PASOS ADELANTE - Reality and the Challenges

THE REALITY

During the 2013 school year we taught six of the Pasos Adelante lessons during the tutorial period (study hall) to 40 third-year and 13 fourth-year high school students once per week for 6 weeks. 

A special guest expert (personnel from the health center) was invited during each session to present on the topic of the week. 

DATE (2013)	TOPIC	AUDIENCE	PRESENTERS
October 29	Healthy Decision-making Seeking My Ideal Partner	3RD year students  4TH year students	Karen Crow, Peace Corps volunteer Elena Iman, Nurse Technician
November 5	Adolescent Sexuality	3RD year students 4TH year students	Dr. Mayulli Rubio Ancajima Karen Crow, Peace Corps volunteer Elena Iman, Nurse Technician
November 12	Family Planning Methods	3RD year students 4TH year students	Cristina Gutierrez, Nurse Technician Santos Albines, Nurse Technician Elena Iman, Nurse Technician
November 19	Sexually Transmitted Infections	3RD year students 4TH year students	Norma Fiestas, Nurse Technician Karen Crow, Peace Corps volunteer Elena Iman, Nurse Technician
November 26	Drugs and Alcohol	3RD year students 4TH year students	Dagoberto Martinez Navarro, Nurse Technician Karen Crow, Peace Corps volunteer
December 3	Planning for My Future	3RD year students 4TH year students	Elena Iman, Nurse Technician Stefani Cano Vasquez, Lead Nurse

CHALLENGES IN 2013

1.       The lessons were taught during the once-weekly tutorial period, which were originally 50 minutes in length.  As the weeks passed, the teachers insisted on utilizing more and more of the tutorial period time to review material for upcoming exams.  Eventually, our time was reduced to 30 minutes per lesson.  

            a.       The lessons are intended to be carried out over a longer time period (1.5 hours) than we were allotted as part of the tutorial period (35-45 minutes).

            b.      Because of the shortened time, we were forced to cut out most of the activities that would have allowed students to practice and apply the newly learned material.

2.       The quantity of students in each lesson was not easily manageable.  There were 13 students in 4^th grade and 41 students in 3^rd grade, giving us 54 students in the combined class.  It was challenging to maintain their attention, keep them on task and limit the distractions and rowdiness.

3.       The Director of the school was suddenly relieved of his position in September of 2013, just as the school was returning from winter break.  After two months passed, the newly appointed temporary Director gave us permission to teach lessons, but the delay due to the circumstances cut short our teaching schedule.  We had only 6 weeks before the end of the school year, allowing us to teach only 6 once-weekly lessons.

4.       We worked as best we could within the confines of the educational system, knowing that taking the lessons outside of the high school walls would have severely reduced participation.  Most teens  are overburderned with responsibilities in the home and spend their afternoon hours studying, working on school projects, working on the family farm, taking care of farm animals, doing household chores, attending church services and/or participating in family activities.  It is rare for a teenager in my community to have free time, especially time to attend additional lessons outside of school.

5.       The copy machine in the Municipality often broke down and was left unrepaired for long periods of time, requiring me to utilize more grant funds for making copies than was originally intended.  Also, the workplan changed several times throughout the lifespan of the project, and a new Pasos Adelante manual was issued (the second edition), requiring additional unanticipated copy and printing needs.

RESULTS OF ACTIVITIES IN 2013

Results of the final survey administered after the end of the last educational session in 2013:

1.       Number of youth trained in sexual reproductive health and modern birth control methods in a small group setting, who can:

a.       identify at least 2 ways to prevent unwanted pregnancy and the transmission of sexually transmitted infections, and

b.      demonstrate the steps to correctly use a condom.

Males aged 10-14	7
Males aged 15-17	14
Females aged 10-14	11
Females aged 15-17	18
TOTAL	50

2.       Number of youth aged 15-24 who reported engaging in sexual activity in the past 3 months and who used a condom at last sex:

Males aged 15-17	1
Females aged 15-17	1
TOTAL	2

SCHOOL YEAR 2014

In June of 2014 my main counterpart and I developed a launch plan and presented it the new, permanent Director of the high school who readily accepted.  We created application materials and invited students in the 4th and 5th year classes to apply to become a peer educator/youth health promoter for the Pasos Adelante program.

