I could tell this was going to be a rowdy session when the teacher warned the class, “The visitors will be showing some graphic images of sexual diseases, so if anyone feels that they are not mature enough to see them, please leave now.” This produced a roar of anticipation from the boys on the back row.
We always start with introductions. I try to break the ice by telling the senior students something personal about me. “I’m Dr Ian and I come from Leicester CITY! You wouldn’t have known where I was talking about last season, but now we are the champions.” This usually raises a cheer, apart from die-hard Chelse or Man U fans in the audience. “Today, we are going to talk about sex.” This elicits another cheer, fists pumping the air or banging on metal desks. I’ve got them eating out of my hand now.
The trick to engaging a student audience when delivering health promotion is to vary the presentation. Our opening gambit is a role play involving a boy talking about his new girlfriend with his mate. The dialogue has to be short and snappy as it is in English, not Nyanja but it has to be authentic. The boys chat about expecting to have sex if they buy a girl “talk time” for their cell phone. Girls may be swayed by protestations of lurve. Do they really think, “He loves me, so it’s okay to have sex.”
In the role play, the boys discuss their “rights” over girls, their sexual needs and if these are not relieved, their testicles will explode. Finally, they discuss the disadvantages of condoms, (“like showering with your boots on”) and the merits of unprotected sex, which is known locally as “live wire”.
The role play takes just ten minutes before we switch to a thought provoking question and answer session.
“Is it ever right to force your girlfriend to have sex?”
“How long can boys go without sex before their testicles explode?”
“How much do you think I will get if I give her 10 kwacha (just less than a US dollar)?”
“Are there any advantages to using condoms?”
This segues into a short lecture session on sexually transmitted infections. After five minutes transmitting information orally, I move on to projecting photographs onto a white bedsheet pinned over the blackboard.
“All of these photographs were taken here in the clinic at Mfuwe,” I say. “So if you recognise your genitals, please don’t put your hand up.”
On setting up the projector, I noticed that the only socket in the classroom was hanging limply out of the wall. It had no power. I ran the extension cable to a socket in a neighbouring room, but that was also dead. Finally, we had to get a boy to stand on a desk and connect bare wires together from the ceiling light to an extension cord. This worked.
Most sex education is directed towards girls. They are the ones who get pregnant and they are the ones who can’t get pregnant in later life after several attacks of tube-welding pelvic inflammatory disease. The boys usually sit back and think that sex education doesn’t apply to them. Just to remind them that it takes two to tango, 90% of the gruesome images I show were of diseased meat and two veg.
Silence descended on the class as I projected photographs of penises afflicted by gonorrhoea, herpes, syphilis, chancroid and lymphogranuloma venereum. The more horrific images elicited a groan from the class. There were three token images of female genitalia, yeast infection, secondary syphilis and warts, and these caused a minor uproar among the boys at the back of the class. The teacher had to calm them down by issuing threats.
I wanted the talk to be informative so students could make their own decisions; I was not aiming to scare them into celibacy. We promote monogamy and that sex was a gift to be enjoyed responsibly – in the words of Woody Allen, “It’s the most fun I’ve had without laughing.” The session ended with the students making comments and asking questions. One girl asked rhetorically why God didn’t solve this problem by issuing us with sex organs on the day we got married.
A few of the questions began with, “I’ve got a friend who…” but everyone knew who had the problem. After we finished, Miss Fwelani (social worker from Project Luangwa) and Mr Chulu (health promotion at the clinic) were surrounded by students who wanted to ask a question but didn’t feel able to do so in front of the entire class.
When I was a GP in Leicester, I used to give a talk to the University Afro-Caribbean Society and the students there dealt with their inhibitions by writing their questions on pieces of paper, which were put into a shoe box and drawn out at random for me to answer. Perhaps we can introduce a similar system here in Zambian secondary schools.
I asked Fwelani and the teacher to pose for photographs outside the classroom. Fwelani was embarrassed and covered her laughing mouth with her hand. When I pointed this out, the teacher said, “I should be doing that, not you!” He broadened his smile and revealed multiple gaps in his dentition.
Mr Chulu, Miss Fwelani and I are planning to do HIV and Sexually Transmitted Infection awareness teaching in 20 schools in the locality, most of which have no power, so Project Luangwa has loaned me a small generator. This means doing three sessions a week until I leave. It is a work in progress. With every session, we are improving and refining what we say and how we say it, but communication and logistics remain problematic. For example, we arrived at the first school at 2pm to find the students had all left for the day at 1:30pm. “Per ardua ad astra” – reach the stars by working hard (the motto of Mfuwe Day Secondary School).