Tuesday, April 13, 2010

Gratitude

I am feeling very blessed by all of you who have made a contribution to this upcoming trip to Haiti! I cannot believe that I leave in a month! Yesterday, and again this morning, I find myself reflecting on some of my favorite donors. My little sister's best friend donated a variety of bottles of pink and purple nail polish that will be used to paint the fingers and toes of the little girls at the orphanage (and I wonder if any little boys will want their nails done as well). And my grandmother called this weekend to tell me she was sending me a donation that must go directly to buying peanut butter and bread for the mamas. I had to promise that I wouldn't do anything else with her donation. "Peanut butter, and whole wheat bread, if you can find it," she said, "is really good for those hungry mamas." Of course I will do just that. Buy peanut butter if I can find it, and bread, and take it with me to the clinic. I am also feeling blessed by all the strangers out there--the friends of friends that I have never met, who made a contribution, in one form or another to this cause. It is amazing to me, and I feel really honored to represent my community and a greater community on this journey.

Special thank-you's to my cousin Sarah, who from the moment I made the announcement that I was heading off to Haiti was excited, motivated, and helpful...
To my Aunt and Uncle--Chuck and Cathy for generous support and sponsorship...
To a long lost midwifery sister, returned baker, and generous, generous soul. You made a huge impact on my heart and sent so much prosperous energy into the universe...Thank you, Alissa...
To Brianna Jones. You are so sweet and I am going to paint all those toes just for you, knowing how much you want to be there yourself! I promise your turn is coming :)
To Anya, my Swanky Siren sister--thanks for motivating your own community and sending such a needed and generous package of supplies
To Lisa--I love you so much, sister!
To my auntie Carol for all of her support, love, warmth, and good wishes. I am so blessed!
To my cousin Linda, for donating her birthday cash to this cause--that really warms my heart...

And to all the rest of you....I am also deeply thankful and filled-up with joy!
Love to you all, aerlyn


Right now I am feeling excited and ready. I am waiting for last minute donations of supplies and cash to come in so I can finish with the purchasing of medicines, vitamins, and general medical supplies.

Also a friend of mine, who is a photographer is going to come on this journey, so there should be lots of beautiful and inspiring images to see when we return. We will keep you posted.....

If you want to make a donation through paypal go to www.paypal.com, account is under my email address: aerlynpfeil@gmail.com....
Thanks!!!

Thursday, March 25, 2010

Haiti Presentation

On Saturday, March 27th, 2010 Jennifer, Desiree, and Patricia will do a presentation at Cedarwood Waldorf School in Portland from 4-7pm. We will do a slide show and discuss our trips to Haiti and what the future work looks like with Mama Baby Haiti. We would love for everyone to come. I will post more information as it becomes available.

Friday, March 05, 2010

Let's not forget that Haiti isn't the only place in crisis...

MSF Top 10 Humanitarian Crises of 2009

New York, December 21, 2009 — Civilians attacked, bombed, and cut off from aid in Pakistan, Somalia, Yemen, Sri Lanka, Afghanistan, and the Democratic Republic of Congo (DRC), along with stagnant funding for treating HIV/AIDS and ongoing neglect of other diseases, were among the worst emergencies in 2009, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) reported today in its annual list of the "Top Ten" humanitarian crises.

Continuing crises in north and south Sudan, along with the failure of the international community to finally combat childhood malnutrition were also included on this year’s list. The list is drawn from MSF’s operational activities in close to 70 countries, where the organization’s medical teams witnessed some of the worst humanitarian conditions.

View the Top Ten Humanitarian Crises of 2009.

Three distinct patterns dominated in 2009: governments blocked lifesaving assistance to trapped populations, including in Sri Lanka, Pakistan, and Sudan, where aid groups—including some MSF teams—were expelled from Darfur; respect for civilian safety and neutral humanitarian action further eroded, such as in Yemen, Afghanistan, Pakistan, DRC, and Somalia, where people—and in some cases aid workers—were either indiscriminately or directly attacked; people suffering from a host of largely ignored diseases were again neglected by the international community, and those living with HIV/AIDS saw their chances of receiving life extending therapy further diminished.

