AFEMMIS: Improved genital health of prostitutes

Cultural beliefs and educational factors strongly influence intravaginal practices by women in Africa. These behaviors appear common in different population across sub Saharian Africa where practices include the use inside the vagina of simple water, water with soap, commercial antiseptique,  juice lemon,salty water, vinegear, antiseptic preparation, traditional medicine or the insertion of fingers into vagina to remove secretion, paper, herb, stone to dry and tighten vagina in order to please the partner.1 Some female sex workers are followers of these practices as they have frequent sexual intercourse. Studies conducted by Luo et al., (2016) in China, Seidman et al., (2016) in Mexico and Fonck et al., (2001) in Nairobi among female sex workers showed a prevalence 84%, 43.3% and 72% of douching respectively.2-3-4 There is a lack of data about intravaginal practices among women and prostitutes in Cameroun. The main reasons that motivate these women to follow these practices are to eliminate vaginal odor, to remove excess vaginal secretion, to clean before and after sex, to fight against sexually transmitted infections and pregnancy and tighten the vagina to please partner.5-6-7-8 Previous research has suggested that  vaginal douching modifies vaginal flora and was associated with bacterial vaginosis, chlamydial infections and urogenital mycoplasma.5 In past study, the rate of genital infections were 53.5% and 33.8% in women who did and did not douche, respectively.9 Douching is associated with adverse reproductive and gynecologic outcomes including bacterial vaginosis, chlamydial infection.10-11Intravaginal practices increase the risk of developing bacterial vaginosis, the most common genital infection associated with transmission of sexual transmitted diseases.2-12-13-14-15. The prevalence of bacterial vaginosis in the study conducted by Alcaide et al.,(2017) was 64.2%.12 A study conducted among Kenyan sex workers found that bacterial vaginosis was associated with intravaginal use of petroleum.16 Another study showed that the time to sexually transmitted diseases (STI) was shorter for adolescents who always (HR, 2.1 95%CI 1.2-3.4) and intermittently (HR, 1.5; 95%CI, 1.0-2.2) douched, compared with never-douchers and the hazard of sexually transmitted infections was 1.8 (95%CI, 1.1-3.1) times larger for participants who always douched than participants who never douched. 17 A prevalence of bacterial vaginosis of 62.9% was found among female facility workers in Tanzania.18 Another study conducted among 584 female  sex workers in Mexico  reported a prevalence of 39% of bacterial vaginosis.19 A prevalence of cervical chlamydia trachomatis infection of 12% was reported in a study conducted by Ryan et al., (1998) among sex workers  in Cameroun.20 A study conducted by Kaptue et al.,(1991) reported a prevalence of cervical chlamydia trachomatis infection by immunofluorescence method of 38.03% among prostitutes in Yaoundé.21 In Burkina Faso the prevalence of Chlamydia trachomatis was 11.54% among prostitutes.22  A study conducted by Poteat et al., (2021) reported a prevalence of 17.7% of chlamydia trachomatis among prostitutes in America.23Annang et al.(2006) reported that 46.1 women of their study were categorized as current douchers and 15.4% were infected with chlamydia.11More numerous studies have noted the relationship between douching behavior and sexually transmitted diseases, particularly Chlamydia trachomatis.24-25  Each year about 127 million of people worldwide are infected by Chlamydia trachomatis says the World Health Organization.26-27Despite the fact that health professionals have deemed the practice non beneficial  women continue to douche.17-28 Martino et al., (2002) reported that the behavior persist among minority women at a high rate (55% of blacks).29. A study conducted by Zhang (2021) reported that 56% of gynecological outpatients were positive for Ureaplasma urealitycum and 11% were positive for Mycoplasma hominis, and women with gynecological disease had an increased risk for mycoplasma isolation (30)

Bibliography:

1. Myer L, Kuhn L, Stein ZA, et al. Intravaginal practices, bacterial vaginosis and women’s susceptibility to HIV infection: epidemiological evidence and biological mechanism. Lancet infect Dis. 2005; 5 (12):786-4.

2.  Fonck K, Kaul R, Keli F, et al. Sexual transmitted disease infection and vaginal douching in a population of female sex workers in Nairobi Kenya. Sex Transm Infect. 2001; 77 (4):271-5.

3. Luo L, Xu JJ, Wang GX, et al. Vaginal douching and association with sexual transmitted infection among female sex workers in a prefecture of Yunnan province China, Int J STD AIDS. 2016; 27(7): 560-7.