Fourteen students applied to become peer educators.  Ten were accepted and invited to attend a training session during the school break in July.  I coordinated with a local Psychologist, along with the Obstetrician and Doctor from the health center to provide the selected youth with leadership-focused educational sessions on self-esteem, self-confidence, choosing positive values, and managing stress.  Among the 10 youth selected to attend the leadership training, 8 completed the four training sessions; four girls from 4^th year, and four girls from 5th year of high school.

Following the leadership training, the eight students were placed in pairs and each pair selected one lesson topic from the list of Pasos Adelante lessons that they intended to present to their peers in during the weekly tutorial periods in September.  During each lesson, a health professional from the community was invited to present an informative speech on the topic, and the two youth peer educators directed activities to practice and reinforce the information provided.

2014 Schedule of Educational Session in El Tallán  High School:

DATE (2014)	TOPIC	AUDIENCE	PRESENTERS
September 17	Pregnancy Prevention	3rd year students	Lic. Digna Nunura Calderon Karen Crow
September 18	Alcohol and Drugs, Decision-making	4th year students	Santos Albines Karen Crow
September 25	Planning for My Future	4th year students	Cristina Gutierrez Karen Crow
October 7	My Ideal Partner Abstinence	1st year students	Elena Iman Quintana Karen Crow
October 9	HIV and AIDS	4th year students	Lic. Digna Nunura Calderon Karen Crow
October 15	Condoms and Methods of Birth Control	3rd year students	Lic. Digna Nunura Calderon Karen Crow
October 22	HIV and AIDS	3rd year students	Lic. Digna Nunura Calderon Karen Crow
October 30	Condoms and Methods of Birth Control	4th year students	Lic. Digna Nunura Calderon Karen Crow

CHALLENGES IN 2014

1.       After summer vacation ended and the 2014 school year began in March, our challenges mounted as the temporary Director was replaced by a permanent Director one month after the start of the new school year.  As the new Director juggled his new responsibilities amid the chaos of launching a new school year, weeks turned into months of waiting to launch the program, and motivation to move forward waned among the health center staff and the focus turned to more immediate, pressing needs.

2.       There was a lack of interest among male students who were too shy to serve as peer educators, had no interest in the lessons, or did want to serve in a leadership role.  Among applicants, two males were accepted but did not participate in training.

3.       The four 5th year students who had been trained to serve as peer educators were overwhelmed with schoolwork and preparing for the next steps after high school, and were therefore unable to participate.  Among the eight students who had received training to become peer educators, only four girls in the 4^th year of high school remained interested and willing to participate.

4.       It was difficult finding time outside of school for the pairs to prepare and practice the lessons, which restricted their ability to learn and digest the material in a manner sufficient to present with confidence on the topic.  Given the circumstances, I decided to continue the practice of inviting special guest experts from the health center to provide the factual information during each lesson, and allow the two peer educators to direct the activities that provided opportunities for students to practice and apply the information learned.  This structure allowed each party to utilize their strengths -- health professionals presenting factual information, and students engaging other students in activities – while sharing leadership responsibilities.

5.       After teaching a lesson on abstinence to 1^st year high school students, a parent complained that the lesson was intended to incentivize the children to engage in sexual activities.  As a result of this complaint, the Director decided that lessons can only be taught to 3^rd, 4^th and 5^th year students, which cut us off from reaching the 1^st and 2^nd year students.  This required that we reach these students outside of class.

6.       Due to the complaint mentioned above, the condom demonstration that was originally planned to take place in the high school was re-scheduled to occur during after school hours, running the risk of losing attendance.

7.       School was closed without prior notice for the elections, religious holidays and teacher in-service trainings, which required us to cancel sessions that we were not able to reschedule prior to the end of the project.

