“What is semen?”.
— “What is menstruation?”.
— “How do I not get pregnant?”
Those who raise these doubts with shame and almost in whisper are high school students. Those who listen to them, after having gained the confidence to have these questions come up, are professionals who make up the comprehensive health counseling in those schools.
Over time, when the relationship with the counselor is strengthened, “adolescents are encouraged to tell about the mental health problems they suffer or situations of violence or domestic abuse,” says Lara Álvarez, a psychologist who works in three schools in the municipality of Charata, in the province of Chaco.
Comprehensive Health Counseling in Secondary Schools (ASIE) was designed in 2015 by the National Ministry of Health, as a response to the lack of consultation of boys and girls about their health. Schools were the space to go and look for them and guarantee them access to their rights.
Then, in coordination with the Ministry of Education of the Nation, it began to be proposed for implementation in different provinces and schools. For three years, the proposal has been part of the National Plan for the Prevention of Unintentional Pregnancy in Adolescence, better known by its acronym ENIA, which operates in 36 departments in 12 provinces. Within this framework, counseling was implemented in some schools in Chaco and Jujuy, although they address many other issues besides the prevention of unintentional pregnancies.
Meanwhile, Neuquén, which is not part of the plan because it is not among the jurisdictions with the highest rates of adolescent pregnancy, which are those with the presence of the ENIA plan, developed the comprehensive adolescent health councils. It began about 20 years ago not as they are now known but as a space in a hospital, like many other adolescent health clinics in the country; then it was moved towards the space where one could go in search of adolescents: schools. Today there are 54 high schools with counseling.
In short, beyond the name and framework in which they are implemented, counseling or counseling services are spaces within secondary schools designed for students to consult about any physical or emotional discomfort they feel or ask questions they may have regarding their overall health. With professionals prepared to guide them and — if necessary — refer them to a specialist who listens to them and provides them with information.
In these spaces “health is addressed broadly, not only from physical ailment or anguish, but also in order to ensure the full use and enjoyment of their secondary schooling,” explains Dora Niedzwiecki. She is a teacher, psychologist, master's degree and doctor in Social Sciences, and she published — together with Camila Ríos Fernández — the book The contents of the ESI in action (Publishing Place).
The advisers are health professionals or social work professionals trained to offer interdisciplinary listening and support.
The impact of these spaces on the lives of boys and girls is overwhelming. In 2018, when counseling began to be implemented in Charata, “in each of the high schools where I worked there were 4 or 5 pregnant students. Today, there is only one of the three schools,” says Álvarez. She is a consultant at High School No. 23 and Special No. 19 that operate in the city, and at High School No. 171 which is in the rural area of Tres Estacas, 60 kilometers from Charata.
In the case of Jujuy, “since counseling was implemented in 2019, teenage pregnancies increased from 19% to 8% in the province,” says Mariela Ríos, health adviser at rural high school No. 2, in La Almona, a small town near the provincial capital.
Also, the effects of the pandemic on boys and girls found a channel in these spaces. “This year, on the first day I went to school, out of six students who came to talk to me, one wanted to know about their menstruation and basic information about the functioning of the female body, and five raised feelings of anguish and suffering, problems with their fathers, mothers, sisters related to living in confinement in the context of the pandemic”, says Paula Giraudo, counselor at the Provincial Center for Secondary Education 55, in the Neuquén city of Plottier. She is a social worker and is temporarily in charge of the Adolescent Directorate of the Ministry of Health of Neuquén.
How does a school in Jujuy work
Every 15 days, Rios allocates two hours to get to the school attended by 12 students. You take two buses and walk a kilometre and a half along a path that is usually cut when the stream that crosses it overflows. “You have to plan and wear clothes and shoes to change if you know it's going to rain. We always remind the kids, because they come walking too,” says Ríos.
When she arrives, at 1pm, boys and girls are finishing lunch. “I always take a piece of fruit to share that time with them and thus engage in informal conversations that generate bonds of trust, that allow me to see how they are doing,” says the advisor.
Ríos also informs them of the days when the general practitioner and the nutritionist will visit the school and articulates with the health worker — a nurse who is in charge of the health room on a permanent basis — who they can turn to for contraception or other medicines or for emergencies.
“When children have concerns, want information or need contraception, they usually ask permission to go to the bathroom during class time, when others don't see them, and they go to get me. Sometimes, they propose to me as a group to play a game with which to work with contraceptive methods or sexually transmitted infections,” says Ríos.
Many students have never been to the hospital and when they need to do so, they often ask you to accompany them. She tries to get them to find another adult who is their reference, so that they acquire autonomy, but if there is no one, she accompanies.
The watchful eye also makes it possible to detect diseases. Rios says: “When the doctor asks them, they never hurt anything. But they usually tell me, because they trust me. So, I alert the doctor when she visits us: 'A few days ago she fell and her knee hurts', 'He doesn't sleep well at night'”.
Students who are close to finishing high school also ask her about what to study and how they can do it. Rios seeks information and provides guidance.
