Here's a link to an article that was published about my experience with this program recently:
http://www.catholic-sf.org/news_select.php?newsid=&id=56393
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.
Sunday, October 4, 2009
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 (jlreed@usfca.edu)
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:
http://www.usfca.edu/artsci/fac_staff/R/reed_julie.html
Julie Reed (jlreed@usfca.edu)
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:
http://www.usfca.edu/artsci/fac_staff/R/reed_julie.html
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
Nicaragua
Richard Hackett
LAS 312 – Sarlo Scholars
Professor Friedman
August 28, 2009
Introduction
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.
Conclusion
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.
*Bibliography
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.
Adolescent Pregnancy and Sustainable Development in
Nicaragua
Richard Hackett
LAS 312 – Sarlo Scholars
Professor Friedman
August 28, 2009
Introduction
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.
Conclusion
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.
*Bibliography
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…
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 (http://www.lavozdelsandinismo.com/nicaragua/2007-06-30/por-que-y-como-fue-el-repliegue-a-masaya/). 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 (http://www.presidencia.gob.ni/index.php?option=com_content&view=article&id=220:marcha-conmemorando-el-30-aniversario-del-repliegue&catid=63:julio-2009&Itemid=54). 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 (http://www.economist.com/displayStory.cfm?story_id=12607338) 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...
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 (http://www.presidencia.gob.ni/index.php?option=com_content&view=article&id=220:marcha-conmemorando-el-30-aniversario-del-repliegue&catid=63:julio-2009&Itemid=54). 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 (http://www.economist.com/displayStory.cfm?story_id=12607338) 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.
Photo 18
A small crop field, not sure what is being cultivated here, but in this region crops like coffee, tobacco, and potatos are grown.
Photo 17
A local caballero gearing up on a Saturday morning to move a small cattle herd from one pasture to another.
Photo 16
"El salto de Estanzuela!" The town generates a little income by charging tourists 15 cordobas (75 cents) to pass along the trail that leads to this waterfall. The pool is deep enough to swim in, and there are also several smaller waterfalls upstream.
Photo 15
The next several photos are from a trip that a few class mates and I took a couple of weeks ago up to the northern part of Nicaragua, outside of a city called Estelí. From there we departed for the small town of Estanzuela, which is famous for a beautiful water fall that I´ll show in another photo.
The northern part of the country is a little different from the south. There´s alot more ranching activity, the terrain is more mountainous and people have told me the culture is a little more "cowboyish." Sounds like my kind of place.
One thing that people in Nicaragua are trying to do more and more, is develop "ecotourism." Nicaragua has lots of natural beauty, more so than some of the other Central American countries, but Nicaragua receives less tourism related to its natural attributes because the country is still struggling to protect these natural resources from environmental degradation, or it does not have the infrastructure to support any significant amount of tourism to many of these locales. This is significant because in a country where many people struggle to make ends meet due to the poor economy, some development in this area could help to bring in more revenue.
Photo 14
This is the road to my house that I walk to and from the hospital most days. In heavy rain, which occurs frequently, these roads become small rivers, and some of the ponds that form contribute to the mosquito population I´m sure. When the road drys out with all of the heat alot of dust is created from passing cars or wind, which I am sure has a long term impact on the respiratory health of the kids growing up here.
Photo 13
This is a mural depicting the volcanic valley and the people living here. The picture was taken in the visitor center of the volcanic park.
Photo 12
Here I am walking the rim of one of the extinct craters. The crater to my right is very deep, with a lush green forest in the bottom. The smoking crater from the previous pictures is to my left. I asked Ramón if anyone had ever been down to the bottom of the forested crater and he told me only once, that he knew of. A while back a distraught man decided to commit suicide by hurling himself into one of the craters, but no one knew which crater, so a rescue worker had been lowered down there to search for him. Can´t remember if the man was found or not.
Photo 11
This is Ramón, whom I also discussed in a previous post. He is the one who recalled the stories of people living in the volcanic caves during the war to escape the violence.