“There is no question that civilians are increasingly victimized in conflicts and further cut off from lifesaving assistance, often deliberately,” said MSF International Council President Dr. Christophe Fournier. “In places like Sri Lanka and Yemen, where armed conflicts raged in 2009, aid groups were either blocked from accessing those in need or forced out because they too came under fire. This unacceptable dynamic is becoming the norm. Our teams on the ground are witnessing the very tangible human consequences of these crises directly, either in war zones or in the AIDS and nutrition clinics in which they work,” he said. We’re therefore compelled and obligated to speak out.”

In Sri Lanka, tens of thousands of civilians were trapped with no aid and limited medical care as government forces battled Tamil Tiger rebels in the spring. Aid groups, including MSF, were banned from entering the conflict zone. In Somalia, civilians continued to bear the brunt of a vicious civil war. More than 200,000 people fled the capital, Mogadishu, in just the first few months of 2009 and aid workers were increasingly targeted – at least 42 relief workers have been killed since 2008, including three MSF staff.

In Yemen, civilians and hospitals were heavily affected by fighting in the Saada region in the north of the country as government forces fought rebels. The fighting forced tens of thousands of people from their homes and compelled MSF to close the only hospital serving an entire district after it was shelled. And in a glaring case of abuse of humanitarian action for military gain, civilians gathered with their children at MSF vaccination sites in North Kivu, DRC in October, came under attack by government forces. The attack threatened to severely undermine the trust necessary to carry out independent medical humanitarian work in conflict settings.

In Pakistan, where tens of thousands fled fighting, hospitals were struck by mortar fire and two MSF workers were killed in Swat Valley, where the organization ultimately suspended its operations due to the violence there.

On the medical front, years of success in increasing treatment for the numbers of people living with HIV/AIDS was threatened with punishment in 2009. The Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President’s Emergency Plan for AIDS Relief (PEPFAR) announced plans to reduce or limit funding.

“Just when more and more people were accessing crucial medicines and medical experts were acknowledging the need to put people on treatment sooner, patients will be turned away from clinics because the funding just won’t be there,” said Dr. Fournier. “The timing could not be worse.”

The neglect also extends to childhood malnutrition, a treatable disease that is the underlying cause of up to half of the annual ten million preventable deaths of children under five each year. Global leaders gathered at the World Food Summit in Rome in 2009 failed to commit to combating the disease, which groups like MSF have shown can be prevented and treated by providing growing children with proper foods that meet their nutritional requirements.

Right now, international assistance to fight malnutrition amounts $350 million dollars, while the World Bank estimates $11.8 billion is required to adequately combat the disease in 36 high burden countries. Additionally, most food assistance is made up of costly and inefficient in-kind donations containing products of poor nutritional value that must be shipped overseas. Resources could be better spent on obtaining nutritionally appropriated foods closer to their source.

Other diseases, such as Chagas, kala azar, sleeping sickness, and Buruli ulcer continue to be neglected, with very few new commitments to expanding access to available treatment or carrying out research for much needed newer and more effective drugs.

“The tremendous resources devoted to the H1N1 pandemic in developed countries illustrates the response capacity for global health threats when the political will exists,” said Dr. Fournier. “Regrettably, we fail to see the same commitments made to combat diseases claiming millions of more lives each year.”

MSF began producing the "Top Ten" list in 1998, when a devastating famine in southern Sudan went largely unreported in U.S. media. Drawing on MSF’s emergency medical work, the list seeks to generate greater awareness of the magnitude and severity of crises that may or may not be reflected in media accounts.

Tuesday, March 02, 2010

And we find beauty and light in even the darkest of places....

More of Jennifer's words...."Today we went to a village to care for 200 people. Just four midwives (Patricia, Carrie, Kalia and me.) Three translators. There were 200 patients lines up for hours. Se set up three stations and consulted with families one by one. We handed out herbs, vitamins, antibiotics and more for many things such as scabbies, fungal infections, parasites, anemia, ulcers, skin staph infections and malnuturtion.

We did prenatals on about 40 women and gave them prenatal vitamins. One mother we diagnosed with twins, her 6th and 7th babies. Many people with high bp (220/120 seems so common, and the highest I took was 300/150).