During the pandemic he worked virtually, articulated with the health worker and (above all) listened. He recalls: “Sometimes they called me to greet me, to ask me what I was doing, they looked for me to talk about their emotions, their family relationships, they trusted me that they couldn't connect with school. They also asked me how to create a video call or how they could communicate with each other. Since they don't have internet, sometimes they asked me to call them to avoid wasting data.”
Consultancy in Chaco
Vanina Ciucci is a social worker, Lara Álvarez is a psychologist and Fiorella Mocca is a nutritionist. In turn, the three are health advisors and since 2018 have formed an interdisciplinary team in Charata from which they accompany eight urban and rural secondary schools.
“We started by going through the courses and coordinating for students to go to the health center where there is dental, pediatrics, diabetes control and nursing services. Then, we articulated with the hospital so that girls who wanted to get an IUD or subdermal implant could access them. And during the COVID-19 vaccination, we organized to get vaccinated in schools,” says Ciucci.
The advisor also stresses the importance of being close to boys and girls at the right time: “Many teenagers are able to get the implant and it is important to act when they decide, to be close to ensure access. If we let that moment pass, then they choose not to take care of themselves. In general, care falls on girls, so we insist on double protection: contraceptive method plus condom to prevent sexually transmitted diseases.”
Among the main difficulties in implementing consultancies, professionals highlight the lack of a private space in some establishments. Sometimes, there is only room to put a small table in a hallway. “In rural schools, if I don't have room I go to a backyard,” says Álvarez.
In these spaces, boys and girls “want to work on comprehensive sexual education (ESI), environment and mental health because teachers are not yet encouraged to talk about these issues,” says Mocca.
In turn, the professionals agree that the context of the pandemic opened up the possibility of connecting virtually and that expanded the arrival of consultancies. “Many boys and girls who have finished school and work in rural activities continue to contact us virtually or call us on the phone when they need medical shifts, get a subdermal implant or because they forgot to take the birth control pill,” says Mocca.
Virtuality also allows students who do not dare to tell situations of domestic violence or anguish in person to start doing so through WhatsApp messages.
The councils of Neuquén
Giraudo emphasizes that, in Neuquén, adolescent comprehensive health counseling works under certain precepts (shared by the Chaco and Jujuy advisories): “Consultation is voluntary and confidentiality is guaranteed. We always tell kids that if their parents, teachers or preceptors ask us what we talk to them, we can't report anything.”
Sometimes it is teachers “who confuse the role of counseling,” says Giraudo. And he explains: “They ask us to talk to a boy because he is homosexual, because he wears a green scarf, because he dyes his hair. We explained to them that this boy has nothing to do in counseling, that if he is being harassed, he has to make group interventions and for that there are three pedagogical advisors who work very well.”
The counselling offices address issues proposed by young people, linked to their overall health: life project, sexuality and affection, food and nutrition, physical practice, tobacco, alcohol and drug use, prevention of injuries from external causes and sexually transmitted infections, among others.
“For the popular sectors, the school is the last public institution they step on,” emphasizes the head of the Provincial Government's Directorate for Adolescents. That is why the work of these councils is so important: to provide timely and relevant information in simple terms, to refer to the health services that exist in the territory whenever people need it and to support them so that they can reflect on their practices. It also promotes autonomous decision-making and self-care, and facilitates empowerment for adolescents to live healthy lives and exercise their rights.
In this context, eating disorders in boys and girls “is a problem that requires trained doctors who are missing in the province,” says Giraudo.
Counseling services, which operate in person once a week for four hours in each school and keep virtual channels open for those who prefer them, are one of the three legs of the Neuquén project aimed at improving the overall health of adolescents. There are also differentiated comprehensive health clinics that operate throughout the province and, since 2015, the training of adolescent health promoters so that the message is among peers. “They are the ones who carry out workshops or make interventions in schools,” says Giraudo.
Knowing their rights and learning to exercise and claim them, the director continues, “the boys become very assertive in their interventions. For example, in some schools they began to ask that the canteens offer food suitable for students with celiac disease or to accompany those who are not encouraged to consult us for an abortion or who have food problems.”
When that began to happen, “teachers and preceptors came to us for help because they didn't know how to work 'with children who knew their rights'. We also worked with them on what they could do when they saw a child cut himself, when he smoked or drank just before entering school. We worked, for example, to make them see that these kids were asking for help,” Giraudo describes.
Many secondary schools still do not have comprehensive adolescent health counseling despite the fact that it is “a way to guarantee access to the rights protected in our National Constitution,” Niedzwiecki says.
For this reason, he insists: “You have to know that in schools there is the germ to achieve it. Perhaps, in the goalkeeper that generates from empathy with adolescents that relationship of trust indispensable so that they can tell what is happening to them, what they feel, consult about something that worries them. And that opens up the possibility that adults can accompany, guide without indicating what to do, respecting their decisions with information adjusted to the right”.
___
This note is part of the Solutions for Latin America platform, an alliance between INFOBAE and RED/ACTION.