Mobile Clinic: A Budding Safe Hub for MARPS

(The Quezon City Social Hygiene Clinic Outreach Project)

by Marries Concepcion

A Peer Educator was helping Dr. Monina Santos explain the proper use of condoms to partner Freelance Female Sex Workers (FFSWs) inside a clinic. Dr. Santos is a Social Hygiene Clinic Physician in Project 7 Quezon City. She extends her schedule to reach out to most-at-risk-populations (MARPS) in the city. “Dapat alam n’yo ang tamang paggamit ng condom kasi ito ang proteksyon n’yo para makaiwas kayo sa anumang sakit na nakukuha sa pakikipag- sex (You should know how to use a condom properly because it is your protection against sexually transmitted infections),” she said to her clients. “Alam n’yo bang 90% ng mga kababaihan ay wala kaagad nararamdamang sakit kaya importante na nagpapakonsulta kayo dito, lalo na sa inyong trabaho na iba-iba ang nakakatalik? (Do you know that 90% of females are asymptomatic that is why it is important to submit yourselves for medical consultation, especially since your work involves multiple sexual partners?),” she added.

Six clients sought medical attention that evening - four of them for a “smear test” and the rest, counselling. A smear test is a simple examination to check for the health of a woman’s cervix. It is called a smear test (or Pap smear) because the doctor takes a small sample of cervical cells and smears them onto a glass slide to be analysed under a microscope. If abnormal cells are found, these will go back to normal on their own (in many cases); but in other cases, they continue to develop. Left untreated, these cells may eventually develop into severe sexually transmitted infections. The examination only took a few minutes and results came almost immediately. Two of her clients were found to have contracted genital infections that evening. They were given post-counselling intervention and a follow-up exam was scheduled. The clients, enlightened as they left the clinic, talked about adjusting their itineraries in lieu of their next check-up as advised by Dr. Santos.

This is a common evening scenario at a Mobile Clinic.

The Mobile Clinic began operating last August 16, 2009, and was set-up within the Novaliches Lying-in Center compound, along Quirino Highway in Quezon City. AIDS Society of the Philippines (ASP), through a Global Fund Round 6 (GFR6) Project, provided the electrical installation, minor renovations and a few other things needed for the clinic; the City Health Department (CHD) of Quezon City provided the medical equipment. Headed by Dr.Annie Innumerable, the objective of the project was to provide accessible services to MARPS in order to reduce the transmission of STI and prevent HIV infections.

In charge of the operation of the Mobile Clinic are Dr. Monina Santos from the Project 7 Social Hygiene Clinic, Dr. Suzzette Encisa from Bernardo Clinic, and Dr. Dottie Mercado from Batasan Hills. They are the official agents of change in the fight against STI/HIV & AIDS in Quezon City.The MARPS could get in touch with them from the said clinics from Monday to Friday and, of course, are even visible beyond their clinic hours at Novaliches, Quezon City every 1st. Monday, Tuesday and Wednesday of the Month from 7PM till 10PM.

Preparation and Strategies

Apart from this venture of the City Health Department of Quezon City in support of preventing STI/HIV&AIDS, other activities such as outreach activities, surveillance, and identification of volunteers to reach the MARPS, were strengthened.

Freelance Sex Workers (FSWs) were successfully reached through Peer Education Training for MARPS. Picking up from the experiences of Peer Educators and Social Hygiene Clinic Physicians, the Mobile Clinic was an innovative strategy for reaching MARPS that was found to be much-valued by Freelance Sex Workers, who are mobile due to the nature of their work. Priority for the choice of a strategic venue to host the mobile clinic was based on the criteria that the venue is an identified hot spot, is heavily populated, and has not been served by other agencies working with a similar project. The City of Novaliches fit the criteria.

The chosen venue for the mobile clinic is a strategic location adjoining the Novaliches Plaza, one of the hot spot areas of MARPS in Novaliches. Services offered via the mobile clinic are easily accessible to MARPS in the evening. John Jardenir and Peer Educators in Quezon City were instrumental in assessing the location and helping establish the Mobile Clinic in Novaliches.

Based on clinic records, 12 Freelance Sex Workers and one male client have visited the mobile clinic on its first day of operation. Dr. Suzzette Encisa was very grateful to the Peer Educators’ active involvement in the project. She shared, “We could not do it alone, the Peer Educators are the right persons to reach the MARPS, they too are in the said situation and I think it is one of the good strategies that we included them in this project”. Dr. Encisa hopes that the Mobile Clinic will be known to MARPS in the area, in the long run.

In terms of attitude, commitment and good-humoured approaches are indispensible to the target population. “If you don’t have it, I doubt that you will succeed in this endeavour”, so says Dr. Encisa from experience. Freebies such as free check-ups, condoms, and medicines excite the clients to return to the Mobile Clinic. Also, Availing of pre- and post- test counselling are important to them, since it gives them a sense of relief and security that there is a safe hub for them that caters to their needs.

Challenges and Recommendations

Peer Educators are still adjusting to the schedule set by Mobile Clinic Physicians. Although the 7 PM to 10 PM schedule of check-up is challenging to the MARPS since they are more active beyond 10PM, they can learn to make it a habit to include a visit to the “safehub” in their calendar. Mobile Clinic Physicians are therefore faced with the problem of lack of clients during the scheduled hours for checkup. However, through the help of Peer Educators, they are able to explain the importance of going for a regular check-up at least once a month, in helping save their life. The Mobile Clinic Physicians forecast that by next year, additional Physicians will be operating the clinic and serving the MARPS 24/7.

Monitoring Approach

For the time being, physicians running the mobiule clinic rely on a Log Book to check the statisitics of MARPS. This includes their gender, age, and location. Through the log book, they are able to monitor their clients’ follow-ups and check-ups. Based on experience at the mobile clinic, there are two clients who constantly keep track of their health status and seek medical help. Their initial consultation has made them conscious of their health and sexual behaviour. They confided that free condoms helped break their fear of acquiring STI/HIV & AIDS.

Plans

Setting up a Social Hygiene Clinic in Novaliches is seen to be a priority in 2010 due to the growing population of MARPS in the City. As Dr. Encisa says, “Everybody is welcome, we do not choose clients, and we do not limit our service to Quezon City resident alone.” More training on Peer Education should be held to gather more MARPS and visit the Social Hygiene Clinic especially the Mobile Clinic in Novaliches.