Sunday, October 4, 2009

Catholic San Francisco News Article

Here's a link to an article that was published about my experience with this program recently:

You can also access a PDF version (which has a couple of additional photos) by clicking on the digital paper link, then download the Sep 25th issue and got to page 3 and 9.

Need for continued funding...

...just a side note for anyone who has read through this blog and feels like they could support this university program in the future, since the program is looking for additional funding to keep the program going. If you think you can help out, please contact:
Julie Reed (
Director of the Office of Service Learning:
Leo T. McCarthy Center for Public Service & the Common Good
University of San Francisco

Here's an additional link to her biographical page on the university website:

Research Paper

Hello, I know this is long overdue, but things have been quite busy beginning the Fall semester so soon after returning. But I am posting the paper I wrote here for the course in case anyone cares to read it. I think it could still use some polishing and a better focus on one specific issue, but with the time I had this what I wrote. Maybe later this year I will return to it and make improvements, so consider it a work in progress:

Adolescent Pregnancy and Sustainable Development in

Richard Hackett

LAS 312 – Sarlo Scholars
Professor Friedman
August 28, 2009
A young girl, wearing plastic sandals and carrying a small bag of belongings and a blanket her mother gave her, enters the Pre-Labor unit at the local hospital. She is nine months pregnant and will be delivering her first child in the next twenty-four hours. No family members are allowed inside of the unit, meaning she waits alone as the attending nurse and physician instruct her to change into a hospital gown and assign her to a bed in the crowded room. She can hear some screaming down the hallway of another woman in delivery, and the girl begins feeling very anxious, knowing her turn to move down that hallway will soon come. After being directed to the bathroom, she changes into the gown and wanders back to the bed, awaiting further attention from the staff.
One of the nurses sorts through some paper work and begins asking the girl questions. She states her name and gives an age of 15, but indicates that it is only an approximate age since the exact year of her birth is unknown, she does appear very young, perhaps a few years younger. When then asked to sign her name on some of the hospital records she says she is unable to read or write, even her own name. After a pause, the nurse instructs her to just do the best she can and explains orally what the documents she is signing refer to.
The above scenario is not fictional. It represents a noticeable share of young mothers in Nicaragua, a young adolescent girl with relatively little or no formal education, due to a lack of access, living in a difficult economic situation and now faced with an even more difficult situation as she will have to provide for a newborn baby. The child will also be carried to term whether the pregnancy was a result of consensual sex or not, as abortion in Nicaragua is completely illegal. The expecting-mother usually has significant support from her side of the family, but also often times little or no support from the biological father. The new single parent-mother will likely struggle financially to provide for herself and her child and it is unlikely that she will ever garner more of a living than what permits day-to-day subsistence, and several years from now she may have additional children to provide for.
For someone unaffected by this type of scenario, it is easy to not pay it much attention. It is easy to place blame on the young girl for her predicament, or to place blame on the parents for perhaps having set the same example in their own lives and not having “done better” for their children. But when you delve deeper into the issue many of these Nicaraguan girls are facing, the situation becomes much more complex and intertwined with institutional norms, values and official policies (and certainly many parallels exist between Nicaragua and other societies where this occurrence is common, but this paper will focus principally on Nicaragua). The overall effect of widespread adolescent pregnancy in this country manifests itself in more sinister forms as an impediment in the lives of these girls towards education and economic determinism. The lack of what these young women can in turn provide for their children (in regards to education and economic opportunity) then cycles back to the children once they become of child-rearing age, making them more susceptible to continue enduring the same conditions of financial poverty that existed for their parents.
This paper will explore the economic, social and health impacts of adolescent pregnancy on these women and their communities in relation to the Millennium Development Goals (MDGs) brought forth by the United Nations (UN) and sustainable development. I will then survey some of the scholarly literature on teen pregnancy in Nicaragua and Latin America. This will be followed by a discussion of data I gathered recently while in Nicaragua and finalized with a conclusion of the information presented here.
A Brief Background – Economy and Education
To understand the life of this girl, it is necessary to consider the traits of the country she is from. Nicaragua is situated at the heart of Central America, with a population of about 5 million people, but is economically one of the poorest nations in Latin America. Approximately 50% of the population lives below the national poverty line (Human Development Report 2007/2008, 337). Public education is also poorly funded, and many people completely lack access, especially in rural areas. The Economist Intelligence Unit reports and illiteracy rate of five years of primary education (13). While not directly related to adolescent pregnancy in this region perhaps, these economic and educational factors have surfaced as a central theme to this topic, as both a symptom and a cause.
How Adolescent Pregnancy Relates to Development –
The Millennium Development Goals