We patched up burns and cuts. We saw a sweet man who was having s&s of a heart attack (also high bp) and told him he needed to go to the hospital (I wonder if they can help?). We referred several people out for more care at the hosptial (a 13 year old with seizures once a week and no glucose in the urine we dipsticked, a baby who was 3 months old, 5 pounds and covered in little spots… I will post a picture when I get home. I could not stop the tears from streaming down my face as I weighed him and we gave the parents money and a medical order to go to the hosptial.)

We are all very tired but feel very satisfied with how much we have done today. Saturday, we go to another village to do this again. Everyday I am welling up with tears at the suffering and the gratitude for my help, and the spirit I feel while serving.

Helped 1,200 People today!!---

Today was an amazing day, we are all on a high.

Started at 6am in the hospital. Got 4 hours of sleep but we aren’t tired. Helped many people during rounds (people in pain are so, so grateful for a couple Tylenol). Fed bread, pb, raisins and gave water to two rooms at the hospital. ( I have given up on feeding the whole hospital, so we do a couple of rooms each day.)

assisted at a cesarean at 10am (mom was syphilis positive). was needed by mom AND doctor. Hels moms hand and calmed her until I had to sterile up and help with the suctioning during the section. I was very immpressed with the doctors skills. He was fast and good.

Stopped by to nurse my Haitian baby on my walk home.

Showered and ate a great lunch of salad, rice, beans and goat meat.

Driver came came to get us to go to Joseph’s Village. We rode in the back of the truck on bumpy dirt roads (no need for amusement park rides in Haiti). We stopped at the gas station to pump gas. You will have to check out the pictures when I get home and post them! The gas is hand pumped from a barrel then hand poured into the tank.

We arrived in Joseph’s Village and were warmly welcomed. Saw about 8 sick people and then got down to the business we were there for. We met with the 9 members on the village council. They took us to their homes and they showed us what they bought with the $500 Desiree and Donna gave them two weeks ago. We took a picture (wheelbarrow, garden tools, PVC piping to get water to their garden plots).

I will write more in a different post about Joseph’s Village, but for now I’d like to say that they are a community of hundreds of families who have banded together and created a council to run their village. They live on 52 acres they have homesteaded for many years, and the government gave it to them a year ago. They have a school (palm fronds), a church (cinder blocks with metal roof) and very small, one room homes that are pretty much shack status (I’ll post pictures when I get back).

They have lovingly accepted hundreds of Port Au Prince earthquake victims into their homes, so they are very crowded. Joseph (their leader) lives in a two bedroom 500 square foot home with 14 other people (his aunt and uncle and their 8 children and 4 refugees).

We were happy to give them $4000 dollars (money we and other people donated) to work towards their goals of having a goat herd, chickens and water to irrigate large gardens. They promised to show us in 3 months what they have accomplished with this help.

All the council was present when we gave the money. We said our goodbyes and drove off into the country to find the water falls.

The ride to the falls was rugged and longer than I expected (an hour?). We bounced around in the back of the truck, soaking in the sights of Haiti: the two children on a donkey, the mom on a horse with a 6 month old in front and a 3 year old in back, families bathing in the rivers while wash is being done at the shore, motorcycle taxis honking past us with 3 or 4 people on them.

We crossed a river and went up a steep incline that I was surprised we made to the top. Finally stopped to walk the rest of the way. Men and children joined us until there was a crowd walking with us.

We walked forever and then came upon a beautiful site. Water cascading down the rocks. A pool of turquoise water below. The walk was so long that by the time we got there it was too late to swim. We snapped pictures.

We then headed to the top of the falls and realized why the crowd had followed us. We were taken by each had by a man and child and helped up the steep, long hill. Some of the boys had no pants, some had no shorts, none had shoes. One had a pair of boxer short underwear with so many holes in the butt that he was quite exposed.

We made it to the top thanks to our friendly helpers. We paid them all, and by their excitement, I am sure it was more money than they had seen in a long time (even the adult men were barefoot and in tattered clothes).

We rode back to town in the moonlight singing a Haitian song.

When we got to town we were dropped off at the central plaza where hundreds of people were praying and singing. Children on the swing set. A group playing soccer. There is no electricity, but at night, all gather to the central plaza where a generator lights the square. The excitement is infectious.

We asked Santos if there are any restaurants in Hinche so we could treat him to a meal (he had joked that other employers fed him, but we are always at the hospital where there is no food and everyone is so hungry and poor). A couple blocks away was a “night club and restaurant”. We were the only ones there. We sat outside around a rickety table on plastic chairs by a cement dance platform with a roof. Hanging from the ceiling as decorations were plastic bottles that ha been cut open into spinning flower designs.