4. Seidman D, Rusch M, Abramovitz D, et al. Intravaginal practices amoug HIV-negative female sex workers along the US-Mexico border and their implication for emerging HIV prevention interventions. Int J Gynecol Obstet. 2016; 133(2):212-6.

5. Yildirim R, G Vural, Koçoglu E, et al. Effect of vaginal douching on vaginal flora and genital infection. J Turk Ger Gynecol Assoc. 2020; 21(1):29-34

6. Funkhouser E, Hayes TD, Vermund SH, et al. Vaginal practices among women attending a university in the Southern United States. J Am Coll Health. 2002; 50: 177-82

7. Crosby RA, Yarber WL, Meyerson B, et al. Prevention strategies other than males condoms employed by low-income women to prevent HIV infection. Public Health Nurs. 2000; 17: 53-60

8. Ness RB, Hillier S, Richter HE, et al. Can know risk factors explain racial difference in the occurrence of bacterial vaginosis? J Natl Med Assoc. 2003; 95: 201-12

9. Ege E, Timur S, Zincir H et al. Women’s douching practices and related attitudes in eastern Turkey. J Obstet Gynecol Res. 2007; 33:353-9

10. Cottrell BH. Vaginal douching. Obstet Gynecol Neonatal Nurs. 2003; 32 (1):12-8

11. Annang L, Grimley D, Hook EW, et al. Vaginal douche practices amoung black women at risk: exploring douching prevalence, reasons for douching and sexually transmitted diseases infections. Sex Transm Dis. 2006; 33(4): 215-19.

12. Alcaide ML, Chisembélé M, Malupande E et al. A bio behavioral intervention to decrease intravaginal practices and bacterial vaginosis among HIV infected Zambian women: a randomized pilot study. BMC infect Dis. 2017; 17:338

13. Holzman C, Leventhal JM, Qui K, et al. Factors linked to bacterial vaginosis in non pregnant women. Am J Public Health. 2001; 91:1664-70.

14. Peters SE, Beck-Sague CM, Farshy CE, et al. Behaviors associated with Neisseria gonorrhea and Chlamydia trachomatis: cervical infection among young women attending adolescent clinics. Clin Pediatr. 2000; 39: 173-7.

15. Foch BJ, McDaniel ND, Chacko MK, et al. Racial difference in vaginal douching Knowledge attitude, and practices among sexually active adolescents. J Pediatr Adolesc Gynecol. 2001;14: 29-33

16. Hassan WM, Lavreys L, Chohan V,et al. Association between intravaginal practices and bacterial vaginosis in Kenyan female sex workers without symptoms of vaginal infection. Sex transm Dis. 2007; 34 (6):384-8.

17. Tsai CS, Shepherd BE, Vermund SH. Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents. Am J Obstet Gynecol. 2009; 200(1): 38.e1-8

18. Baisley K, Changalucha J, Weiss HA et al. Bacterial vaginosis in female facility workers in North western Tanzania: prevalence and risk factors. Sex Transm Infect. 2009; 85(5): 370-5

19. Jain JP, Bristow CC, Pines HA, et al. Factors in the HIV risk environment associated with bacterial vaginosis among HIV-negative female sex workers who inject drug in the Mexico-United States border region. BMC Public Health. 2018 ; 18(1):1032.

20. Ryan KA, Zekeng L, Roddy RE et al. Prevalence and prediction of sexually transmitted diseases among sex workers in Cameroun. Int J STD AIDS. 1998; 9 (7): 403-7).

21. Kaptue L, Zekeng L, Djoumessi S et al. HIV and Chlamydia infections among prostitutes in Yaoundé, Cameroon. Genitourin Med. 1991; 67: 143-5.

22. Tovo SF, Zohoncon TM, Dabiré AM, et al. Molecular epidemiology of human papillomavirus, Neisseria gonorrhoeae, Chlamydia trachomatis and mycoplasma genitallum among female sex worker in Burkina Faso: prevalences, coinfection and drug resistance genes. Trop Med Infect Dis. 2021; 6(2):90.

23. Poteat T, White RH, Park JN, et al. Characterising HIV and STIs among trangender female sex workers: a longitudinal analysis. Sex Transm Infect. 2021; 97(3):226-31.

24. Blythe MJ, Fortenberry JD, Orr DP, et al. Douching behaviors reported by adolescent and young adult women at risk for sexually transmitted transmitted infections. J Pediatr Adolesc Gynecol. 2003; 16:95-100.