What does the issue of adolescent pregnancy have to due with development? Using the UN’s MDGs, it becomes apparent that the negative effects of young motherhood are very relevant. Of the eight MDG’s proposed in the Millenium Declaration in 2000, more than half of them deal directly with common consequences of adolescent maternity. Goal 1, to “eradicate extreme poverty and hunger,” is impacted by the inability of a young mother to adequately support herself, since she usually has no tangible market-wage job skills and little, if any, formal education. Goal 2, to “achieve universal primary education,” is impacted by a young mother’s inability to attend a school if it is available, in lieu of caring for children at home. Goals 3, 4 and 5 are also equally relevant, addressing issues of gender equality and women empowerment, a reduction of child mortality and improving maternal health. All of these are issues which arise when looking at the root causes and effects of this issue in Nicaragua (as is mentioned repeatedly in scholarly literature and witnessed in my personal experiences), and any efforts to reach these goals through development work must focus on this widespread occurrence.
Literature Review
How exactly does a poor economy and marginal access to education contribute to teenage pregnancy? Are there other contributing factors? What are the health implications for the mother and child? Have there been any successful development strategies to intervene on behalf of these mothers and other at-risk youth? These were the types of questions I sought to address in reviewing this topic as specifically to Nicaragua as possible in the articles available.
The first article, by Berglund et al., aimed to understand the reasons for the prevalence of adolescent pregnancy amid Nicaraguan youth despite the fact that these young girls must see and experience the negative consequences of it among their own family and friends. As the authors state, “they know that having unwanted children often leads to infant malnutrition, child abuse, family instability, and difficulties in caring for all of the children, as well as keeping them off the street with their material as well as educational needs” (1). All of these consequences reflect back to the MDGs previously mentioned.
Factors attributed to these pregnancies by the authors included economic deprivation, broken family relations, low self-esteem, strict religious practices (Catholic church teaching of sex for procreation and disapproval of contraceptive use or abortion), lack of education, and social isolation. Another factor the authors mentioned is Nicaragua’s dependence on an agricultural export economy, which requires large numbers of working men to migrate throughout the country for months at a time and may contribute to a loss of the traditional family structure (2). This would contribute to men who are away from their partners for long periods of time, selecting other women to have relations with, and then being unable to provide adequate support for multiple mother’s of fathered children. Likewise, the abandoned young mothers and growing daughters are left at home, and are more likely to suffer sexual abuse resulting in unwanted pregnancy from boyfriends or stepfathers (2, 4).
Berglund et al., conclude their article by calling for increased access to sexual education. They point out that many of the youth actually have moderate access to contraceptives, but do not use them (or do not use them properly) because of misconceptions about the effects and use, or social values, such as machismo and religious attitudes, that frown on contraceptive use. The authors state that “access to sexual education is evidently the most effective insurance against unwanted pregnancy,” and that Nicaragua as a whole, must “reveal and publicize, as widely as possible, the reality of unwanted pregnancy in the country” (11).
A separate article by Castillo picked up on a point, also mentioned by Berglund et al., by examining the overt social pressures placed on young women in Nicaragua to marry and have children as soon as possible. The article says that many times it is the actual parents of the young woman that place the most pressure on her to have children, often saying things such as “’ be careful that you don’t discontinue the train, you must have children so that someone cares for you when you are older’” (5). Additionally, because of the elevated status that married women and mothers receive, progressing from a young single teenage girl to a married woman and/or mother can be seen as a quick way to increase your social status; as one young woman says in the article, “’for [our] society a married woman is a respected woman...the civil status of a woman is like a title, as if it is a professional degree’” (6).
Regarding adolescent pregnancy as a global health issue, a third article by Conde-Agudelo, Belizán, and Lammers examined the more independently the physiological health consequences from adolescent pregnancy in Latin America. Given that close to 20% of all births in Latin America are attributed to teenage mothers (World Health Organization, as cited in Lammers et al., 342), these authors conducted a research study to look for an increase in adverse outcomes while adjusting as possible for confounding variables.
Using a hospital-based retrospective cross-sectional study, the researchers screened over 850,000 pregnancy outcomes of Latin American women under the age of 25. According to their study, adolescent mothers actually had less likelihood of requiring a cesarean delivery, experiencing third-trimester bleeding, or developing gestational diabetes (345-346). However, women under 15 had a higher risk for maternal death, early neonatal death, and anemia, compared to mothers in their early twenties. All adolescent mothers had a greater incidence of postpartum hemorrhage, puerperal endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for gestational-age infants (345-346). Additionally, the researchers cited additional studies relating increased adverse maternal outcomes for young mothers, as being independent of socioeconomic status, meaning the occurrence of adolescent pregnancy should be prevented even in communities where poverty is of less concern (348).
Two final articles, by Langer and by Meuwissen et al., in addition to commenting on many of the risk factors and consequences already elaborated on here, call for a solution which incorporates improved and increased access to sexual education and related healthcare services. Langer states that given the trend in Latin America, it is necessary to develop “mass communication programs that address gender issues, education, programs for girls, and sex education [in addition to] health services that include family planning methods” (203). Meuwissen et al., support this finding, but also specify the importance of a “free-of-charge, easy and confidential access to meet the needs for sexual and reproductive health care among poor adolescents” (1866).
