Reports from Nicaragua

Week three in Managua! Much more activity to report – Lindsay and I spent Friday night in Grenada with the translators from our Mulukuku adventure, and we ended up at a restaurant with FSLN ballads from the Sandinista-Contra war performed live. Good rousing stuff. We also got to visit 6,000 year old footprints in Managua and the oldest cathedral in Central America in Léon, across the way from a Sandinista war museum staffed by former rebel soldiers. It was incredible to see the museum’s images of Léon, a center of Sandinista activity, with shelled out buildings, tanks, and makeshift barricades little more than twenty years ago. Especially given the current situation in Honduras, it was sobering to imagine streets Lindsay and I were walking on patrolled by la Guardia National, or to picture buildings we passed manned by snipers not that long ago. Realizing how recently Nicaragua emerged from a devastating civil war puts the country’s poverty and development in a very specific light, and emphasizes again the crucial role of political alliances. The reason the women’s cooperative in Mulukuku has been able to scale down their clinic work, for example, is because they are staunchly Sandinista and the current government, led by president Daniel Ortega, is too. The communities near Mulukuku are benefiting from the political affiliation of the women’s cooperative – because the women support the government, the government has brought health care services, limited but desperately needed, to the area. It will be interesting to see what happens in Mulukuku if the FSLN doesn’t retain power in the next election. Given the drastic changes associated with each transition of political power in Nicaragua, ASODENIC’s Christian emphasis and lack of political affiliation seems to be a sound policy.

Back to work: Monday morning saw us off to Tipitapa, a reasonably large pueblo 30-40 minutes outside of Managua. From the ASODENIC agency in Tipitapa, we traveled another 40 minutes or so down unpaved roads to San Roque, a rural community with two bancos de confianza (groups of women in the same microfinance pool). Our first stop was at a cooperative of sorts – one woman in the banco de confianza has turned her home into a panaderia, and the other women in the group come over and make tortillas, sweet bread, rolls, cheese, and cream to sell in Managua daily. It was an impressive example of of the micro-enterprise facilitated by ASODENIC.

We presented a capatación on Breast Cancer screening and detection to the women, and to say I was taken aback by the reception is a gigantic understatement. Our lesson covered what cancer is, how it progresses, how it manifests in the breasts, risk factors for developing it, how to do a self-exam for breast cancer, and the importance of mammograms. Though the women seemed to be familiar with the self-exam and mammograms, the Q&A session shocked me. One woman yesterday told us that she had lumps in her left breast that hurt to touch, and wanted to know if she should see a doctor. Another women said she had dark secretions from her nipple and general pain in her breasts, and that her doctor told her that nothing was wrong. Hearing their questions and stories made me mad at the world, honestly. It feels so obvious to me that dark secretions or localized breast pain would be a cause to visit the doctor immediately, but I grew up with American health care and personal experiences with breast cancer. Also, for the women that do go to the doctor, there’s a chance that the medical professional could decree that dark secretions are nothing to worry about. It was hard for me to tell these women that sometimes a second opinion is a good idea, because doctors are such a trusted profession, yet at the same time, these women’s lives are at stake. One of the ASODENIC health promoters said that most women in the area go to a free health clinic first, rather than the clinic ASODENIC contracts with, and that the quality of care is just not up to snuff. Economically, it makes sense: why pay, even at a deeply discounted rate, when you can receive care for free? In terms of justice, however, it’s not right. The lack of education and awareness re: breast cancer detection is a huge factor, of course, but it makes me want to holler (Marvin Gaye reference) that even a little money – it cost me $4.50 to see the doctor for my tonsilitis – is such a huge barrier to quality care. It’s far easier to educate and inform women than it is to readjust the national infrastructure for health care delivery…and promoting factually accurate, culturally acceptable health information is no small feat. I’ve been simmering since yesterday morning.

After we finished our breast cancer presentation, an ASODENIC health promoter asked if there were other subjects the women might like to see covered. They responded with menopause and cervical cancer. As it turns out, Lindsay and I have a capatación on cervical cancer, so we presented an abbreviated version of the information, emphasizing the importance of yearly pap exams. Again, the women were familiar with the material conceptually, but had little personal experience with cervical cancer screening. One woman explained that although she had a cousin and a mother die from cervical cancer, she had never had a pap exam because she was embarrassed. It made me sad and angry to hear  stories like that. One the one hand, it’s really great that Lindsay and I can share this information on a personal level with the women who so dearly need it, but on the other hand, we’re only here for six weeks and at most, 200 women will hear these lessons. The women we are able to speak with and connect with are wonderful – animated, appreciative, and supportive even though we’re young and norteamericana, for the most part. But what about the thousands upon thousands of Nicaraguan women that ASODENIC doesn’t meet face-to-face? And what happens when we return to Texas – there’s not a sustainable health promotion system in place through the government, and ASODENIC is still searching for a full-time health promoter. It’s frustrating to feel like our capataciones are a one-and-done deal. Beyond Traditional Borders very much emphasizes sustainable interventions and innovations in global health, and I wish Lindsay and I were able to do more.

Putting our role this summer in a  more positive light, Lindsay and I do have the privilege of implementing ASODENIC’s health education materials for the first time, and we have the opportunity to make suggestions or modifications based on our experiences on the ground. We also have ambitions to create  outlines for other capataciones not covered yet by ASODENIC – nutrition came up as an idea yesterday. And, if nothing else, we will have spent 8 weeks in a country very different from the USA, one not many Americans travel to with great frequency, and will have gained a perspective on Central American health care service and delivery that not many of our peers can claim.

Finally, on a lighter note, I have acquired a Nicaraguan alias. For as many people that call me Katy, at least as many if not more refer to me as ‘La Chela’. Nicknames are a salient aspect of Latin American culture, and it is not uncommon to meet someone and have them introduced by two different names – their given name and their apodo. ‘Chela’ is a generic name for someone with light coloring, often used interchangeably with gringa or norteamericano or yanqui. One would think that Lindsay and I, both as white Americans, would each be a ‘chela’, but that’s not the case at all. The translators at Mulukuku, all the children at the clinics with the UTMB medical delegation, women in ASODENIC bancos de confianza, our taxi driver, and a random pair of old men on a street corner while Lindsay and I were in a cab refer to me as ‘Chela’ at first sight. I feel like I must be wearing a nametag for so many different people to bestow me the same name individually, and with such frequency. Sometimes it’s even accompanied by pointing. The only hypothesis Lindsay and I can come up with is that because I have lighter hair than she does, I am more Chela than she. Regardless, it’s entertaining to have a Nicaraguan nickname and I’m actively trying to work out a way to bring it back state-side.

In the interlude between this post and the next update on the adventures of Lindsay and la Chela in Nicaragua, feel free to check out our facebook pics on each of our profiles. There are some great photos that can illustrate what we’re up to much better than blog text. Hasta luego!