25. Iannacchione M. The vagina dialogues: Do you douche? Am j Nurs. 2004; 104: 40-6.

26. World Health Organization (WHO). Report on Global Sexually transmitted infection and Suveillance. 2018 available online : https://www.who.int/reproductivehealth/publications/stis-surveillance-2018/en/. 27. Rowley J, Vander- Hoorn S, Korenromp E, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: Global prevalence and incidence estimates. Bull World health Org. 2019; 97:

28. National Center for Health Statistics. Fertility, family planning, and women’s health: new data from the 1995 national survey of family growth. National Survey of Family growth and Health Statistics 1997; series 23, Number 19, US Department of Health and Human Services. http://www.cdc.gov/nchs/data/series/sr_23/sr23_019.pdf.2003.

29. Martino JL, Vermund SH. Vaginal douching: Evidence for risks of benefits to women’s health. Epidemiol Rev. 2002; 24: 109-24.

30. Wei Zhang, Liluan Li, Xuelian Zhang, Hongshu Fang, Huajian Chen, Changxian Rong. Infection prevalence and antibiotic resistance levels in ureaplasma urealyticum and Mycoplasma hominis in gynecological outpatients of a tertiary hospital in China from 2015-2018. Canadian Journal of Infections diseases and Medical Microbiology 2021.

My solution is to improve genital health of prostitutes:

my solution is in three steps:

the first will be to inform participants about the harmful effects of intravaginal practices:intravaginal practices promotes the acquisition of HIV AIDS , gonorrhea, bacterial vaginosis, chlamydia, urogenital mycoplasma by destroying the vaginal flora and attacking the vaginal mucosa .Introduce herbs, stones, powder  can cause recurrents genital infections and cancer .The vaginal pH loses its acidity and promotes the installation of pathogenic germs. These practices can cause pelvic inflammatory diseases, uterine growth retardation, salpingitis, chorio amniotitis, spontaneous abortions and infertility.

The second step is to educate them on the maintenance of the vaginal cavity: the vagina is self-cleaning. It is necessary to limit the toilet to the vulvar area only. Do not put any product in the vaginal cavity to preserve it from infections. Avoid using commercial antiseptic, lemon juice, vinagear,salty water, petroleum, traditional herb,powder, water with soap inside the vagina. We know they have many sex partners in a day, but we are going to advice them to not clean inside the vagina after sexual intercourse

thirdly, I communicate with the prostitutes and make them aware of the dangers of intravaginal practices( they will no longer suffer from recurrent genital infections and they wil be able to use their earned money for something other than to treat themselves) and recommend that they make their colleagues that we could not join  aware of this intravaginal practices.

I make them aware of the harmful effects of these practices (Intravaginal practices) and I encourage them to use the condom also.

My solution serves to women in general and to prostitutes in particular as they have frequent sexual intercourse. Educate them how to maintain their vaginal cavity will preserved them from many recurrent sexually transmitted infections and they will kept money they won as they will no more treated their genital infections. When the prostitutes go to hospital they hardly tell to the doctor they are prostitutes, their fear the stigma and sometime do not say  what they suffer from. In our structure they are kindly welcome, they are confident as they are not judged and we have a psycho social assistant who help them to overcome their problems they have with customers (agression, those who do not use condom and want to pay more, those who do not pay) and the problem they face at home (children, and partner). No longer have sexually transmitted diseases will make them more available to their clients and they can won more money as they will no longer suffer fromm recurrent genital infections

In our solution's team we have a representative of the prostitutes of the Ann rouge District who informed us of the health's problems of these prostitutes and how their maintain their vaginal cavity, their objet of trade to be sexually efficient. She reported to us all the prostitutes intravaginal practices (using of commercial antiseptic, saline water, lemon juice, petroleum, herbs ,paper ,stone, cloth inside the vagina). In order to get close to the population served, we offered them condom and tell them that we have a psycho social assistant who could advise them and help them to overcome their problems and a medical doctor who can treat their current infections.We are the right people to design and provided this solution because we have health professional in our team who are aware of the harmfulness of intravaginal practices.We will educated prostitutes how to improved their genital health and serve prescription for current sexually transmitted infections, we give them advice on family planning when they arrive at our structure and we have an open call number where they can call when in need. We do not judge them and at AFEMMIS they are not afraid to be stigmatized , we accompany and support them every time.