Personal Data Analysis
I originally chose to write about the subject of adolescent pregnancy in Nicaragua after my experience working in a labor and delivery unit in a public hospital in the city of Masaya. I spent almost six weeks working on the unit as a student nurse, and was able to have many discussions with expecting mothers and the working staff. I was first amazed at the number of young mothers (less than 18 years old) having not only their first child, but perhaps a second or third. At the same time, it was apparent in discussions with them, that they often had very little formal education, as evidenced by low levels of literacy or complete illiteracy. The women with the lowest levels of literacy often came from the surrounding rural areas of Masaya, and it was not uncommon that a woman would report the pregnancy was a result of non-consensual sex, meaning she was a victim of rape. She was still obligated to carry the baby to term given the government’s complete ban on abortion, or risk an illegal induced abortion which can have grave health consequences for the mother. The common Catholic teaching in Nicaragua of “all life is sacred” further encourages pregnant women, even those who have been raped, to deliver and nurture the child regardless of the circumstances surrounding the pregnancy or the situation (economic, psychological, social) of her personal life at the time.
While working at the hospital I gathered both quantitative and qualitative data. For quantitative data I relied on the Registry of Deliveries and Births, maintained by the hospital I was working in, Hospital Dr. Humberto Alvarado. Assessing all births between July 27th and August 5th, a total of 155, 34 were deliveries to mothers age 18 and younger, about a 24% adolescent birth rate for the sample selected. This is relatively consistent with overall adolescent maternity rates on the national level that I have reviewed in the articles above, and also found in the 2006/2007 Survey of Demographics and Health, published by the Nicaraguan Ministry of Health (MINSA) (38).
Of the 34 adolescent births I surveyed, 6 of the mothers had experienced some sort of problem such as requiring a cesarean delivery, having a premature membrane rupture, pelvic problems, and/or delivering a pre-term underweight child. With the data available in the registry, I was not able to compare more long term complications or more concrete demographic information. This ratio of complications also did not appear much different when compared with the 126 births to older mothers in the registry, but the sample size is too small to make any meaningful conclusions from this.
Other primary information contained in the MINSA report included the statistic the women were 13% (a total of 79% of the women surveyed) more likely to use contraceptives if they had received formal education on their benefits and use compared to only 66% of the women who had not received formal education that reported using contraceptives (13). Education overall was seen as the greatest coordinating factor for women avoiding an unwanted adolescent pregnancy (7,11).
Seeing the repeated significance of education in preventing the adverse outcomes of adolescent pregnancy, why has not more been done to address this? I interviewed several local Nicaraguans, including a retired social worker, labor and delivery nurse, and government attorney regarding this issue and other aspects of the occurrence.
Rosa Gonzalez worked at the local hospital in Masaya for over 15 years as a social worker and has a Master’s degree in Public Health. She often witnessed and had to work with the complications experienced by young mothers, who sometimes prove unable (psychologically or economically) or unwilling to care for a newborn child. In cases such as these her job was often to supervise interventions to see that the child is cared for, or in more sever cases, find other placement for the child. She describes the current rate of adolescent motherhood as “a crisis of public health” that results in poor outcomes for the mother and child, and is exacerbated by the lack of education and resources for youth in Nicaragua.
She also blames the lack of effective sexual education not only on economic poverty, but also on a political and religious unwillingness to address the issue. In her words, she says that these groups “have launched a war on meaningful sex education in Nicaragua.” This viewpoint can be supported in articles, such as those by Kampwirth and by Mannen, that elaborate the government’s antifeminist stance and “war on women’s rights,” especially in regards to reproductive rights and empowerment.
Interviews with Milena Hernandez, a labor and delivery nurse, and Carlos Andrés, an attorney with the Ministry of Justice, further supported the comments made by Gonzalez and the discussed literature. They both agreed that adolescent maternity is a public health issue, contributing to the continuance of poverty for the affected families, but an issue that has not been adequately addressed by government and religious institutions due to the traditional Catholic teachings discouraging sex education and reproduction rights.
The literature I gathered on this topic, from primary and secondary sources, as well as the raw data and discussions I had with other people, all seem to support the same ideas. Those outside of strict religious circles or machismo ideals, agree that adolescent pregnancy is a serious problem in Nicaragua that is detrimental to the lives of the mothers, children, and affected community. The reasons for the high prevalence include broad economic, social, and religious, as well as more specific individual factors that combine to create a vulnerable environment. But overall, the fundamental issue that can be addressed through development efforts is improving access and quality of effective sex education for adolescents that may not have a means of paying for services. As the national government has proven both unable and unwilling to do so, non-governmental organizations (NGOs) need to assume the responsibility of providing this type of outreach into the community, where it is accepted with local approval and direction. Recipients of this education should also be encouraged to refer or instruct any friends or family that could benefit from resources and information. These efforts will help make progress towards the stated MDGs and promote improved human development in the Nicaraguan community.

