The
jeep was maneuvering its way through the main city of Managua. The air was hot
and heavy, but the clouds were starting to roll in. It was rainy season in
Nicaragua, and the rain (which was unusually punctual- it almost always came at
around 6pm everyday) provided a temporary relief to the heat. I was with
Rebecca, one of the board members of FNE International, which was the NGO I was
working with. We were on our way to León, my home base in Nicaragua where I
would be doing most of my work. We arrived about two hours later. The first
thing I noticed were the women carrying baskets of fruit on top of their heads.
I could barely balance a book. The cars’ ceaseless honking, people yelling
their merchandise out loud like “Aguacateee!” or “Sapote! Sapote!”, the
colorful painted walls of revolutionary heroes, the streets full of locals and
tourists, and the sound of reggaeton in the background coming from one of the
air conditioned department stores. It was a whir of life and it was
refreshing.
I
had two assignments here: one was to study the prevalence and risk factors of
gastrointestinal infections in the country (like Giardia lamblia and Entamoeba
histolytica) and the other was to develop a resource database to connect
patients with external resources such as water improvement programs and special
education services. But above all else, my main intention was to learn as much
as I could about the community. One of the biggest reasons projects fail in the
first place is because we, the people who offer services or aim to make a
positive change, fail to recognize the finer details of a community’s culture
or acknowledge those at the bottom of the socioeconomic ladder whose voices
often go unheard. Without knowing their story, it’s impossible not to run into
unforeseen trouble. My goal in the long-run is to strengthen healthcare
systems, but to do this, it is absolutely necessary to understand the culture,
history, and political economy of a country and the local nuances of a
community.
During
my time here, I spoke to locals from all walks of life- scholars, doctors, taxi
drivers, patients, NGO workers, students, locals working in the informal
sector, former military, farmers- whoever was interested in conversing. I
wanted to hear everyone’s voices. One of my main questions was why Nicaragua
was so poor. It’s the second poorest country on the Western Hemisphere, second
only to Haiti. Once I learned about their history, it was easy to see why. The
country had been ravaged by war, one after another during the 20th century.
First, against the United States at the beginning of the century, then the
civil war in 1979 between the Sandinistas and the Somoza dictatorship, then the
Contra War right after, which was also secretly funded by the United States.
The country had no time at all to recuperate and the effects of the endless
fighting were highly tangible, even in the main cities like León and Managua. There are very little
job opportunities, even for trained professionals like doctors. Education,
although greatly improved from previous years, was still of low quality and not
heavily emphasized. There were homes in rural areas built of cardboard, metal
sheets, and black plastic bags. I study health and disease, but the reason why
I mention all of these things is because they’re all connected.
Just
25 minutes from León is the rural town of Chacraseca,
which is comprised of different sectors and has only one clinic staffed by 2
nurses and a doctor. They serve 8,000 people in the area, 3 days a week for
about 7 hours a day. People have to start queuing in at 4:30 am if they want a
chance to be seen. Actually, there are two clinics in Chacraseca, but one of
them has no running water or electricity and way below standard sanitation. So,
no one really wants to go there. Everyone goes to the new clinic instead, which
actually had just been finished a little before I arrived. It was a huge
milestone for Chacraseca. The health post was funded by MINSA, Nicaragua’s
Ministry of Health. It provides free health care services and medicine to
patients, as long as resources are available. I visited Chacraseca almost every
week. The bus that ran from León to Chacraseca didn’t have a regular
schedule. One of my local friends had even told me, “Go ahead and ask five
people what time the bus gets to a specific stop and they will give you five
different answers.” So, if I happened to miss the bus, my only other option was
to hitchhike to and from the clinic, which I had to do a few times.
During
the first few weeks, I tried to learn as much as I could about the community
before starting my project. After working at the clinic and joining the medical
students on home visits, I started to learn about the biggest issues people
faced in accessing resources and how that translated into the quality of health
of the local population. One of the people we visited was a diabetic patient
whose main concern was having regular access to insulin. The health post
provided her with free insulin, but it often ran out of medicine. When that
happened, she often went without it or if she had the money, she would have to
travel to León to purchase it. Another patient we
visited was a child I will call David (his real name is censored for privacy
reasons) who had a rare genetic mutation that caused problems in brain and limb
development. His family lived deeper in Chacraseca where the road ended and the
path toward their home was mostly dirt, wild grass, and farmland. Their
family’s main concern was lack of transportation and specialty services,
especially in that area. On top of that, the financial stress of weekly
hospital visits was taking its toll on David’s mother, who was barely making
enough to sustain the family. At the time we spoke to her, she was making a
couple dollars more than the total cost of the hospital visits. After
witnessing these cases and others like it, it became clear that there wasn’t
one answer to everyone’s concerns. All of these issues were embedded in the
country’s social history and were all interconnected, which complicated the
solution even more. The best thing I could do was to find a connection between
all of them and start from there. From this, I began to draft the resource
assessment that would assist FNE International and the local health post to
identify gaps in the healthcare system and provide a basis for future
development and service projects. My hope in the long run is to improve health
outcomes by enabling FNE and other NGOs working in the area, as well as local
medical facilities to connect patients to the resources they need.
Field Picture 1: Clinic mentoring from Doctora Reyna Sommariba, director of
the local health post in Chacraseca
Field Picture 2: Completing resource assessments at the rural clinic
Field Picture 3: Salud Para Todos los Niños specialty clinic; the team is
seeing wonderful progress with all the children enrolled in the program
Field Picture 4
Field Picture 5
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