Globaldev careers: The reproductive health expert

For more than five years, Dr. Mirela Rista has been working with Youth Center “PO” — the only clinical center in Tirana, Albania, that provides free services related to sexual and reproductive health, or SRH. It is a branch of the Albanian Center for Population and Development, or ACPD — a member association of the International Planned Parenthood Federation — and trains health personnel in reproductive health, post-delivery contraception, and safe abortion techniques. As a gynecologist, Rista was used to working in Tirana’s maternity hospitals but realized her clinical experience could help provide lifesaving information, education, and services to women and adolescents from vulnerable communities. Through trainings, Rista has since developed knowledge around youth-friendly approaches, as well as tools to take new perspectives into account and ensure that services meet the needs, realities, and rights of the groups she serves. “Working with vulnerable groups is an added value in [my] professional experience, especially when you see that your work and contribution have served to improve the health of [an] entire community,” she said. Rista told Devex about the challenges and impact of her work. This conversation has been edited for length and clarity. What does your day-to-day look like? I work part time in the clinic from Monday to Friday. Together with the nurse, we provide services for the community, [with] approximately five to six clients per day. ... Most of the visits are related to ultrasound examinations, Pap smear sampling, [or] contraceptives counseling and supply, [and then there are] other visits such as pregnancy tests and counseling [and] sexually transmitted infections counseling. Based on the action plan we prepare together with the programmatic staff at the beginning of the year, we [also] move to rural and remote areas to [provide] community-based services for women and girls. Mobile clinics are implemented in collaboration with health care centers, who also offer us their facility settings to provide services. “The most satisfying part of my job is working with and for vulnerable groups ... seeing [people] come out the door smiling or returning for services to [the] center.” --— Dr. Mirela Rista, gynecologist, Youth Center “PO” What brought you to this role and motivates you in your work? I thought it would be a great opportunity to work for vulnerable groups in order to provide and support [them through] free services. There are many reasons why vulnerable groups cannot benefit from services in state hospitals, such as the prevalence of out-of-pocket payments [that] has led to a disproportionate exclusion of many Roma from accessing the health care system or health insurance, as many are unemployed or do not have a regular income. The lack of essential documentation — for example, birth certificates — also makes it difficult for them to access health insurance. For adolescents, the stigma of accessing SRH services, lack of information on SRH, and financial barriers were paramount. A general climate of fear, especially for girls, seriously impedes their ability to discuss SRH issues or seek services. [Youth] Center “PO” is the only one in Albania which offers youth-friendly SRH services and free-of-charge SRH for the vulnerable groups. [It’s] also [using] social media and the internet as primary resources for SRH information, which is helping young people to get to know about the clinic [services]. [Through my work, I am able to] serve these groups that have even more pronounced needs than the rest of the community. What skill sets have you found to be most valuable for progressing in your career? [Aside from medical training] there are some other skills that [I’ve] developed with the years of experience and with further training, such as: critical thinking — using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems; active listening — giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate; [and] social perceptiveness — being aware of others' reactions and understanding why they react as they do. [There’s also] service orientation — actively looking for ways to help people — [and] persuasion — persuading others to change their minds or behavior but at the same time respecting their choices. [This profession] requires integrity, honesty, and [being] ethical. What are the best — and worst — parts of the job? I think the most satisfying part of my job is working with and for vulnerable groups ... seeing [people] come out the door smiling or returning for services to [the] center. It is very challenging working with vulnerable groups, and of course sometimes I may face difficulties [because] the system lacks the proper policies, infrastructure, and health care providers’ proficiencies to fulfill the needs of clients when we refer them. Therefore, they have to follow up at private clinics for specialized services. But having a network of collaborators helps us to find the right solutions for “difficult” cases. … [And] I do believe in and love the job I do, so that [enables me] to be incredibly persistent and have a huge amount of passion for my job. How do you see the impact of your work? During the COVID-19 pandemic, in general, sexual and reproductive health services were left behind, and vulnerable communities were hit [hard]. During this time, I — together with the nurses, outreach workers, and the ACPD staff — have been on standby in order to serve vulnerable communities. We have been providing sexual and reproductive health counseling via Skype and WhatsApp and sensitization [information for] the public about the effects of COVID-19 to SRH and gender inequalities through our website and social media, as well as providing information and articles about how coronavirus is affecting victims of gender-based violence, tips for pregnant women, [and information on] how COVID-19 impacts people seeking abortion care, etc. I have [also] shared videos through social media and [the] ACPD website with messages and information on contraception care, gender-based violence, [and] abortion care. I believe [these] efforts … have positively impacted this community.