We were asked how many plates and answered four (Kalia and Rayna are at the hospital tonight).

There is only one dish on the menu, so no decision making necessary. We were brought grilled chicken, fried green plantains and cabbage slaw with lime and hot peppers in it. The chicken was the longest, skinniest leg you have seen with very little meat. I took the tiniest nibble and then gave it to Santos. Carrie gave hers to him as well. Patricia ate hers (I hope she doesn’t get sick). The four pieces of fried plantains and cabbage slaw were delicious. I also had a soda (my first since arriving in Haiti). It was even cold!

At 8pm the music started and about 8 people showed up to dance. Wonderful Carribean music and some amazing dancing going on. Talented dancers Cha Chaed and twirled. I tried to get Carrie, Patricia or Santos to dance with me, but they were too shy. I couldn’t stand missing this opportunity to dance to my favorite kind of music, so I got up and asked one of the best dancers if he would dance with me. Everyone was very surprised and there was much laughing at the white lady dancing cha cha with the Haitian. As soon as the song ended, I thanked him and sat down, when another Haitian asked me to dance. By the time the song was over there were many dancers on the floor and large crowd of about 30 people had gathered to watch, as many people from the street had been pulled in to see the show.

We grabbed our things and left laughing (I didn’t want to get asked to dance again as my feet were so tired after our five mile hike plus all the other walking we had done just to get from place to place).

We stopped by at 9:00pm to nurse my Haitian baby, then arrived home to the orphanage to find brother Mike had been fretting over our absence.

We apologized for worrying him. He said we are the first group to come that goes out at night to work the hospitals and that gets around so much. He said, “You are the most active group I have had.” We took that as a compliment. We love being out with the people and working at night. However, tonight we sleep for tomorrow we have to visit the village, Pan de Azul to do medical care on many people. I am told hundreds will show. Today was a very full and beautiful day. Our “vacation day” in Haiti."

Wednesday, February 24, 2010

Jennifer's words on Haiti



Below are words that Jennifer wrote about the conditions of the hospital in Hinche (pronounched "inch). Women are not nursing their new babies because the earthquake "scared" their milk and made it turn bad. I wonder if any of the Maya Spiritual healing techniques I know are similar to the ones in Haiti? Can we spritz these women, do spiritual bathing and return their milk to it's original sweetness? I will have to do some research about that. The result is very sick babies--diarrhea from the rice milk they are being fed and general severe malnutrition--and the moms all seem to have horrific yeast infections.

And the picture of birthing mamas is not pretty...already a mama has died and this morning another woman lost a baby. I spoke with one of the women the started the Midwives for Haiti program last night, she said that there is no way to preppare for the things that we will see. That at least one baby dies every week and it is common to lose mamas as well. In Senegal it was almost impossible to get a woman to a doctor for a cesarean if needed. It sounds similar here. And the picture of birth is far from compassionate. Jennifer said that one of the midwives saw a fifteen year-old woman get brutalized by five "midwives" and a doctors-- slapped, held down, screamed at. It was described as rape. Raped while giving birth. I am amazed at what we are capable of doing to each other and what we are capable of surviving. The description reminds me of what I saw in Senegal--the worst of 1950's American obstetrics practices. The midwives currently in Hinche are talking about starting a birth center, so that maybe this can occur less, maybe women will get off their backs, remove their feet from the stirrups, and have more empowered birth experiences. We will see.

"We did the round and fed everyone in the trauma area (amputees, burns, etc.) Most injuries are from the earthquake. Patricia and I bought 10 loaves of bread and some peanut butter. We fed 50 people (the loaves here are so tiny). So many grateful people.

The hospital is full of hungry people because they are fed one meal per day–lunch.

My little patchwork quilt boy was happy for the dinner. He let me take his picture. He is beautiful and amazing. I told him through translator that I am so proud of him for surviving the quake. He was burned so badly in the quake that he would not have survived had it not been for operation smile coming two weeks ago to staple skin grafts all over his body. The skin grafts are white skin so he looks like a beautiful patchwork quilt of black and white. He has staples all over his body. He is so happy and smiles so sweetly to me as he says, “bonswa.”