Photo 10
This was on the approach up the rim of Volcan Masaya. The cloud like formation isactually sulfuric smoke coming up out of the crater. You can also see the cross of Bobadilla that I mentioned in a previous post.
Photo 8
Here´s a photo of Dr. Cordonero and I during some down time in the emergency department. He is probably one of my favorite doctors at the hospital thus far, very bright and good with patient care. He actually went to medical school in Cuba on a scholarship, but grew up here and returned to practice here. He is someone who has taught me alot about the Nicaraguan healthcare system and the problems it faces with funding contraints and more.
Photo 7
Here´s a picture of the front of the hospital I have been working in. If the building looks a little aged, it is. But it still stands. The ambulances that we have have mostly been donated by other organizations...otherwise emergency cases would likely be brought here in the bed of a pick-up truck.
Thursday, July 2, 2009
¡Vive San Pedro!, The Heart of America, med cabinets, labor y parto, Honduras, death of a boxing champ
A story before I begin, or am I just beginning with a story? ...
Monday night I attended a patron saint festival in the small town of Diriá. The festival honors San Pedro, the dedicated saint of the town, with a celebration that lasts several days. June 29th, on whatever day that happens to be, is the final culmination of the festivities. The festival itself was interesting and lots of fun. A replica of the saint was paraded through town with music and revelry. There was also an hour were all of the people circled together for a rosary and to speak about how San Pedro is the heart of the people there, although challenges remain that the community still faces, such as poverty, domestic violence, etcetera. But through prayer and community they hope to see positive changes in these areas.
One of the funny moments of the night though came when I had first arrived in the town. I was walking through the central park, with another student and a local friend, when a middle aged man came up to us with a question. He was obviously drunk, stumbling with his speech and steps, but we cautiously let him approach to hear what he had to say.
"¿De donde son amigos, alemán o gringo?" He asked the other student and I if we were from Germany or the US, alot of the fair skinned travelers here tend to be Germans for some reason. So we told him we were from the US, eyeing him for a reaction since some people here don´t like US travelers due to the history of US government and business exploitation in Central America. But our response didn´t phase him.
"Ahhh, amigos! Tengo una pregunta para ustedes...¿dónde está el corazón de América?"
Where is the heart of America? I thought...what is he asking exactly? Is he asking what the capitol city of the US is? I wasn´t sure what he meant and no one else in my group was forthcoming with a response, so I doubtfully replied "Washington D.C.?"
He looked at me funny, and then repeated the question several times, a little slower with more emphasis each repitition. I, not having any other idea to what he was asking, gave the same response, repeating it slower and with more emphasis each time.
Finally he shouted, "¡Nicaragua, Nicaragua es el corazón de América!" This did not make sense to me, was he saying Nicaraguan culture, or the Spanish language are so engrained in the US that it has become the heart of "America?" I decided that must be the case, and it didn´t matter much at that point as my company was urging me to move on rather than philophosize with an inebriated stranger in a park, something I am often a sucker for.
But I was still scrathing my head, so I asked the local who we were with what he meant. She smiled and told me that in schools in Latin America, America represents all of the americas, north, central and south. I had heard this before (thanks Silvana!) but it had never officially clicked I guess. Thus, being in the center of Central America, you can call Nicaragua "the heart of America." So I guess we are all americans afterall? I don´t think that has been written into immigration policy though, not by any country. And I haven´t heard if Lee Greenwood´s "I´m Proud to be an American" song has been translated into Spanish or any of the countless indigenous languages between Fairbanks and Patagonia...I´m still laughing at myself over that one.
Is this July already? My time here is starting to pass quickly in contrast with the first week here that seemed like a much longer period of time. I´m finally becoming accustomed to my stay here, learning how to get places independently and able to get along easier with the language, which is still far from fluent, but more functional than when I arrived. I´m also developing friendships with the people I work with or see regularly in the hospital and neighbors, which is something that a shorter stay here would not cater to. So while it is difficult being away from home for so long (I won´t be back until Aug 8th), I´m finally starting to see the benefits of being here for a longer period and feel more like a part of the community here as opposed to just someone passing through...which is essential when you want to serve the community you are in.
