Gynecological health

Amid the context of the COVID-19 pandemic and, more specifically, social isolation, an increase in pregnancies among young people has been reported, especially those in vulnerable situations, homeless or refugees. In the report published in April 2020, the United Nations Population Fund (UNFPA) revealed that 47 million women in 114 countries, including Brazil, had their access to modern contraceptives compromised. UNFPA also indicated that each three-month period of confinement corresponds to more than 2 million women who could not have access to the use of contraceptives (UNFPA et. al., 2020).

In 2020, with the aim of expanding basic guidelines on topics in the area of gynecology, such as contraception and sexually transmitted infections (STIs), the University Extension project “Gynecological Health” was created. The project aims to bring young people closer to university, seeking to value the subject as an agent who critically intervenes in the world (GUIMARÃES et. al., 2020). The proposals involve processes of autonomy proposals, encouragement and dialogue, being developed through actions that promote socialization and the sharing of knowledge. (FREIRE, 2006) (FREIRE, 1979).

Thus, the demand arose to create a powerful means of disseminating information that would help women in relation to family planning and pregnancy. The project's initial objective was to create materials that would guide pregnant women about the risks of COVID-19 and the need for prenatal care; and contraceptive users, regarding their use, availability and importance of continuity. However, contact with the target population showed an extreme lack of knowledge regarding the area of gynecology and, often, medical services, such as consultations with specialists or exams. Given this scenario, the project expanded to different topics within the area of gynecology, such as STIs. As indicated by the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics (IBGE), around 1 million people contracted sexually transmitted infections in Brazil in 2019 (Ministry of Health, 2021), which demonstrates the importance of this topic, the example title.

Amid the context of the COVID-19 pandemic and, more specifically, social isolation, an increase in pregnancies among young people has been reported, especially those in vulnerable situations, homeless or refugees. In the report published in April 2020, the United Nations Population Fund (UNFPA) revealed that 47 million women in 114 countries, including Brazil, had their access to modern contraceptives compromised. UNFPA also indicated that each three-month period of confinement corresponds to more than 2 million women who could not have access to the use of contraceptives (UNFPA et. al., 2020).
In 2020, with the aim of expanding basic guidelines on topics in the area of gynecology, such as contraception and sexually transmitted infections (STIs), the University Extension project “Gynecological Health” was created. The project aims to bring young people closer to university, seeking to value the subject as an agent who critically intervenes in the world (GUIMARÃES et. al., 2020). The proposals involve processes of autonomy proposals, encouragement and dialogue, being developed through actions that promote socialization and the sharing of knowledge. (FREIRE, 2006) (FREIRE, 1979).
Thus, the demand arose for the creation of a powerful means of disseminating information that would help women in relation to sexual and reproductive health. The project's initial objective was to create materials that would guide pregnant women about the risks of COVID-19 and the need for prenatal care; and contraceptive users, regarding their use, availability and importance of continuity. However, contact with the target population showed an extreme lack of knowledge regarding the area of gynecology and, often, medical services, such as consultations with specialists or exams. Given this scenario, the project expanded to different topics within the area of gynecology, such as STIs. As indicated by the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics (IBGE), around 1 million people contracted sexually transmitted infections in Brazil in 2019 (Ministry of Health, 2021), which demonstrates the importance of this topic, as an example.

In relation to the women served, the main communities served will be around the teaching hospital, which are socioeconomically vulnerable, with little access to health services and information. The main conversations and actions take place in the Mário Cardim, Mauro I and Mauro II communities – all participating in the Vila Clementino Community Forum (union of leaders from the surrounding poor communities with the Public University). In them, respectively, there are around 7,000 residents (approximately 4,000 women), 3,500 residents (approximately 2,000 women) and 2,500 residents (approximately 1,500 women). 

Actions can also be carried out in partner locations of the NGO, such as ONG Mais or Casa de Assis or Autonomia em Foco. The ONG Mais is an organization that serves the homeless population, providing food and goods such as blankets and basic food baskets to needy communities. The Casa de Assis is a refugee shelter from the Franciscan Solidarity Service (SEFRAS), which has around 30 women per period, with high turnover (maximum stay of 6 months) and most of them from Angola. Autonomia em Foco is a government shelter, where residents have a small income but still cannot achieve total independence.