Andrés, Carlos. “Re: Interview Questions – FSD.” Email to the author. 14 Aug. 2009.
ºBerglund, Staffan, Jerker Liljestrand, Flor de María Marín, Norma Salgado, and Elmer Zelaya. "The Background of Adolescent Pregnancies in Nicaragua: A Qualitative Approach." Social Science and Medicine 44.1 (1997): 1-12.
ºNote: this article may appear dated, being published in 1997, but I chose to use it because it still is very relevant and illustrative of my experiences this year in 2009.
Castillo, Ericka. "Cuidado Te Deja El Tren! Le Presion Social Para Casarse Y Tener Hijos (Don't Miss the Train: Social Pressure to Marry and Have Children)." La Boletina.6 (2007): 5-11.
Conde-Agudelo, Agustin, Jose M. Belizan, and Cristina Lammers. "Maternal-Perinatal Morbidity and Mortality Associated with Adolescent Pregnancy in Latin America: Cross-Sectional Study." American Journal of Obstetrics and Gyneocology.192 (2005): 342-49.
Economist Intelligence Unit. "Country Profile 2008: Nicaragua". 2008. Overview of Nicaraguan politics, resources, and economy. Economist Intelligence Unit. 8/15/2009.
Gonzalez, Rosa. Personal interview. 8 Aug. 2009.
Hernandez, Milena. Personal interview. 5 Aug. 2009.
Kampwirth, Karen. "Neither Left nor Right: Sandinismo in the Anti-Feminist Era." NACLA Report on the Americas.January/February (2008): 30-43.
Langer, Ana. "El Embarazo No Deseado: Impacto Sobre La Salud Y La Sociedad En America Latina Y El Caribe (Unwanted Pregnancy: Impact on Health and Society in Latin America and the Caribean)." Revista Panamericana de Salud Publica (Panamerican Journal of Public Health) 11.3 (2002): 192-205.
Mannen, Laura. "The Government War on Women's Rights in Nicaragua." Industrial Worker 106.4 (2009): 14.
Meuwissen, Liesbeth E., Anna C. Gorter, Zoyla Segura, Arnold D.M. Kester, and J.A.Knottnerus. "Uncovering and Responding to the Needs for Sexual and Reproductive Health Care among Poor Urban Female Adolescents in Nicaragua." Tropical Medicine and Internatioal Health 11.12 (2006): 1858-67.
República de Nicaragua, Ministerio de Salud (Republic of Nicaragua, Ministry of Health). "Encuesta Nicaragüense de Demografía y Salud (Survey of Nicaraguan Demographics and Health)." Ed. Ministerio de Salud (Ministry of Health): Instituto Nacional de Información de Desarollo (National Institute of Development Information), 2007.
---. Registro de Partos y Nacimientos (Registry of Deliveries and Births). Hospital Dr. Humberto Alvarado. Masaya, Nicaragua, 2009.
United Nations Development Programme (UNDP). "Millennium Development Goals". 2009. Description of United Nations Development Goals. United Nations. 8/16/2009.
--- “Human Development Index.” Human Development Report 2007/2008. United Nations.