Monday morning I arrived at the hospital and was pleasently surprised to see a new medcabinet in the emergency room...it has separate droors for medications with alphabatized labels and everything! It´s nothing brand new, but gets the job done much better than what we had before. I had a picture of the old med cabinet to share but the film for that photo did not pan out.
This will be my last week in the emergency room though, as the next two weeks I will be moving on to the labor and delivery department, which I am kind of dreading but feel like it will be an important experience to have, especially to see how things are handled here. I think it will just be hard to see alot of the very young mothers giving birth. It is relatively common for women to give birth at very young ages, 14, 15 or 16. And often times their bodies aren´t developed enough to handle birthing well, which can create complications. It is unfortunately almost equally common for these young mothers to end up as single mothers with little means to further themselves, and children to raise, which creates a cycle of poverty. But we´ll see how things go next week, I am sure there will be more to talk about then.
Other news and gossip here...the coup in Honduras, a neighboring country, is making alot of headlines here. Some people are worried that if Honduras destabilizes it could spill over into Nicaragua. But presently it seems like there is lots of international involvement and pressure for things to resolve peacefully, although there is alot of conflicting opinion here on the ousted president Zelaya and whether he deserves to be reinstated.
Alexis Argüello, the mayor of Managua and a former boxing champ (http://www.bbc.co.uk/mundo/america_latina/2009/07/090701_1717_nicaragua_arguello_muerte_jrg.shtml), was also found dead yesterday (possible suicide), so the government has officially declared three days of mourning.
Okay, that´s all I have time to write, not sure if I´ll still be able to get these photos loaded, but if not tonight then I´ll try again tomorrow. Hope all is well for anyone reading this.
Monday night I attended a patron saint festival in the small town of Diriá. The festival honors San Pedro, the dedicated saint of the town, with a celebration that lasts several days. June 29th, on whatever day that happens to be, is the final culmination of the festivities. The festival itself was interesting and lots of fun. A replica of the saint was paraded through town with music and revelry. There was also an hour were all of the people circled together for a rosary and to speak about how San Pedro is the heart of the people there, although challenges remain that the community still faces, such as poverty, domestic violence, etcetera. But through prayer and community they hope to see positive changes in these areas.
One of the funny moments of the night though came when I had first arrived in the town. I was walking through the central park, with another student and a local friend, when a middle aged man came up to us with a question. He was obviously drunk, stumbling with his speech and steps, but we cautiously let him approach to hear what he had to say.
"¿De donde son amigos, alemán o gringo?" He asked the other student and I if we were from Germany or the US, alot of the fair skinned travelers here tend to be Germans for some reason. So we told him we were from the US, eyeing him for a reaction since some people here don´t like US travelers due to the history of US government and business exploitation in Central America. But our response didn´t phase him.
"Ahhh, amigos! Tengo una pregunta para ustedes...¿dónde está el corazón de América?"
Where is the heart of America? I thought...what is he asking exactly? Is he asking what the capitol city of the US is? I wasn´t sure what he meant and no one else in my group was forthcoming with a response, so I doubtfully replied "Washington D.C.?"
He looked at me funny, and then repeated the question several times, a little slower with more emphasis each repitition. I, not having any other idea to what he was asking, gave the same response, repeating it slower and with more emphasis each time.
Finally he shouted, "¡Nicaragua, Nicaragua es el corazón de América!" This did not make sense to me, was he saying Nicaraguan culture, or the Spanish language are so engrained in the US that it has become the heart of "America?" I decided that must be the case, and it didn´t matter much at that point as my company was urging me to move on rather than philophosize with an inebriated stranger in a park, something I am often a sucker for.
But I was still scrathing my head, so I asked the local who we were with what he meant. She smiled and told me that in schools in Latin America, America represents all of the americas, north, central and south. I had heard this before (thanks Silvana!) but it had never officially clicked I guess. Thus, being in the center of Central America, you can call Nicaragua "the heart of America." So I guess we are all americans afterall? I don´t think that has been written into immigration policy though, not by any country. And I haven´t heard if Lee Greenwood´s "I´m Proud to be an American" song has been translated into Spanish or any of the countless indigenous languages between Fairbanks and Patagonia...I´m still laughing at myself over that one.