Regarding the affected students, there are around 30 students from Escola Paulista de Medicina who voluntarily participate in the project. They are supervised by three teachers, two gynecologists and a social educator.

Saúde Ginecológica is part of the EPM Volunteering project, which is a university extension project at Escola Paulista de Medicina. In it, we have 80 student volunteers and around 15 teachers for support. We have specialists from different areas, with the 3 closest to the project being in the area of health education and gynecology.
The Vila Clementino Community Forum project is linked to EPM Volunteering, which consists of a monthly meeting with the leaders of communities with high levels of vulnerability in the Vila Clementino Health District. These meetings aim to bring the University and Communities closer together in discussions and implementation of extension projects aimed at empowering their residents. Thus, your demands are brought forward and we can, together, produce actions and educational materials, which aim to promote individual and collective health.

As the project is aimed mainly at women from the Vila Clementino communities (Mauro I, Mauro II and Mário Cardim), we have, on average, 7500 women. However, we carry out several actions beyond our main area. For example, "Casa de Assis", a refugee shelter from the Franciscan Solidarity Service (SEFRAS), which has around 30 women per period, with high turnover (maximum stay of 6 months).

Currently, the project seeks to develop:

• The dissemination of important information in the area of gynecology to the communities of the Vila Clementino Community Forum (CVC), a project developed by the Volunteers of the Escola Paulista de Medicina (EPM), and to the School Hospital (HSP)/EPM community (workers, students and residents); • Identification of difficulties in knowledge and access to information or services related to gynecology; • Sharing information and trying to overcome difficulties that are observed within the communities and the HSP/EPM complex; • Helping communities, through partnerships, to meet demands for knowledge or even care and exams in the area of gynecology.

These objectives are crucial to bridge the gap between the academic knowledge of a Public University and the general population. In the territory where Hospital São Paulo is located, we can survey 50 communities in vulnerable situations, 18 of which have high social density. The monthly reports from the leaders of these communities, in the CVC Forum, show the specific needs of these women, demonstrating more clearly the demands of each community. This allows the creation of specific materials and actions for locations, which more fully meet their demands. This opens up a communication channel between the University and the population, directly helping to guarantee these women's right to health.

The dissemination of information about women's care is fundamental for the functioning of the Unified Health System (SUS), which advocates universalization, equity and comprehensiveness in Health (Ministry of Health, 2020). The actions proposed by this project are supported by items V, VI and VIII of Article 7 of 8.080/90 that establishes the SUS, defending the active participation of society and the right to information. "V - right to information, for people receiving care, about their health; VI - dissemination of information regarding the potential of health services and their use by the user; VII - use of epidemiology to establish priorities, allocate resources and programmatic guidance; VIII - community participation" (Constitution of the Federative Republic of Brazil, 1988)

It is an innovative project in that it is entirely built by young girls, for women and girls, based on the demand of the affected population. This project has a great impact on participating students: through the active search for information, they learn knowledge of gynecology, skills and attitudes in solving problems and helping patients. There is also the social impact: in addition to empowering individuals with knowledge, public health problems are reduced, such as the transmission of STIs.

Main goal: quality education (especially in gynecological health).

IMPROVING PUBLIC HEALTH ISSUES

The actions of this project aim to improve women's quality of life, in addition to reducing public health problems, such as early pregnancy or the transmission of STIs. The lectures, conversations and materials produced guide women about the types of contraceptives available and how they should be used; the importance of prenatal care and how to access it; the need to use condoms not only for contraception but also to prevent STIs; the symptoms of the main STIs and the importance of testing; between others.