PARENTS SCHOOL

Mothers and fathers of the 53 students in the 3^rd and 4^th year classes of high school were invited to attend an educational session to develop tools and skills needed to improve communication between parents and their teenagers. The educational session was intended to help parents improve communication with their teenagers and reinforce the information presented in the Pasos Adelante lessons.  It offered an opportunity for mothers and fathers to gain important communication skills and learn to use techniques to discuss sensitive issues such as family planning, critical for building trust, respect and communication between parents and children. Each participant was asked to apply the newly acquired behaviors and report the effective use of communication skills and better communication with their teenagers.

The session was taught by a local Psychologist who had been recommended by a nurse working in the community health center.  I spoke with the Psychologist and informed her that her presentation should cover the following topics:

1.       Understanding communication styles

2.       Positive communication techniques

3.       Demonstrating active listening

4.       Speaking clearly, precisely and assertively

5.       Barriers to good interpersonal communication

Twelve parents attended the session and were very interested in improving their parenting skills and improving communication with their children.

CHALLENGES OF PARENTS SCHOOL

Unfortunately, the session did proceed in the manner in which we had planned.  The Psychologist did not prepare a presentation that followed the topics we had agreed upon. 

Instead, the main points of the session were:

1.       Don’t beat your children

2.       Be a good role model to your children

3.       Speak with respect to your children

While these are valuable points in general, the information covered in the session did not follow the list of topics (above) that I had provided to the presenter.  Clearly lacking were simple, easy-to-remember steps for working through difficult conversations that parents could have taken home and put into practice immediately.  This created a problem for tracking progress of the goal to improve communication between parents and children.  Given that the parents had not learned nor practiced new communication techniques during the educational session, it was impossible to document use of those techniques. 

It may not have been a total failure, however, as the attendees appeared to enjoy the session and generally seemed appreciative of the opportunity to participate.  My hope is that it sparked some desire to make an effort to change the way parents interact with their children, and possibly some will discover on their own ways to improve communication.

Ideally, this would be the first session in a series, with the second and third sessions including concrete steps and detailed action items for attendees.   I envisioned the second session involving parents learning and practicing steps to improving listening and speaking skills, and breaking down barriers to good communication.  After the second session, parents would be expected to utilize their newly acquired skills and report on the results during the third session.  The third session would involve both parents and teens, who will together learn and practice enhanced communication techniques.  This session would provide a safe space for the teens to discuss with their parents topics learned in the Pasos Adelante lessons, which could include sexuality and reproductive health issues, as well as planning for their future.

HIV AWARENESS EVENT

The Pasos Adelante program initially reached a small number (53) of the total 612 adolescents in four main villages in the district of El Tallán with information on avoiding HIV transmission and unintended pregnancy.  A broader outreach effort was needed to reach more youth with critical messages to promote healthy decision-making in a sexual health context.  

A community-wide event was designed to provide accurate information about HIV, dispel myths and normalize the use of condoms for reducing the risk of transmission.  The event was scheduled to occur after school hours to avoid complications from parents resisting sexuality-based education on school grounds.

We began by showing a series of videos provided to us by a representative of PEPFAR (President’s Emergency Plan for AIDS Relief), which included a variety of messages from humorous television commercial spots to documentation of discrimination against people living with HIV/AIDS in Peru, as well as an informative teaching tool detailing the facts about HIV transmission, testing and treatment.  After viewing the videos, a nurse from the local health center reviewed the differences between HIV and AIDS and an overview of routes of transmission.

Next, two peer educators directed an activity to allow students to practice the new information by forming groups that were given the task of categorizing a set of situations as either being a risk for HIV transmission or not a risk.  Following this activity, a different pair of peer educators demonstrated the steps to using on a condom.  Each group of participants was provided with cards listing the steps, and the groups worked in a competitive manner to list the steps in the correct order and demonstrate the steps by placing a condom on a plastic soda pop bottle.

CHALLENGES OF THE HIV AWARENESS EVENT

1.       Adolescents are often overburdened with schoolwork and chores in the home and cannot attend events after school.

2.       It was difficult to attract a variety of teens from the community beyond those who had already received or participated in the HIV lessons.

3.       The reluctance of parents to allow their children to participate may have had an effect on the number of participants.

Please continue reading to find out the impressive results of the project.