*Note: all translations into English from Spanish language sources made by author.

Monday, August 3, 2009

Preparing for departure, final refelections

Hard to believe I worked my last official day at the hospital this past Friday, July 31st. That means I am in my final week here, preparing to head back for the U.S. on August 8th. After almost three months of living here it feels a little bittersweet, people have made me feel like a part of the community here and I have been here long enough that I seem to run into people I know from work or social circles at random places around town. Not knowing if I will ever see some of these people again, it is sad to say goodbye, but I’d like to think that we are at least better off for having known and influenced each other in some regard.
My overall experience working in the labor and delivery department has been very rewarding and insightful. It has been a little tough at times to see some of the young mothers who come in. Sometimes the mother can only guess at her actual age, since birthdates are not always officially recorded, especially in more rural areas. I recently spoke with a girl being admitted to collect a brief history from her, and she told me she was 15 years old, but approximated her birth date as sometime in December of 1996, which would mean she would be turning 13 in December of this year, so I was not quite sure how to document even her approximated age. I then asked to get some signatures from her on some of the hospital admission forms and she told me that she was unable to read the forms or even sign her own name, having never had formal education, she was completely illiterate. I was not quite sure how to react to this, and the nurse I was working with instructed her to just write her name on the paper the best she could looking at a typed example of her own name.
On one level I tell myself not to be surprised or judgmental when encountering people with complete illiteracy. I know that for a majority of the illiterate people here, it is simply a matter of not having had access to that type of education, something which it is easy to take for granted coming from a country where primary education is much more accessible and obligatory. On another level, I tell myself that my being literate and her not, in no way makes me more of a person. It is perfectly possible that in the community she comes from, literacy may not be a necessary tool of daily life, and I am sure that there are necessary skills in her community that I do not posses. But for whatever it is worth, I think literacy, in any language, can be a great tool no matter where you live as an additional means of communication. And in this country, which struggles with such high levels of economic poverty, I would think a community that had access to literacy and education would embrace it, even if only as a means to increase economic prospects in the future. But given the distribution of resources here in Nicaragua, many communities still do not have access to that type of learning, and even if they had the access, the time to dedicate would be another issue. Many of the people in the poorer communities work 6-7 days a week, often 10-12 hours a day, for an equivalent of $60-80 U.S. dollars per month. Here in Masaya, I spoke with a woman who commutes here daily on bus from her home near Managua. She works here in Masaya as an empleada, or house keeper (cooking, cleaning, hand washing laundry, running errands, etcetera) for another family. She has two young children that she brings with her to work, as there is no one at her home that could care for the children for that duration of time. She comes here 6 days a week, arriving at 7am and working until 6-7pm, for $80 per month.
However, something I have had many discussions over with “middle-class” Nicaraguan people, is that even having an education and set of skills here in no way guarantees a life without sufficient economic hardship. Many of the workers in government and public service receive little compared to equivalent positions in other countries. For example, many of the nurses I have worked with at the hospital receive only a U.S. dollar equivalent of $250-400 per month for full-time employment, depending on their specific level of training and responsibilities in the hospital. In Nicaragua, that amount is surely enough to survive off of and keep a roof over your head, but for the nurses with children that they want to send to school, or caring for elder relatives, the salary is often just not enough. This moves many to take on a second job at a separate health clinic or private hospital to provide enough financial support, but at the cost of less physical time present with their families…something which can create other long-term costs.
In addition to the public health workers being underpaid, other service sectors endure similar hardship, such as the police force. Many people here have told me that for an individual police officer to get by financially, because of the low wages, he/she often resorts to relying on bribes or other illicit funds. This obviously weakens meaningful police enforcement and protection from criminals in the community and leads to deeper corruption.
