in the early going, there was a gasp when we realized that malaria medications were dependent upon China and all the borders were closed around there in terms of the flow, the outflow and the shipping. Yeah, it's been extremely complicated for many areas of medicine. To bring it back to sexual reproductive health, Maura, how is it looking from the Honduras side in terms of closed borders and the effect that's having on women and girls?

Dr. Maura Emelina Lainez Vaquiz:

Actually it's really affecting a lot, because there is so many supplies that we need and it's not coming in because the borders are closed. Most of our supplies and medicine that come from other countries, far away countries, and especially those that have to do with family planning. So we're not receiving all the supplies, and most of the health centers doesn't have any family planning medicine right now. So they're low in stock, they're going back to use just condom instead and most of the people doesn't want to use barrier method. So they stop using it, and we have a lot of pregnancy right now, actually today, early this morning, I was talking one of the doctors of our community in Choloma, and she was like, "We have to find a way out to make this work because we're having a lot of pregnancy during this quarantine."

When she was like, in a month we had like 10 new girls pregnant, now she has like 30. She is really worried because these are pregnancies that are not planned at all. So this not only affect the family, but will affect the community in this manner. It's not only with this health, is also with all of the medicines that we have. With this ivermectin is getting a little bit low in our country because it's now one of the protocols that we have for COVID in here, it’s not like FDA approved but we have to ... in here locally, we're using it, and it have been tested and we can see some kind of work in it, but it's not like we're going to go into a drug store and get it with a physician prescription, but we have to go into the hospital, see how we get it, and it's a little bit more collapsible, it's like a chronicle of the death, already announced with that.

Avril Benoît:

We have another question actually about the big picture, it's from Maria, who is asking, do we have hard numbers showing a reduction in sexual reproductive health services for women and children globally or for specific countries? Manisha, do you have a view of the global numbers?

Dr. Manisha Kumar:

So, in terms of the global numbers, what we have now at this stage in the pandemic is estimations. So, different organizations or different agencies have conducted studies that looked at what the impact of a 10% reduction in service would be. The impact showed that there would be, in low and middle income countries alone, an additional over 15 million unwanted pregnancies, over 3 million unsafe abortions and over 28,000 maternal deaths. So if you look at the number of maternal deaths from unsafe abortion annually, it's at least 22,800. So that's a doubling of maternal deaths from that one particular cause.

But if we look at what's actually happening on the ground frontline health workers like Marie Stopes International and International Planned Parenthood Federation, they're reporting service reductions as great as 80%. So those numbers I gave you were with a 10% reduction. So, imagine eight times those figures. In terms of MSF and our data and our numbers, because we work in so many different countries and so many different contexts, in some places I would say we've seen an increase, for example, the number of deliveries that we're seeing in the hospitals, if, for example, the other hospitals in the area have shut down their maternity service and the MSF hospital's the one that's open.

In some places we see the opposite. So we see a decrease in the number of deliveries or the number of women coming for other services, either because potentially we've stopped those services or the people that we're working with have stopped supporting, or women are no longer able to access them, because transportation to health facilities has also become an issue. So right now at this phase in the pandemic, we mostly have estimations and predictions moving forward.

Avril Benoît:

I guess related to this is what is the timeline? And Maria is also asking, how long will it take for these numbers to show up? You say there are already indications, and even Maura you were saying there seem to be more pregnancies. When we know that the pandemic will go on for an indefinite period of time, maybe a year, a year and a half, two years, until it is presumably hopefully brought under control, how do we expect those numbers in that burden and in that hardship, are those statistics with always human stories behind every single one of them to show up in the graphs over the course of the pandemic?

Dr. Manisha Kumar:

I mean, I think right now, as you said, our biggest worry is that the numbers and the figures and the graphs are going to go up, right? That we're going to see a big increase in mortality and morbidity. Right? But if we're looking more specifically at maternal deaths, that we are going to see an increase, one of the really challenging things about maternal death and maternal mortality in calculating or counting maternal deaths, for example, when we're talking about unsafe abortion, so one of the leading causes of maternal death worldwide, but obviously a very stigmatized topic.