Lots of moms in labor, including a mamma who came in with a fetal demise. She hadn’t felt the baby move for a few days. I kissed her on the forehead after telling her with my eyes that her baby died. I tried memorizing “your baby died, I am so sorry” in Creole on the airplane, as I knew I would have to say it to someone. When the moment came, I couldn’t remember the words. She understood and caressed her belly longingly. I had to walk out to cry.

No one birthing at the moment. Fifteen beds filled in the same large room of laboring women. Once one is pushing she will walk to the delivery room and climb on to the table and deliver on her back with her feet in stirrups. Then, she walks to a large postpartum room with many beds with moms and babies, usually grandma laying between the beds on the cement floor.

It’s not so bad at night when the doctors are gone and the midwives are willing to watch us catch the babies.

I don’t know how to get the moms off the tables, as the floor is filthy and the birth stool I ordered didn’t make it in time to bring to Haiti."

Friday, February 19, 2010

Reminders of Senegal...

I have been reading more about the needs of the hospital I am going to work at in Hinche. What I am learning sounds so familiar, like the clinics in Senegal--electricity is intermittent, running water scares and unsanitary. The staff has to work by flashlight once the sun goes down. The photos I have found look similar too--cracked walls, dirty walls (I remember thinking that the curtains in Senegal hadn't been cleaned in years and years and that touching them would be very unwise). I wonder if there is an autoclave to sterilize the rusty instruments (I heard there are few instruments anyways, and that the ones there are rusted) and if it is even used. The autoclave in Senegal was used for storage and not because it didn't work. It worked perfectly fine, but it took too much time--by the time it would have finished sterilizing the limited number of instruments too many women would have been in and out of the clinic.

There are now problems occurring with sanitation and the access to clean water is diminishing. I am uncertain how this is all impacting the hospital in Hinche and the St. Joseph's community. The board members of Midwives for Haiti are traveling there in March, so hopefully they will have more to report. This morning I read the statement "the stench of decomposing bodies [has been] replaced by that of excrement." The rain that has been falling on the Haiti is causing further problems. I wonder what the sanitation will be like when I arrive--at the peak of rainy season and malarial outbreaks. Already there are concerns about the rise of diarrheal related illnesses like typhoid and an expectation for cholera outbreaks.

I have been asked several times in the last 24 hours what it is that I am going to eat and where the food will come from. Right now the report is that we have access to rice and beans, provided by the monks who will be hosting us--but where are they getting the rice and beans? And if the market is open and we can purchase food--what will even be available and at what cost? I may be able to afford to buy a chicken from some local farmer (and apparently there are chickens to buy), but how will it feel to know that I am one of a few with the means to buy food. When I was in Senegal food wasn't an issue, there was plenty of fish (more fish than I care to remember) and plenty of millet, powdered yogurt, hard boiled eggs, and bitter root vegetables. If we were hungry in the middle of a shift it was easy for one of us to walk to the market and buy a watermelon--the perfect sweet, refreshing snack for the hot environment. It was a fun snack to share with the medical staff and they purchased plenty that they shared with us. The people in the small, poor village of M'boro for the most part seemed well fed. Granted there was malnutrition, but I know it will be nothing in comparison to the conditions of Haiti. I am not sure I am or can be prepared for that reality.

Wednesday, February 17, 2010

Items Needed for Trip to Haiti

Supplies Needed In Haiti include:

Suggestions of things the new mothers need:
Clean new or gently used sheets, flat.
Light cotton nightgowns - especially good for moms without a surviving baby
Cloth diapers
Diaper pins
Receiving blankets
One-sies
Washcloths
Small bottles of baby wash or baby shampoo
Soap bars

Ongoing needs for the hospital: Funds to buy items will aslo be greatly appreciated
Cloth surgical towels
Bulb syringes
Cytotec
Ibuprofen
Tylenol
Anti-hemorrhagics (Pitocin, Methergine and Cytotec)-no expired meds, please!
Antacids
Suture material
Prenatal or multi-vitamins (from your local healthfood store)
Gloves-sterile and non-sterile, size SM and MED range in price
New or gently used receiving blankets, onsies, newborn baby hats
Suturing instruments:
Tissue Forceps, Hemostats, Retractors, Needle Holders, Scissors
Fetascopes
Pinard's horns
Newborn or Ped's stethescope
Stethescope
Cord tape and clamps
Cord bander
Needed yet for students:
Brown doll to practice birthing
5 fetoscopes
Inexpensive fish scales for weighing babies - 9 of them

Needed now:
A good used laptop so Theard can translate some tests while you are there
A power strip so you can plug in the printer and laptop.
#21 HP black inkjet cartridge
Staples
Paper for printer

Other:
Soccer balls (with needle to pump them up) would be much appreciated
Other balls and hula hoops would be good, if not too hard to transport.