I am applying for this challenge initially to improve the genital health of prostituted women, I find that their work is not easy because their bodies are involved. I am applying for this challenge initially to improve the genital health of prostitutes women. Then I do not have enough financial means to support the diagnostic examinations (tests) of genital infections,I don't have enough resources to properly diagnose genital infections. If I obtain the financing I could avoid this obstacle (test could be done easily for each prostitute who ask for the test). The funding received will help me also to temporarily employ a legal representative who will  allow a better positioning of it at the nationaly and internationaly level and a computer specialist who will be able to create a website that will improve the visibility of our structure in the world and could help us to put a pitch in this document

My solution is innovative insofar as intravaginal practices are taboo subjects, no structure has ever approached prostitutes to educate them on the maintenance of their vaginal cavity. They are especially sensitized on the wearing of condoms. Sometimes when the client pays more, they no longer wear the condom. Many African women suffer from vaginal infections because of these practices. We will inform prostitutes about the harmful consequences of these practices, namely repeated vaginal infections, salpingitis , pelvic diseases, spontaneous abortions, infertility. We are going to convince them by doing a study on their population (intravaginal practices and genital infections; gonorrhea, chlamydia, mycoplasma,bacterial vaginosis). This information, education and communication with prostitutes will reduce the acquisition of sexually transmitted infections and will make their customers less exposed to these infections, we will reduce these sexually transmitted infections in the general population. They will learn how to better maintain their vaginal cavity because we will tell them that this cavity is self-cleaning, it is not necessary to clean the vagina with any product whatsoever, or to put traditional herbs in it which can expose them to cancer.  They will thus preserve the vaginal ecosystem which will protect them from genital infections.

Our impact goal for the next year:

We aimed at examining the effect of intravaginal practices on the vaginal flora and genital infections

Specifics objectives

-Determine the prevalence of intravaginal practices among prostitutes

-Determine the prevalence of bacterial vaginosis, gonorrhea, urogenital mycoplasma cervical chlamydia trachomatis infections among prostitutes who follow and who do not follow  intravaginal practices

-Evaluate the association between pathological vaginal flora and intravaginal practices

-Evaluate the association between intravaginal practices and  genital infections

3-Project design

-Type and location of the study

We conducted a cross sectional study among prostitutes in Yaounde at AFEMMIS

-Duration of the study

The study was carried out from December 2022 to November 2023

-Sample size

The sample size for the study was 2000 female sex workers, calculated using the formula by Lorentz based on a prevalence of cervical chlamydia trachomatis infection of 12% reported among sex workers in Cameroun.20

-Inclusion criterials

The inclusion criterials were all female sex workers, aged 18 to 45 years old, who provided informed consent and worked in prostitution since one year

-Non inclusia criteria

The non inclusia criteria was female sex worker under antibiotic treatment since two weeks

-Research Methodology

-All participants provided written informed consent before enrolment and each recruited participant had a questionnaire interview and cervical and vaginal swab collection.

An ethical clearance will be introduced to the Regional ethics committee for Human Health Research at the Center.

Participants were asked to avoid vaginal cleansing before attending the visit. Collected samples were processed in the Human Biology Laboratory of IMPM

Participants were interviewed face to face by trained nurses interviewers . The informations were collected using the questionnaire included socio demographics informations (age, marital status, education level), intravaginal practices behavioral data (cleaning inside the vaginal cavity, vaginal toilet with finger, vaginal douching with water alone, water with soap, commercial antiseptic solution, vinegar, lemon juice, salty water, insertion of products to dry or tighten vagina as powder, cream, herbs, stones, leaves), the use of intravaginal practices before or/and after sexual intercourse, the frequency of using these intravaginal practices in the past two month, since when have you been applying these practices, who recommended you these practices, the reason that motivate you to follow these practices (eliminate vaginal odor, eliminate excess vaginal secretion, fight against sexually transmitted diseases, avoid pregnancy, dry or tighten the vagina, by education), if a health professional explain you the adverse reproductive and gynecologic outcomes of these practices do you stop doing it, medical history (past and current sexual transmitted infection such as gonorrhea, chlamydia trachomatis infection, HIV-Sida, mycoplasma infections, syphilis), history of self-medication and recent treatments, the use of condom the last sexual encounter.