Lots of times women that resort to unsafe methods, they suffer at home or in the community, and don't even make it to a hospital, or if they make it to a hospital the diagnosis is not in line with what the actual cause of death was. Right? So they might get diagnosed as an abdominal infection. Right? And that would be the cause of death or a trauma to the intestines. Right? So, one of the things that I think is going to be really challenging is to really try to quantify the exact impact of the pandemic, but it's certainly something that we're doing in all of our projects. We already have very systematic data collection systems in place so that we can keep an eye on this.

Avril Benoît:

Yeah. It's devastating to think about it. When you think of Honduras, Maura, what do you expect will be the overall outcome and impact of this on death rates?

Dr. Maura Emelina Lainez Vaquiz:

On death rate? So the death rate will be going up, definitely. Most of the women doesn't want to go to the hospitals because they're afraid to get contaminated with COVID. So they're avoiding to go there and they're going to start going back to the midwives, they are not like professional midwife we have in here. So they are the ones that go in the terrain with them, they're in the community already. So, most of them won't have the access to a proper health service. All the mortality will go up, all the pregnancy will start showing up indefinitely. Actually, we don't have a culture where you can say that the family will say, "Okay, we're going to have just this amount of babies or we're going to plan to have a really spacious time for the babies."

So it's going to increase mortality, is going to increase poverty, is going to affect the whole community in this sense, because we're not going to have pregnancy in a lot of manner, but we're going to see death. We're going to see risk, a lot of risk in these girls, they're going to try to find out a way how not to get pregnant, and they're going to start making some practices that are not going to be really good for their health.

Avril Benoît:

We have a great question here for you Manisha from Michael asking to what extent has the current U.S. administration, the U.S. President Trump impaired MSF operations in any way, particularly regarding all aspects of women's reproductive health. Now, we do not accept funding from the U.S. government, that's to be clear. However, we work alongside organizations that do, and we work in that global health space where some of the statements about sexual reproductive health have been made from the U.S. government. Can you describe what's going on there and how that's had an effect on MSF?

Dr. Manisha Kumar:

Absolutely. So, historically the United States has been in a position to have a lot of influence about the sexual and reproductive health care and the services that are available to women and girls all over the world. So even pre-COVID, things like the global gag rule, for example, which Trump reinstated and reinforced and made stronger, really limited how people could talk about abortion, what providers could say, who could provide abortions, who could not, and that is already on top of other policies in which no U.S. government funding can go to support places that provide abortions or abortion care.

During this pandemic in the United States, some state governors have used this as an opportunity also to really label abortion as a non-essential healthcare service, and try to use the opportunity to restrict abortion within the U.S. even more. Beyond the United States, the U.S. government actually wrote a letter to the United Nations, arguing that sexual and reproductive health services should not be seen as an essential service, and even more specifically, that abortion should not be regarded as an essential healthcare service. This was to the United Nations, that's part of what puts in place a lot of the practices and the WHO guidance in particular that impacts women and girls all over the world, and MSF we don't work in isolation, we work in partnership with lots of other organizations with ministries of health.

So these types of messages from the United States really undermine our ability to really work in this system where we can talk openly about what are the real health needs of women? How can we look holistically at all of the needs and then do our best to provide that before unable to even say the phrase sexual reproductive health? Then that really limits our ability to provide any type of care.

Avril Benoît:

One of the reasons that we've spoken against this from the international president to statements we put on our website, and you can find those on doctorswithoutborders.org. Okay. Let's move along to a question to you, Dr. Maura. Are pregnancies going up during quarantine because of rapes, sexual violence or domestic violence? Or, you seem to be alluding before, it's more ... well, you had mentioned that the lack of being able to access contraception, that people are willing to use?

Dr. Maura Emelina Lainez Vaquiz:

Essentially for the lack contraception, we have a lot of cases of sexual violence in our country, especially in our area that we're in Choloma and here in Department of Cortés where we have our MSF staff. But at this point, what I have in hand is that is because of the lack of family planning.