Is this July already? My time here is starting to pass quickly in contrast with the first week here that seemed like a much longer period of time. I´m finally becoming accustomed to my stay here, learning how to get places independently and able to get along easier with the language, which is still far from fluent, but more functional than when I arrived. I´m also developing friendships with the people I work with or see regularly in the hospital and neighbors, which is something that a shorter stay here would not cater to. So while it is difficult being away from home for so long (I won´t be back until Aug 8th), I´m finally starting to see the benefits of being here for a longer period and feel more like a part of the community here as opposed to just someone passing through...which is essential when you want to serve the community you are in.
Monday morning I arrived at the hospital and was pleasently surprised to see a new medcabinet in the emergency room...it has separate droors for medications with alphabatized labels and everything! It´s nothing brand new, but gets the job done much better than what we had before. I had a picture of the old med cabinet to share but the film for that photo did not pan out.
This will be my last week in the emergency room though, as the next two weeks I will be moving on to the labor and delivery department, which I am kind of dreading but feel like it will be an important experience to have, especially to see how things are handled here. I think it will just be hard to see alot of the very young mothers giving birth. It is relatively common for women to give birth at very young ages, 14, 15 or 16. And often times their bodies aren´t developed enough to handle birthing well, which can create complications. It is unfortunately almost equally common for these young mothers to end up as single mothers with little means to further themselves, and children to raise, which creates a cycle of poverty. But we´ll see how things go next week, I am sure there will be more to talk about then.
Other news and gossip here...the coup in Honduras, a neighboring country, is making alot of headlines here. Some people are worried that if Honduras destabilizes it could spill over into Nicaragua. But presently it seems like there is lots of international involvement and pressure for things to resolve peacefully, although there is alot of conflicting opinion here on the ousted president Zelaya and whether he deserves to be reinstated.
Alexis Argüello, the mayor of Managua and a former boxing champ (http://www.bbc.co.uk/mundo/america_latina/2009/07/090701_1717_nicaragua_arguello_muerte_jrg.shtml), was also found dead yesterday (possible suicide), so the government has officially declared three days of mourning.
Okay, that´s all I have time to write, not sure if I´ll still be able to get these photos loaded, but if not tonight then I´ll try again tomorrow. Hope all is well for anyone reading this.
Tuesday, June 23, 2009
Esophageal varices
I know I posted an entry just the other day but after what happened today I felt like writing about it. It´s definitely healthcare related in nature, so sorry for any jargon that dosn´t make sense...and if the thought of blood makes you nauseated you might just want to disregard this post.
A 45 year old man came into the emergency department this morning with an altered level of consciousness. The Masaya bomberos (firefighters) had brought him in after someone had reported seeing the man sitting in his car and having cognitive trouble. When he got to the hospital we took his vitals, which showed a blood glucose of 421 (we had glucose sticks today!), a low blood pressure and a rapid pulse. The man could state his name but was mostly incoherent and unable to open his eyes fully.
We gathered what medical history we could from him given his state and not having any family or close friends present. He said he was diabetic (and the multiple large ulcers on both feet were probably a result of this) and had a history of alcohol use. The docs did a rectal exam which showed a back up of black tarry stool, meaning he probably had an internal bleed somewhere. IV fluids were started and then one of the doctors inserted a nasogastric tube, a large bore tube inserted through the nose into the stomach. We also had no lubrication available today so the tube was inserted using water as a lubricant, instead of something to make the passage a little easier.
The tube went into the stomach okay, but the next minute we were draining over 1000cc of blood from the tube. What probably happened is the man had esophageal varices (http://www.mayoclinic.com/health/esophageal-varices/DS00820) which ruptured when the NG tube was placed. This is something you would normally screen for by asking the patient (this person was not cognizant enough to understand the question), or performing an endoscopy or CT scan to check for varices (resources we do not have), since a rupture can be life threatening. But now the damage was done, all we could do was try to drain the rapidly accumulating amount of blood from his esophagus and replace fluid IV at the same time.
