Reports from Nicaragua

Things are going a bit better in Managua than they were last week. We now have a good idea of what we’ll be doing the rest of the time with ASODENIC, and neither of us is sick! Katy and I have spent most of last week and this week preparing the preventive health capataciones (trainings/lessons) for ASODENIC’s clients. Our primary job will be to present these capataciones to the various bancos de confianza and grupos solidarios both in Managua and further out.

ASODENIC is a microfinance organization helping the poorest people of Managua and other surrounding pueblos. This organization strongly emphasizes Christian values and the idea of client transformation—socially, economically, and spiritually. Clients, or poor Nicaraguans (mainly women) who have a small business, create bancos de confianza of 25-30 people who live in the same geographic area. ASODENIC provides loans to the clients, who are then expected to pay back this loan according to a pre-set schedule. The bancos de confianza meet once a week with representatives of ASODENIC, and a capatación (lesson) is usually provided byASODENIC for the women. Topics can vary from business management to Bible study, but ASODENIC has recently decided to emphasize preventive health issues.

ASODENIC had lessons already made for cervical cancer, breast cancer, acute respiratory diseases, and acute diarrheal diseases when we arrived. A group of BIOE 260 students from Rice had rewritten several of these lessons to better cover these subjects, but ASODENIC has been hesitant to listen to these suggestions because many of the lessons are in English and do not follow exactly the format of their capataciones. Katy and I are doing our best to translate and rewrite the BIOE 260 lessons because we believe that these lessons will help to improve the ones that ASODENIC currently has.

Katy and I were able to lead our first capatación this past Tuesday at the Ciudad Jardín sucursal (branch), which is a short walk down the street. We presented our lesson on cervical cancer to 4 grupos solidarios, which consisted of 14 women and 1 man who were from areas around Ciudad Jardín. While the clients started out quiet and unwilling to talk, they were laughing and having fun and engaging in the topic by midway through. It was great to start our capatación career with an energetic group of people from the middle of Managua, because as we learned from our capatación in a more rural area today, the women in rural areas are much more timid and less willing to volunteer responses. While we did not crash and burn today, there was significantly less interaction. The women appeared to be interested and enjoying themselves; they just didn’t want to talk!

Katy and I will spend the rest of today and parts of next week rewriting the capatación on diarrheal diseases. Next week will largely be a traveling week, and we will be giving 2-4 capataciones per day on cervical cancer and breast cancer. This weekend, we’re planning to stay in Managua on Saturday to continue our exploration of the city and then travel to León on Sunday to enjoy a tourist town and to see another city in Nicaragua.

Katy and I are back safe and sound in Managua after Round 2 of our internship: two and a half weeks in a rural region of Nicaragua called Mulukuku. This was a drastically different experience from our time in Antigua for a number of reasons. Most notable was the change in our environment: we went from one of the most affluent cities in one of the most successful countries in Central America to a very rural and underdeveloped region of the second poorest country in the Western hemisphere. Fortunately, we had a much broader team with which to share this experience. While we worked with two wonderful organizations in Antigua which consisted of small groups of very dedicated people, we had the opportunity to work with a huge team of UTMB medical students, doctors, occupational therapists, and dentists in Mulukuku.

Our team lived at the Maria Luisa Ortiz Women’s Cooperative, which was founded by an American woman, Dorothy Granada, who is very dedicated to human rights and women’s rights (http://www.mulukuku.org/). This cooperative had been providing the only health care to the Mulukuku region until recently. Because of recent political changes in Nicaragua, the activities of the Ministry of Health (MINSA) have been drastically altered. While there used to be no MINSA doctors in Mulukuku, there are now 14. The original purpose of UTMB’s trip to Mulukuku, which began in the mid 1990s, was to work with the cooperative to provide health care to the people of Mulukuku. That plan had to be altered this year, as there was not as strong a need for health care in Mulukuku. Instead, we travelled 70 minutes every day to the pueblos of Santa Rita and La Bodega for two weeks. Some of my favorite memories are from riding in the back of our “cow truck” on loose wooden benches and unpaved roads, covered by a rain tarp and unable to see anything around us.

Katy and I went into Mulukuku intending to implement Katy’s OB/GYN Lab in a Backpack and incorporate it into the work of the cooperative, to disseminate instructions for the neonatal hot cots, and to help the UTMB team in any way we could on a daily basis. Most of our time was spent at the clinics in Santa Rita and La Bodega. Katy created a position for herself at La Bodega as the “gatekeeper”: we had noticed very early on the first day that stray dogs, chickens, children, and patients tended to wander in and out of exam rooms at will, and that the doctors were having trouble communicating which patients needed to go where. Katy organized all the patients and their files and kept operations running smoothly. I spent most of my time at Santa Rita helping in the pharmacy—we were a bit short-staffed in that area, and it was the place where I could make the greatest impact. I greatly enjoyed learning about all the drugs, the difficulties in acquiring medications, how to improvise a back-up plan when the correct medications aren’t available, and interacting with the patients in order to relay administration instructions. I had a number of flashbacks to my BTB internship in Botswana, where I was working to implement pediatric HIV/AIDS dosing guides. Most times it is crucial that a medication be taken correctly in order for it to be effective, but not much time is spent making sure that these patients understand what they’re being given. A huge number of antibiotics were prescribed, but I often questioned the sagacity of this course of action; several patients were unable to repeat back to me their administration instructions, while others simply had too many medications to keep straight.

Katy and I were happy to find that the neonatal hot cot given to the Cooperative last year is functional and being used on a weekly or biweekly basis. The midwives and nurses have been using it correctly and have not had any problems with it. I was disappointed to find that there was little potential for the incubator in the rest of the region. We heard from several women on the staff and in the town that the Cooperative was one of the few birthing centers in the region. There was one 2.5 hours away in Rio Blanco, but most women just had their children in their homes. Many of these women have 7 or 8 children and do not feel that it’s necessary to receive medical attention beyond a midwife or family members. Katy and I set up a meeting with MINSA doctors to discuss MINSA’s potential use of our incubators, but they echoed what the women at the clinic told us: there was simply nowhere to use them.

On a happier note, we were glad to find out that the rumors we’d heard about the justa stove being used incorrectly were largely incorrect. Two members of BTB travelled to Mulukuku last summer and built this justa stove in order to decrease the amount of smoke that typically pervades a rural Nicaraguan kitchen. We had heard that the women at the Cooperative were using the stove but removing the plancha, a critical component in keeping the smoke contained. After a brief meeting with several of the staff members who did the cooking, we found that the staff members were using the stove correctly, but that the women who were patients at the Cooperative did not know how to use the stove and were instead removing parts so that they could cook over an open flame. One of the staff members agreed to speak with the patients who were staying there and to teach future patients how to correctly use the stove.

I’m excited to be working in Managua now—it will be interesting to get both urban and rural perspectives of this country.