Avril Benoît:

Okay. Another one for you, this is from Rashid asking, how do you compare the past coronavirus infections, which were SARS and MERS to that of COVID-19 in terms of pregnancy outcomes in the areas where you're working? And actually, I guess it's not just coronavirus, because any kind of pandemic, we've talked about Ebola or we've talked about other things, you had Zika in the region. Dr. Maura, can you speak to that in terms of what you saw during the past ones?

Dr. Maura Emelina Lainez Vaquiz:

Well, actually during the past ones, we didn't have SARS or MERS in here in Honduras, but we have like dengue and Zika, there are more transmitted by mosquitoes bites. We can see that, for example, in pregnancy, we have a lot of issue with the babies in that moment, especially with Zika, because it was like STD. It was a sexual transmitted disease, not just because of the mosquito bites, and we have difficulties with the moms that were having pre-labor terms, we were having abortions, spontaneous abortions. We would have malformations in babies during their period of pregnancy, and when they come here with microcephaly, we have a lot of babies in that period of time when Zika was in here and it was one of the most effected.

So during COVID, we have seen that these ladies, the pregnant women in our country have been reducing their visits to the doctors and putting their self in risk without taking all the measures, when they go out, the bio safe measures, or taking their pills, the prenatal pills or eating well, because they're afraid to go out. We have a low rate of pregnant women in Honduras with COVID, but all the women that have been with COVID and are pregnant, most of them have been recuperating, actually we have a loss in this morning, a girl that was ... she was 29 weeks pregnant. They had to do a C-section and an emergency C-section because it was too unstable to take it to the OR, and so they did it in the ICU unit, and sorry she died today. It was a big case for all that community, the gyno community here, because it was like ... losing a patient is already really hard to us as doctors and losing a patient that is already a new mom is bigger.

So COVID have been pushing out all the prenatal care, even though we're trying to in tele-health consults, we are trying to have this prenatal care to these ladies so they can have all this information they need. And with the past, it wasn't this big of a deal because it wasn't mosquito bites, and if you can use a barrier contraceptive it will be fine if you want to have a sexual relation, but now it's like you don't know anything. Everything is contaminated, and as we said in here, in Honduras everything is COVID unless it's proven contrary.

Avril Benoît:

Yeah. You mentioned there that you were doing more tele-health for the antenatal and prenatal care.

Dr. Maura Emelina Lainez Vaquiz:

Yes.

Avril Benoît:

Describe that for us.

Dr. Maura Emelina Lainez Vaquiz:

Okay, we have a number here in Honduras that you can call or you can text us and I can give you some advices, tell you what to do. If you have any questions related and you need some tests that you have to take, I do the prescription, send a picture and they can take it out in the lab or in a drug store. So, they can have or at least try to have all the counsels they need during their pregnancies.

Avril Benoît:

Sounds like ... yeah, you're boxed in by necessity to do things that way and hope for the best. Let's shift our focus a little bit to a country with a very high burden of COVID-19 cases. Manisha, we have a question from Joanne, have you seen differences in sexual reproductive health services in Sub-Saharan African countries, from other countries in the world when you compare, especially wondering about South Africa, where there are so many COVID cases?

Dr. Manisha Kumar:

Yeah. So, specifically in South Africa, our project teams have really had to adapt and work hard in order to maintain the sexual and reproductive health services that we provide. So, in a lot of places what the health facilities did was to take a lot of measures, to try to increase the infection prevention and control measures, make sure we kept our patients safe and did a lot of triage, by necessity that reduced the number of patients that we could treat. But what we saw was that a lot of clinics went beyond that and shut down services, more so than they really needed to, again, thinking that these are less essential.

So antenatal care services or postnatal care services, contraception, and more of the outpatient ones, where that morning you walk into the clinic you're healthy and you can walk out of the clinic and you're still healthy, but the care you're receiving is still essential. So in a lot of those countries, we really had to work even harder to make sure that we could maintain services. Sometimes we were successful in that, and sometimes were not successful.