Due to the amount of blood being lost a blood tranfusion was started and another doctor was notified to insert a ballon tamponade. Essentially this is just a smaller tube which is again inserted into the esophagus (after the NG tube is removed). There is a long balloon that can be inflated once the tube is inserted that puts pressure against the esophageal wall in an attempt to stop the bleeding. The tube was inserted, but by this point the man was in unimaginable distress, coughing up blood and bits of tissue that I can only imagine were parts of tissue from the varices. Aye...que puede hacer?
During this time I got called away to help deal with other people coming into the hospital, like a young kid who had accidentally cut one of his wrists open with a machete. But when I returned to see how the man was doing he was surprisngly still alive, with IV lines wide open. But somehow it seemed like the bleeding had either stopped or slowed down significantly. The baloon tamponade had been removed and he was no longer coughing up blood, he was just curled up in a fetal position as his mother, who had shown up at some point, made sure he did not inadvertenly fall off the narrow bed without side rails as he tossed around in agony.
Before I left that day he had been transfered to a med-surg unit since he was going to need longer care then what we provide in the emergency department, but I hope he makes it through the day.
That is all, just felt like I had to vent that in some way...
A 45 year old man came into the emergency department this morning with an altered level of consciousness. The Masaya bomberos (firefighters) had brought him in after someone had reported seeing the man sitting in his car and having cognitive trouble. When he got to the hospital we took his vitals, which showed a blood glucose of 421 (we had glucose sticks today!), a low blood pressure and a rapid pulse. The man could state his name but was mostly incoherent and unable to open his eyes fully.
We gathered what medical history we could from him given his state and not having any family or close friends present. He said he was diabetic (and the multiple large ulcers on both feet were probably a result of this) and had a history of alcohol use. The docs did a rectal exam which showed a back up of black tarry stool, meaning he probably had an internal bleed somewhere. IV fluids were started and then one of the doctors inserted a nasogastric tube, a large bore tube inserted through the nose into the stomach. We also had no lubrication available today so the tube was inserted using water as a lubricant, instead of something to make the passage a little easier.
The tube went into the stomach okay, but the next minute we were draining over 1000cc of blood from the tube. What probably happened is the man had esophageal varices (http://www.mayoclinic.com/health/esophageal-varices/DS00820) which ruptured when the NG tube was placed. This is something you would normally screen for by asking the patient (this person was not cognizant enough to understand the question), or performing an endoscopy or CT scan to check for varices (resources we do not have), since a rupture can be life threatening. But now the damage was done, all we could do was try to drain the rapidly accumulating amount of blood from his esophagus and replace fluid IV at the same time.
Due to the amount of blood being lost a blood tranfusion was started and another doctor was notified to insert a ballon tamponade. Essentially this is just a smaller tube which is again inserted into the esophagus (after the NG tube is removed). There is a long balloon that can be inflated once the tube is inserted that puts pressure against the esophageal wall in an attempt to stop the bleeding. The tube was inserted, but by this point the man was in unimaginable distress, coughing up blood and bits of tissue that I can only imagine were parts of tissue from the varices. Aye...que puede hacer?
During this time I got called away to help deal with other people coming into the hospital, like a young kid who had accidentally cut one of his wrists open with a machete. But when I returned to see how the man was doing he was surprisngly still alive, with IV lines wide open. But somehow it seemed like the bleeding had either stopped or slowed down significantly. The baloon tamponade had been removed and he was no longer coughing up blood, he was just curled up in a fetal position as his mother, who had shown up at some point, made sure he did not inadvertenly fall off the narrow bed without side rails as he tossed around in agony.
Before I left that day he had been transfered to a med-surg unit since he was going to need longer care then what we provide in the emergency department, but I hope he makes it through the day.
That is all, just felt like I had to vent that in some way...
Monday, June 22, 2009
Volcán de Masaya, proyecto
Hello everyone! Sorry it´s been a while since my last post but here it is. There will also be lots of photos to share from the past couple of weeks, but I am going to have to make a trip to Managua to get the film developed, so I hope to have some photos posted sometime next week at the latest. In the meantime I´ll just update you all on happenings here.