Tuesday, February 16, 2010

Trying to Save Lives in PAP

Haiti Recovery

Letter about Haiti and report from UNICEF

Dear Friends & Family,

As many of you may know by now, I will be going to Haiti in May to volunteer in a midwifery training project, Midwives for Haiti! I am thrilled to have the opportunity to put my midwifery skills and training to good use and hope that you all can help support this experience!I will be teaching basic prenatal care skills and attending births along-side local student midwives.

The lack of skilled obstetrical workers makes Haiti the most dangerous place in the western hemisphere to have a baby. According to World Health Organization statistics 670 women die for every 100,000 births. That rate is 60 times higher than in the US.
In the rural areas of Haiti only 15% of births are attended by someone with the training and supplies needed to make birthing safe. Midwives for Haiti has been working since 2004 to train community midwives. The organization has received the support of the local population and the Ministry of Health.

I have attached the link to the organization’s website which provides a wealth of information about this inspiring and ambitious project. http://www.midwivesforhaiti.org

As a midwife, I have more time and skill to offer than I do funds, so I am writing to ask you to become a part of the Midwives for Haiti team by providing a donation to help support this life-saving work. Since the earthquake, it has become even more challenging to get much needed supplies into Hinche and delivered to the midwives. Additionally, there are 150 refugees that are also in need of supplies and assistance. Donations will help cover the purchase of much needed medical supplies, a “medical” translator, and possibly food and other supplies for the clinic.

Any donation you make will be greatly appreciated and judiciously used. There are a few ways you can make a difference.

1. A check made out to me will allow me to purchase desperately needed supplies and non-prescription medicines to carry into Haiti in May. This will immediately impact the lives of the poorest mothers and mothers-to-be in our hemisphere. Donations may also be used to cover cost of a translator to help with teaching the local midwives and in-country travel. If you would prefer to gather/purchase supplies directly, please let me know and I will send you of list of items needed, also see the list below.

2. Or if you would prefer you can purchase medical supplies via Cascade medical supplies
at http://www.1cascade.com/ or (503) 595-1720 and have the supplies shipped to me. Currently no supplies are getting in to Haiti, so ordering and shipping to me or making a donation ensures that the clinic will receive what is needed. See the list below in an upcoming post....

Please send your donations to my home address (if you don't have it drop me an email). I will be leaving in mid-May but in order to have time to purchase supplies would need to have your donations by March 30th.
Thanks so much for your support. I will be keep you all updated as preparations continue.
Blessings
Aerlyn Pfeil, CPM
Phone: 503.539.5733
email: aerlynpfeil@gmail.com

UNICEF on Materntiy cases in Haiti:

"Since the earthquake, maternity wards have been overwhelmed with surgical cases, leaving only the most at-risk deliveries attended. But life, of course, goes on. Medicins Sans Frontieres, just one group of medical volunteers in the country, reports an average of 12 deliveries a day [at their location], 40 percent of which are by caeserean-section. Premature births are another common, but regrettable, result of the trauma inflicted on mothers by the quake.

Health workers on the ground are doing all they can to prevent more deaths—a second wave of fatalities that lurks in the debris of the ad hoc play-yards children run through barefoot, and in the bacteria that thrives in crowded encampments lacking basic sanitation. Skin ulcers, gastro-intestinal illnesses and dehydration are already a problem.

The vaccination campaign will last about two weeks and aim to reach 500,000 children. Of course, there are many children who will not benefit from the immunizations, due to lack of access or already weakened immune systems.

And then, again, there are the unborn—120,000 Haitian women are pregnant today. Half of them have been affected by the quake. Of the 7,000 mothers who are due this month, 1,000 are likely to miscarry, according to the United Nations Population Fund."