Avril Benoît:

Well, let's keep going with you, Manisha with a question from Ashley. What do you think the ideal course of action is in terms of the allocation of resources in the midst of a pandemic? So, how can the magnitude at which sexual reproductive health services and resources are compromised be minimized?

Dr. Manisha Kumar:

Yeah, that is really great question, and something that we've been thinking about obviously, and working a lot here at MSF. So, one of the things that I think we can do is to be more innovative and creative in what we do with our resources, right? To think about new ways of doing things, it was clear in the coronavirus that we can't keep doing things the way that we used to before. The one way, for example, that we could have a more effective use of our resources in some ways is instead of sitting in the health facilities and waiting for patients to come to us, right? Which is the traditional approach, and then you have a face to face consultation, then the patient leaves is to do what I refer to as more self-care or community based care.

So in self-care, the approach is more one of empowering communities, families, women, people to manage their own health. So this can be via community health workers, this can be via peer educators, this can be via women's groups, and I think contraception and safe abortion care lend themselves to these types of interventions really easily because they are so safe, right? So something like emergency contraception, there's almost no contraindications to emergency contraceptions. In many countries, you don't need a prescription from a doctor, right? This is something that you can get over the counter by a pharmacist.

So, one approach to have a more effective distribution of our resources or allocation of our resources is to say, "Okay, we are going to make sure that emergency contraception is now available at the community level”. We don't want to have to wait for people to come to the facility.

Avril Benoît:

And for those who are unclear about emergency contraception, can you explain what that is and why you're so hopeful that that can really help?

Dr. Manisha Kumar:

Absolutely. So, emergency contraception is a contraceptive method that you can use within five days of having unprotected sex, if you do not wish to become pregnant. So in the United States, we also refer to it as the morning-after pill or Plan B, and the pills is one of the more common methods of emergency contraception. So it's one pill that you take within five days of unprotected sex. The earlier you take it, the more effective it is, and it can prevent the unwanted pregnancy and that whole cascade of complications that we were talking about earlier.

So, as I said, there's no contraindications and it's an extremely safe pill and it's quite an effective pill, yet it's really hard to get into the hands of women and girls that need them in the United States, let alone in humanitarian settings, right? Let alone in poor and crisis conflict settings. But that would be one way, right? To try to adapt, to modify at least our services in a way that really meet people where they're as if ... the same way that I could go to buy condoms at a local store or a local pharmacy, or buy ibuprofen or Tylenol for a headache, if I could also access, the women also access to emergency contraception, that could really prevent a lot of deaths and save a lot of lives.

Avril Benoît:

Okay. Next one for you Maura, this is again from Zainab, some women may be hesitant to go to a hospital due to misinformation around how doctors inject patients with a lethal injection, notions of misgivings that people might have, maybe misinformation as Zainab is calling it. How is MSF tackling this issue?

Dr. Maura Emelina Lainez Vaquiz:

Actually misinformation in here is like everyday stuff. We have to tackle it from the community. We have our health promoters that started talking about how you contract the infection, how you prevent it, how you can go into the hospital and nothing's going to happen to you because some doctors are going to go and put you a lethal injection just because you have COVID. We try to educate the population. Actually, that's our goal to go into the community and start talking about what is a health service actually, that is not like you're going to go in and you're going to die, is trying to make those bullet points necessary to them to get fixed in their head that we're here to cure, we're here to protect, we're here to help you around, not to mistreat you, not to make you harm.

We're here to make you well, actually, we're here to try to make you feel better and to try to bring your health back to you, and misinformation in here, for example, with COVID have been extremely, some people are taking Clorox as a method of cleaning their self, making themselves ill, and they have to go to a doctor and they think there is something else, but they're getting intoxicated because my neighbor told me that she did that and I go and do it. So, misinformation, we tackle with true information, we tackle with posters, we tackle with mouth to mouth when we go into the community, we tackle in meetings with the community so they can hear from expertise, or they can hear from us too, that is not we're killing people, hospital doesn't kill people.

Avril Benoît:

Okay. A final question for both of you, and we'll start with you Maura, since you're there.