Walk up a Volcano
On Sunday, June 14th, another student and I went for a local hike up a nearby active volcano (I realize this sounds like a counter intuitive thing to do). The hike was very beautiful though, and the volcano is the centerpiece of a protected park, with a nice visitor center and park staff that maintain the area. We walked from the entrance to the park, right off of the Managua highway, up a long gravel road with lots of thick, green vegetation on either side to the top of the volcano. It is possible to just drive that distance or take a taxi...but walking up the volcano just made the journey seem more genuine.
As we approached the top, which took a decent amount of time and water, we could see the thick smoke rising from the crater...in addition to the giant cross that was erected at the side of the crater a couple of hundred years ago by a Spaniard who was convinced the mouth of the volcano was an entry to Hell, and given the series of eruptions the volcano has produced in its lifetime its understandable why.
Once we reached the top, we were able to peek down into the crater to see the source of all of the smoke. We could see farther down then I had imagined, hundreds of feet down a crater that was also probably several hundred feet wide (Ill try to post a picture next week). The smoke was especially thick that day because of recent rain, and the park employees adivsed not to linger too long at the top of the crater since the sulfuric smoke was not good to breathe in for much duration.
We left the rim of the active crater to hike a little bit further up the mountain to see some of the extinct craters. One of these had a thick forest growing in the bottom of it, also hundreds of feet down with steep walls on all sides, you would need lots of rope to rappel down and make it out again. But it was an interesting site to see.
With the incredible views of the extinct volcanic crater to one side, and active volcano on another, and a mountain top view of the valley below, we sat down for a rest to admire the view. There was also a park employee up there who monitors the trails, and we struck up a conversation. He told us quite a bit about the park and was curious who we were and what we thought of Nicaragua.
In his decription of the park we were in, he told us there were a series of caves on the southside of the craters that had been formed by past lava flows. He told us how during the revolution and contra war a lot of people had fled from Masaya (about 10 km east)and some surrounding small towns to live in the caves and hopefully escape some of the violence, or even to prevent their young sons from being consripted and sent to war.
Project update
I talked with my hospital supervisor (the emergency dept. nurse manager) last week about project ideas, and the idea of a peer health group for the hospital. However, her feedback (along with some of the other employees and doctors) is that they would like to focus on improving their staff education capacity. Currently, the department holds a staff training class at least once a week, but without a board, printer to make handouts, and absence of other classroom type materials, the classes are really not as effective as they should be. So right now I´m working with her to see what we can do about improving the staff training sessions.
However, after today I think I´m also ready to propose reorganizing the medicine cabinet in the emergency room. There is just one big drawer with a flip top lid where all of the medicines are kept. There has been an attempt to make labels to keep certain medicines in distinct locations...but everything becomes jumbled together pretty easily, making it hard to find what you need when you need it, and I am sure also increasing the likelihood of a medicine administration error. There was a man who came in today having severe chest pain, and while I could find most the medicines the doctor ordered without too much problem...it took a considerable amount of time to find the one ampule of morphine that was left. Another nurse had just figured we were out (its pretty common that our pharmacy just dosn´t have basic drugs on a given day), but I did find one ampule of morphine after looking everywhere it shouldn´t be. But we´ll see what the management thinks about med cabinet reorganizing.
I did feel very bad for the man having the chest pain and his wife who had brought him in. The doctors wanted to have a cradiac enzyme test performed to confirm that his pain was cardiac related...but our lab here lacked what was needed to perform the test today, and we could only refer them to a private hospital for the blood test, which would cost the family quite a bit out of pocket. The capabilities of our lab vary day by day depending on what supplies they have available. Sometimes we don´t even have what is necessary to check someone´s blood sugar. But we do what we can with what we have when we have it, but until the Nicaraguan government pours more money into their healthcare system resources will remain hard to come by.