-Vaginal specimens: a sterile cotton wool-tipped swab (Henso Medical, Hanghan, Co, Ltd) was used to collected secretion from the vagina walls and served to diagnose bacterial vaginosis

For bacterial vaginosis, vaginal smears were heat-fixed and gram-stained then examined by light microscopy by a single reader and the results were interpreted by using a standardized method for diagnosing bacterial vaginosis, as described by Nugent et al.,(1991).1 Bacterial vaginosis was defined as a Nugent score of 7 to 10. Small gram negative or variable bacilli were assumed to be Gardnerella vaginalis morphotype and curved gram variable to be Mobiluncus. Sniff test was performed with potassium hydroxide solution (10%). It is positive in case of bacterial vaginosis.

-Cervical specimens: before sampling the endocervix, we cleaned the cervical with sterile gaze to remove excess mucus. Swab endocervix by using cotton wool-tipped swab approximately 1 cm into the cervical canal. Rotated several time at the squamo-columnar epithelial junction and withdraw the swab without touching vaginal surface

We used ImagenTM Chlamydia Kit (Thermofisher Scientific, reference K610111-2, Oxoid Limited, Wade Road, Basingstoke, Hampshire, RG 24, 8 PW, UK) to diagnose fluorescent elementary bodies of chlamydia in cervical specimens

A direct immunofluorescence method was performed on smears from endocervical junction

Principle of the test: The Imagen Chlamydia test is a direct immunofluorescence test for the detection and identification of chlamydiae in clinical specimens or cell culture. The Imagen Chlamydia test reagent contains fluorescein isothiocyanate conjugated monoclonal antibody. The genus specific monoclonal antibody will detecte elementary bodies from all known human serovars of Chlamydia trachomatis. Specimens are incubated with isothiocyanate conjugated reagent for 15 minutes. Excess reagent is then removed by washing with phosphate buffered saline. The stained areas are mounted and viewed using epifluorescence illumination microscope. If chlamydia is present within the clinical specimen they will be seen as bright apple-green fluorescent elementary bodies. Ten or more Chlamydia elementary bodies per smear and the presence of epithelial cells were necessary for a positive diagnosis in fixed, stained specimens

For gonorrhea gram stained can showed us gonococcus ,in addition  the cervical sampled were cultured in chocolate agar and incubated during 24 hours in CO2 atmosphere.

For urogenital infections ,the cervical sample were cultured ,identified by using Kit Mycofast Evolution 3 (Elitecj Microbiol). We used the kit according the instructions of manufacturer.

Approach use to maximize the research outputs:

Participants were offered syndromic management for any sexual transmitted disease diagnosed at enrolment, risk reduction counselling (about intravaginal practices, bacterial vaginosis and sexually transmitted diseases), condoms and family planning

  -Data analysis

The data were entered and analysed using Epi infos 7.2 software and Excel 2013. Qualitative data were compared using the Chi-square test and Fisher’s exact test (for number below 5). P values of <0.05 were considered to indicate statistical significance. This statiscal analyze will showed us the possible link between intravaginal practices and genital infections

For the next 5 years we will follow the prostitutes's genital infection when they come at our structure. We are going to follow the prostitutes of the others districts of Yaoundé over 5 years concerning the intravaginal practices and genital infection and we are going to continue educate them

1.  Nugent RP, Krohn MA, Hillier SL, et al. Reliability of diagnosis
bacterial vaginosis is improved by a standardized method of Gram stain
interpretation. J Clin Microbiol. 1991; 29: 297-301.

Specific impact indicator: decrease in the prevalence of genital infections (bacterial vaginosis, gonorrhea, chlamydia, urogenital mycoplasmas) among prostitutes. All the participant was interviewed and those who follow intravaginal practices  will be educated on how to maintain their vaginal cavity and six months later we will call them again and take a genital swab to screen for infections. if we observe a decrease in the prevalence of infections we could measure our progress.

The second impact indicator will schow us that less prostitutes come at our structure for testing for sexually transmitted infections because they follow our advices concerning the intravaginal practices

In some part of Africa douching may be practices by 97% of women. Several studies have linked this practices to several outcomes such as bacterial vaginosis and pelvic inflammatory diseases. Black women and those with less than high school education were most likely to douche and about 44.4% of women who did not douche were diagnosed with bacterial vaginosis compared with 58.8% of women who douched (Clark, 2007). Many women believe that intravaginal practices protected them from infections and pregnancy. But these practices may adversely affect normal vaginal flora and mucosal and increase acquisition risk of VIH-SIDA and others genital tract infections (Lazarus 2019). This practices may be an important factor promoting the spread of HIV in women (Scott 2006) by injuring vaginal epithelium or by increasing risk of bacterial vaginosis an established risk factor for HIV

In the most time protitutes are just educated to wear condom durins sexual intercourse and are not aware of intravaginal practices (using petroleum inside the vagina for example)

Now we want to explain that this way of doing (doing intravaginal practices) destroy the vaginal ecosystem wich protect the vaginal cavity from infections. This vaginal ecosystem maintains an acid vaginal pH unfavorable to the installation of pathogenic germs. traditional herb inside the vagina can exposed them to recurrent infections and cancer of cervical canal.