Dr. Maura Emelina Lainez Vaquiz:

Okay.

Avril Benoît:

What can individuals who are watching do to push authorities to make maternal healthcare and sexual reproductive health a priority during this pandemic?

Dr. Maura Emelina Lainez Vaquiz:

Actually, it's really hard in here in our country, our government is like, they don't really care. So individuals in the communities, they should start asking for their rights because it's a right, especially healthcare is something that you need. It’s not that you can avoid it, especially to pregnant women or, sexual reproductive health is something that is a right. It's a woman right that we have earned through the last years, and it has been taken from us right now. At least I feel it that way, and most of the girls that I have been talking to, feel it that way, that they don't have power in their self anymore because no one cares at all.

They can go internationally as they file petitions and stuff but the government doesn't really care. We're trying from the doctor's side, try to tackle it from the inside so they can go into the outside to the health care communities. But it's like really hard to go in there. There is so many politics involved, at least in here.

Avril Benoît:

Yeah. It's devastating to hear you talk about a sense that no one cares.

Dr. Maura Emelina Lainez Vaquiz:

Yeah. It's really hard. You can feel the politics, we have a lot of bunch of money for this emergency, and none of it is have been really going through the emergency. It hasn't been doing it at all, we have lost a lot of resources, we have lost human resources, doctors, we have lost from health promoters, we have lost nurses, RNs, and no one really cares from the government, they're leaving us in the behind.

Avril Benoît:

Well, the rest of us care. So now let me ask you this question Manisha, which came in through YouTube. What can individuals watching do to push authorities to make this a priority during the pandemic?

Dr. Manisha Kumar:

So, I have two answers. So, one of them is, if you're in a country where you can vote, vote. Your elected officials have a huge impact, especially in the United States, right? Have a huge impact on the type of healthcare that people around the world, including women and girls receive. So, if you can, that's great. I think change also starts on a personal level, on an individual level, think about the women and girls in your life, and what type of care you want for them, and how are we showing up for each other, in what way, shape or form, I think this pandemic has really put us in a position where we're rethinking, and we're re-imagining what we want our society and what we want our world to be.

I think that for me, the future is thinking about how can we be in solidarity with women and it made me think about the title of this panel, even, protecting women and girls, right? I want to be in a place where we can listen to women and girls, where we can support women and girls, where we are in solidarity with women and girls. So for me, I think also thinking on an individual personal level, how do I do that? How do I show up? For the women and girls in my life is another thing that viewers can do.

Avril Benoît:

Great. We shall show up. Thank you so much both of you for sharing your expertise today, very difficult topic, but you absolutely have brought us into the complexity of this world and the things that we can all do. Today's panel is Dr. Manisha Kumar, a family medicine physician, head of MSF’s taskforce on safe abortion care, who joined us from Amsterdam, and Dr. Maura Lainez, community doctor working with MSF in the Cortés Department of Honduras. Thank you so much to both of you for being with us today.

Dr. Maura Emelina Lainez Vaquiz:

Thank you.                  

Avril Benoît:

And apologies if you're watching and you asked a question we didn't get to, but we're trying to get to them in the chat as well. So thanks for your patience. We are going to be back in another couple of weeks with another, Let's Talk COVID-19, and that time we're going to be talking about the disproportionate effect on older adults, particularly those living in long-term care facilities, nursing homes here in the U.S. and also in other parts of the world, namely in Europe, where we saw quite a burden, it's been a tragic trend that we've seen as part of this pandemic in our programs and we will share what we've seen and what we've learned in two weeks, same place, same time.

So if you want more information, go to our website, it's doctorswithoutborders.org for the U.S. and the international website is msf.org. You can follow us on Facebook on many languages, but look for us in msf.english, on Twitter you can find us @MSF_USA, Instagram @doctorswithoutborders, and if you have any specific information or questions that we didn't quite get to, you can always contact us for the team that put this together, [email protected]. I'm Avril Benoît, the executive director of Doctors Without Borders in U.S. Signing off, see you next time. Thanks for watching.