EMPOWERMENT THROUGH KNOWLEDGE
This project, in this way, empowers individuals with respect to knowledge. "Empowerment (...) permeates notions of democracy, human rights and participation, but is not limited to these. It is more than working at a conceptual level, it involves action, implying processes of reflection on action, aiming at taking consciousness (...), affecting the subject. An education for emancipation, conceived, according to Freire, as a cultural action for liberation, can constitute a valuable instrument in projects and actions aimed at empowering subjects." (Baquero, 2012)

CREATION OF A COMMUNICATION CHANNEL
By openly discussing topics, which are often stigmatized, the project allows the creation of an important communication channel with the communities served, bringing the population closer to the Academy and the Public University. This movement allows the population to feel more comfortable in expressing their concerns and doubts, providing the possibility of clarifying doubts and disseminating valuable information on self-knowledge and disease prevention, thus obtaining an in-depth understanding of needed information.

IMPLEMENTATION OF UNIVERSITY EXTENSION IN MEDICAL TRAINING
It is worth highlighting the impact that University Extension projects have on medical training. Health professionals must be able to diagnose, solve problems, make decisions, act as a team and self-organize. The training of these professionals is necessary with the aim of integrating general and specific knowledge, theoretical and practical skills, habits, attitudes and ethical values (AM NCIO FILHO, 2004). Thus, medical education aims to train a health worker capable of integrating their knowledge and being able to understand and act in the social and cultural world in which they are inserted (DELUIZ, 1997).
“In the process of building these skills and competencies, it is necessary to provide training that allows workers to act as citizens who produce goods and services and as actors in civil society. More than ever, 'education must enable workers (.. .) to participate in scientific and technological society not as objects, but as subjects, thus rescuing the political dimension: the construction of social identity and full integration into citizenship” (DELUIZ, 1997)
In this sense, medical education is seen as a commitment to the ideals of society, aiming to preserve or improve the conditions and quality of life of a given population. It is a social product, which requires the exercise of citizenship. (AM NCIO FILHO, 2004) and University Extension is essential to remind future health professionals of their social commitment and demonstrate ways of exercising their citizenship.

The actions of this project aim to improve women's quality of life, in addition to reducing public health problems, such as maternal morbidity and mortality or the transmission of STIs. The lectures, conversations and materials produced guide women on the importance of prenatal care and how to access it, in addition to indicating the need to use condoms and the symptoms of the main STIs, leading to the search for testing and diagnosis.
By sharing (project volunteers and participating women) experiences and information about women's health, in addition to taking ownership of our own bodies and, therefore, having greater freedom in how we act with them, we also strengthen ourselves. This also happens through the sharing of different knowledge, considering the different contexts in which we find ourselves daily.
In this way, the project's methodology is designed to meet the extension proposal based on Paulo Freire's principles, that is, empowering, listening, welcoming and sharing knowledge (FREIRE, 2006). Among the expected results of these actions, we can mention the learning of students and the empowerment of women through knowledge, in addition to the creation of an important communication channel with the communities served.

The Gynecological Health is a university extension project linked to the Escola Paulista de Medicina - UNIFESP. Thus, the volunteer students are part of the courses at the São Paulo Campus (Medicine, Speech Therapy, Biomedicine, Health Technology) and a student of the Psychology course. Coordinating professors also have an employment relationship with the University.

O Projeto Saúde Ginecológica surgiu em plena pandemia, com o objetivo de divulgar orientações básicas de ginecologia. Então, cerca de 3 anos.

All people, whether part of the team or participants (target audience) of the project, are welcome, regardless of gender. Furthermore, we seek to publicize the actions that will be carried out and the selection process for voluntary participation in the most diverse groups, always valuing diversity. Furthermore, the volunteers are students from a Brazilian public university and, therefore, are people from the most diverse social contexts, making our group very diverse.

Our products are booklets and pamphlets, in addition to lectures in the communities already mentioned with teaching materials (such as physical contraceptives).

Examples:

Livreto 1

Livreto 2

Panfletos 

We ran for a Parliamentary Amendment by Federal Deputy Tabata Amaral and won around 150 million from her. Therefore, we will purchase durable material goods for the project in order to keep them for a long time. Furthermore, in specific campaigns we managed to collect donations through the community that supports EPM Volunteering.

Schedule approved by Tabata Amaral

Voluntariado EPM Instagram