 We will educate them on the maintenance of their vaginal cavity. no longer cleaning the inside of the vagina with simple water, water with soap,commercial antiseptique, juice lemon, vinegear or no longer introducing herbs, stone, petroleum or powders into the vagina will protect them from recurrent genital infections and cancer

This is our theory of change.

1-Clark Rebecca et al. frequent douching and clinical outcomes among HIV infected Women. Sex Trans Dis 2007

2-Scott et al. Evaluate the contribution of vaginal washing to incident HIV infection: prospective study. Aids 2006

3-Lazarus Erica et al. Vaginal practices amoung women at risk for HIV acquisition in Soweto; South Africa. South Afr j Hiv Med 2019

My technology is to inform the prostitutes of the adverses outcomes of the intravaginal practices,

 To education them how to maintain and preserve their vaginal cavity

To communicate with them so that they no longer be follower of these intravaginal practices and sensitize them so that they can make aware their colleagues we can not join easily

we have in our team two nurses who will interviewed the participants and collected the data of the prostitutes. Prostitutes will answer a questionnaire wich included socio demographic data, intravaginal practices behavioral, past medical history

We have two technicians who will swab (cervical and vaginal swabs)

We have a medical doctor who is also clinical biologist who will treated sexually transmitted infections and who will give them advice to how to maintain their vaginal cavity and explain to the the participants the adverses outcomes of intravaginal practices and finally who will supervize the work in the laboratory when tests are processing.

We have a psycho social assistant who help the participant to overcome their problems

AFEMMIS is a structure that fights to improve the health of underprivileged and disabled women in general and neglected street children. Our team is diverse insofar as both genders are represented (men and women) coming from almost all regions of Cameroon, and from various social strata (some staff come from a disadvantaged environment and others from a more advantaged environment. we have a disabled woman due to the consequence of poliomyelitis in our team she walks with crutches and is the leader of our solution and a prostitute representing prostitutes in our team. We regularly organize meetings where each member of the team must intervene to give his opinion on various problems posed and each opinion given by a member is studied seriously before being adopted. sometimes outside of work  we share a meal (we have a restaurant time), symbol of our integration into the team and various problem are discussed and we help each others when having problem somewhere and we celebrate birthdays of each member by sharing a cake and a few drink. Each member is respected and valued. Each member of the group has its place and is important for our team. We plan to diversify our team by recruiting part-time a lawyer for our legal problem and a computer scientist who will create a Web site of our structure and we will have a better visibility in nationaly and internationaly

We want to improve health of underpriviledged persons

For prostitutes we improve their genital health by educate them on intravaginal practices, we treated common sexual infections, we advise on family planning and the use of condom. We diagnose sexual transmitted infections of prostitutes by doing bacterial tests (gonorrhea, urogenital mycoplasma, bacterial vaginosis, chlamydia)

For street children we screen for malaria wich is endemic in Cameroon and for geohelminthiasis as the reagents are not expensive and we treat them as we can. We treat wounds and and do injections of antitetanic serum if necessary

And for women with disabilities in need we facilitate access to care with our driver who leads them to our structure if they need our help and to the appropriate establishments to receive care.

We are struggling to stay financially viable, nevertheless we fight with the advantages that we have (The chief of the team is a medical doctor and clinical biologist and she is a disabled women).Time to time we do screening  of certain examinations (biological tests) and health check-ups in larger campaigns at reduced cost  and the profits collected help us to finance our objectives. We organize charity balls with paying plans and during the ball we exposed our problems and some people give us grant in spot and the profits collected are used for our activities. Sometimes we turn to large local companies which sometimes give us small grants that help us to finance ours objectives. We have asked the Ministry of Social Affairs of our country for financial help as the leader of our team is a diseabled woman, we are waiting for their response. Sometime we organized football matches between prostitutes and other group women and people pay the ticket to assist the match and the profits are use to finance our objectives.

last years we organized two charity ball and we collected 3365 dollars wich help us to finance our objectives

The last match organized gave us 400 dollars