All of this might be excusable by many of the people I have talked with if EVERYONE here was enduring a similar level of financial struggle, but what upsets them most is that the majority of citizens here endure these burdens, such as poor access to education and infrastructure, under funded health services, poor wages for the majority of public service employees, while the TAX FUNDED politically elected officials in the country receive wages, paid in U.S. dollars, far superior. One public health physician told me that a national assembly member here in Nicaragua earns $5,000-6,000 per month…almost double what an entry-level nurse here makes in a year.
But I will leave my political rambling at that for now (I am technically supposed to be apolitical, but being my parent’s son that can be hard to do, ha ha). On a personal level my time here has been very meaningful. The staff in both departments I worked in, emergency and labor and delivery, have told me they really enjoyed having me around and are sad to see me go. They said I was the first “gringo” to come alone, spend time in their respective departments and actually work alongside them as equals and converse and break bread together. Apparently, they often get visitors from the U.S. and other countries, but they often come in small groups, stay a very short time, only observe, and speak little if at all with the actual staff, instead speaking only amongst themselves. While my Spanish still has a way to go, they were impressed with what I have learned and really appreciated my efforts in communicating with them and the patients. And certainly I feel this was probably the most “sustainable” aspect of my time here, being able to build those relationships and trust with some of the people here, in a way that if I am able to come back and work here again, I will already have a meaningful link to the community (although I would say that reorganized med cabinet in the emergency dept is a small improvement over what was there beforehand, and I was also able to provide some additional sphygmomanometers, stethoscopes, and a printer for the emergency department, things which they have always been short handed on or unable to attain).
So I don’t know, it’s hard to describe my time here. This was my first time in a developing country in other than a military capacity…and having to deal with people without using and/or receiving the constant threat of force and physical destruction definitely changes the way you are able to relate to people, there is a stronger sense of genuine cooperation as opposed to coercion. And I definitely like the approach here of working through the local community organizations that are already here to try and improve conditions for the people in one aspect or another, as opposed to what I experienced in years past, which was generally a forceful external implementation of social/political change…and the consequences of that still have not resolved.
Coming here to Nicaragua has also enriched the learning that took place prior to this trip. When our student group was selected back in January/February earlier this year, we met once a week to discuss the history and current situations in Nicaragua, as well as the more broad topic of development work. The classes were very informative and I feel they did a good job of preparing our group of students for coming here. Once I arrived everything we learned and discussed took on a much more personal meaning. Instead of reading words on a page or notes on a lecture slide, I could see and hear the Nicaraguans talking about the conditions and problems here and the direct impact on their lives. I got to work in a local hospital and experience the frustration of trying to care for people without adequate resources, something that the staff here deals with on a day-to-day basis. All of this is so much more powerful than learning in a strictly academic environment; learning through actual service (hence the term “service-learning”) gives you exposure for a genuine visceral reaction that is not easily forgotten. I only hope that I can take this experience from today and use it as a foot forward in serving whatever community I am a part of, whether it is back in the U.S. and/or returning here at some point once I have finished school. A thousand thanks to the Sarlo Foundation, FSD, and USF for making this opportunity possible for me, I would not have been able to come here without the financial support that was provided.
While this is my last narrative post on this blog, I will post more photos of my last week here by sometime next week, so don’t hesitate to check back then. I will also post a copy or link to my research paper stemming from my research here, once it is completed, although that may not be until August 21, when it is due to be submitted. Please don’t hesitate to email or post comments about additional questions you have for me. Thanks to everyone who actually took the time to read this, ‘hope it has been worth the effort in one form or another…

Sunday, August 2, 2009

Final Week

Hello everyone! Sorry i have not posted in over two weeks, things have been very busy here and i have not had much time to update the blog, but i have not forgotten! I hope to have a lengthy, and possible final, post up in the next couple of days. I also bought another disposable camera, and I will post some of those photos from my last couple of weeks here when I can, but that might not happen until Aug 10th or so. Okay, that´s all I have time to write for now, hope all are well...

Tuesday, July 14, 2009

Repliegue Táctico, Labor y Parto

Hello everyone! Lots to write about it seems. The 4th of July came and went in the U.S., and for me the day saw lots of celebration here in Nicaragua, but in the name of a different cause. On that day, a major celebration took place known as the Repliegue Táctico. This is an event which commemorates the anniversary of the guerilla fighters battling Somoza´s National Guard during the revolution in 1979. The Repliegue commemorates a specific instance where the guerilla fighters retreated from the city of Managua to Masaya to reconsolidate before trying to take the city of Managua ( Every year since a walk has been held from Managua to Masaya (approximately 30 kilometers) to commemorate the “tactical retreat”. I attended the event to learn about the historical significance of the Repliegue, and as a cultural learning opportunity. But it was also a much more political laden event than I had anticipated, feeling like a rally for the FSLN and Daniel Ortega supporters.
Nonetheless, it was an exciting day. The event began in the afternoon, as thousands of people crowded the plaza at the Mercado Roberto Huembes in Managua, a market named after another revolutionary fighter. I was there early enough to see everything being set up, as police cleared an area for the stage and soccer games were being played in the parking lot. By 4pm, the plaza was filled with thousands of people, wearing red and black (the colors of the FSLN), waving flags, and celebrating with song and dance. This year, 2009, marked the 30th anniversary of the Repliegue, so things were amplified in scope and degree.
Around 5pm the President of Nicaragua, Daniel Ortega, appeared on the stage, along with his wife, Rosario Murillo, the Nicaraguan ambassador to Perú and old time Sandinista, Tomás Borge, and a few others ( The group I was with was actually pretty close to the stage front, so despite all of the waving flags we were able to see Ortega and the others in detail. Ortega then opened up with a speech as the crowd quieted down. He talked about the significance of the history here, and he also spoke quite a bit about the situation in Honduras, talking about the importance of supporting Zelaya and reinstating a democratically elected president. Although, I couldn´t help thinking of the irony this presented, since Ortega and his party have been accused of blatant election fraud by numerous international sources ( when they came back to power in the last election. Additionally, there was so much rhetoric present, including waving images of Che Guevara and Augusto Sandino, having to do with helping the poor and empowerment of the people, but it just doesn’t fit the reality of his presidency.
That afternoon, before the festivities began, our group had lunch in the market place. It is common, anywhere in Managua or surrounding regions, to be approached for money or food from impoverished men, women and children. As we were finishing our lunch, a young boy, who appeared about 5 or 6 years of age approached and asked quietly for some food. A friend I was with had some remaining beans and rice on her plate and offered it to the boy, who gladly accepted and sat down with us to eat. She asked him his name and age, and everyone in the group was a shocked to hear him say he was 9 years old. We have been realizing that here it can be very difficult to gauge someone´s age. The young people tend to appear much younger than they are, since their bodies often have less than ideal nutritional intake to develop on the same time frame as children in the U.S. or other industrialized nations. Further, the older generation here tends to appear much older than they are, since the hardships, heat, sun and malnutrition exacerbate the impact of aging here. I have talked to 50 year olds who appear 20-30 years older than their stated age. But even considering this, the boy in the market appeared very underdeveloped for a 9 year old. Having to beg for food in the market on a daily basis, it´s easy to understand how that might happen, just hard to palate.
With these kinds of images in my head, from just a few hours earlier, and the political realities of election fraud and corruption, it was a little hard to listen to the “rise poor people of the world” rhetoric stemming from the crowd and stage. But I know this was not a place to speak my mind, I was just there as an observer. I also know that there are other, or former, members of the FSLN party who recognize these contradictions and voice dissenting opinions from Ortega. But at that rally he seemed to still have a pretty strong base of support.
After the speech ended, the crowd of thousands made way, in perfectly chaotic fashion, for the streets leading to the highway towards Masaya. The walk had begun. In addition to the people walking the streets, hundreds of cars, trucks, and buses, packed inside with revelers waving flags and/or speakers blaring nationalist music made their way towards Masaya. There were also lots of motorcycles weaving their way through pedestrians, street stands, and automobiles. The sun had nearly set by this point, since it gets dark here around 6pm, but there was plenty of city and traffic lights all the way back to Masaya. Walking in the cool of the evening was much more preferable to walking that long distance in the heat of the day.
By the time we made it to the highway, the police had closed it to opposing traffic, and there were so many vehicles driving and people walking on the road towards Masaya that the walkers were moving nearly as fast as the vehicles. The walk was memorable, there was so much energy from the masses of people and celebrations, that it felt as though I could have walked forever. It was also a great opportunity to talk to other Nicaraguans. For a good portion of the walk, I traveled alongside a 60 year old man who kept up the pace the whole way. He was a life time resident of Managua and shared with me stories about the revolution, his family, current problems the country faces, etc. Stands along the road side also offered free snacks and coffee to the people walking, which kept us going. A five or six hour walk is a great way to get to know someone!
Along the way, I stopped in the city of Nindirí to watch Ortega pass by. He makes the walk himself every year, although there was debate on whether he would this year since he has developed a heart condition. We finally made it to Masaya around midnight. People gathered in the barrio of Monimbó for a final speech and celebration, and then the tired masses made their way back to their respective homes throughout Nicaragua. It had been quite a day.
Labor y Parto
The following Monday I started my rotation in the labor and delivery portion of the hospital. I was a little nervous going into it, not having any experience in this area, but I told the staff about my reservations and they have been very helpful in explaining everything that goes on and letting me assist in the process as I become comfortable.
It´s a little hard for me to compare my experience in this department to what it might be like in the U.S., since my rotation for maternity nursing is not until this fall semester, but overall it seems like everything gets done that needs to be, i.e., baby comes out of mom, baby stays alive, mom stays alive, everyone goes home (granted a little more complicated than that). Generally, every delivering mother requires the same sort of care, so it feels like we don’t struggle as much for resources as was apparent in the emergency department, where every patient might require different tools and treatment. There have been a few occasions this week that required cesarean deliveries, but these cases are wheeled into the adjoining operating room to be handled by surgical staff and equipment.
The biggest shock for me in working here, as I related to in a previous post, has just been the ages of the mothers. First time mothers seems to range from 13 – 19 pretty commonly, a 19 year old I saw last Thursday was on her third child! But young motherhood tends to be pretty normal here, and in developing nations in general, and there are pros and cons to be mentioned in both respects. Right now I am trying to collect further research data from the patients and staff here to explore the issue on a local level. I may post a little about this in the future as I learn more and just post my final paper here, once it is completed, for anyone that has interest in reading it.
Also, I would be remiss if I didn´t mention how amazing it is to watch a birth. Outside of the blood and drama, it´s amazing to see a new born child as they take their first breath. One side of me feels a lot of hope for the potential that this one new person can assume, and another part of me feels fearful, knowing the struggles they may have to endure, especially here in Nicaragua. But at some point all you can do is hope and pray…

Alright, that looks about all I have time to write about today. I´ll try and buy another disposable camera soon so I can post some more pictures in the next couple of weeks. Take care all...

Friday, July 3, 2009

Photo 19

Okay, here´s the last photo I am going to be able to publish for at least the next week or two, since I am out of film. But this is the Mirador de Tisey. From Estanzuela we walked about 12km up the mountain where there is a great viewppoint that overlooks the valley in all directions. Unfortunately, I could only fit a narrow point of that view in this photo, but it gives you some idea of the natural beauty here.