Walk up a Volcano
On Sunday, June 14th, another student and I went for a local hike up a nearby active volcano (I realize this sounds like a counter intuitive thing to do). The hike was very beautiful though, and the volcano is the centerpiece of a protected park, with a nice visitor center and park staff that maintain the area. We walked from the entrance to the park, right off of the Managua highway, up a long gravel road with lots of thick, green vegetation on either side to the top of the volcano. It is possible to just drive that distance or take a taxi...but walking up the volcano just made the journey seem more genuine.
As we approached the top, which took a decent amount of time and water, we could see the thick smoke rising from the crater...in addition to the giant cross that was erected at the side of the crater a couple of hundred years ago by a Spaniard who was convinced the mouth of the volcano was an entry to Hell, and given the series of eruptions the volcano has produced in its lifetime its understandable why.
Once we reached the top, we were able to peek down into the crater to see the source of all of the smoke. We could see farther down then I had imagined, hundreds of feet down a crater that was also probably several hundred feet wide (Ill try to post a picture next week). The smoke was especially thick that day because of recent rain, and the park employees adivsed not to linger too long at the top of the crater since the sulfuric smoke was not good to breathe in for much duration.
We left the rim of the active crater to hike a little bit further up the mountain to see some of the extinct craters. One of these had a thick forest growing in the bottom of it, also hundreds of feet down with steep walls on all sides, you would need lots of rope to rappel down and make it out again. But it was an interesting site to see.
With the incredible views of the extinct volcanic crater to one side, and active volcano on another, and a mountain top view of the valley below, we sat down for a rest to admire the view. There was also a park employee up there who monitors the trails, and we struck up a conversation. He told us quite a bit about the park and was curious who we were and what we thought of Nicaragua.
In his decription of the park we were in, he told us there were a series of caves on the southside of the craters that had been formed by past lava flows. He told us how during the revolution and contra war a lot of people had fled from Masaya (about 10 km east)and some surrounding small towns to live in the caves and hopefully escape some of the violence, or even to prevent their young sons from being consripted and sent to war.
Project update
I talked with my hospital supervisor (the emergency dept. nurse manager) last week about project ideas, and the idea of a peer health group for the hospital. However, her feedback (along with some of the other employees and doctors) is that they would like to focus on improving their staff education capacity. Currently, the department holds a staff training class at least once a week, but without a board, printer to make handouts, and absence of other classroom type materials, the classes are really not as effective as they should be. So right now I´m working with her to see what we can do about improving the staff training sessions.
However, after today I think I´m also ready to propose reorganizing the medicine cabinet in the emergency room. There is just one big drawer with a flip top lid where all of the medicines are kept. There has been an attempt to make labels to keep certain medicines in distinct locations...but everything becomes jumbled together pretty easily, making it hard to find what you need when you need it, and I am sure also increasing the likelihood of a medicine administration error. There was a man who came in today having severe chest pain, and while I could find most the medicines the doctor ordered without too much problem...it took a considerable amount of time to find the one ampule of morphine that was left. Another nurse had just figured we were out (its pretty common that our pharmacy just dosn´t have basic drugs on a given day), but I did find one ampule of morphine after looking everywhere it shouldn´t be. But we´ll see what the management thinks about med cabinet reorganizing.
I did feel very bad for the man having the chest pain and his wife who had brought him in. The doctors wanted to have a cradiac enzyme test performed to confirm that his pain was cardiac related...but our lab here lacked what was needed to perform the test today, and we could only refer them to a private hospital for the blood test, which would cost the family quite a bit out of pocket. The capabilities of our lab vary day by day depending on what supplies they have available. Sometimes we don´t even have what is necessary to check someone´s blood sugar. But we do what we can with what we have when we have it, but until the Nicaraguan government pours more money into their healthcare system resources will remain hard to come by.
Saturday, June 13, 2009
Photo 6
This is just a random street intersection in Masaya, that´s me and another student on the right crossing the road. I just liked the colors and artwork on the building. Even though there´s plenty of poverty here, many of the homes and buildings express a lot of color and vibrancy.
And this is my last post for this week, so I hope you enjoyed the photos...might have more in another week or two.
Photo 5
This is just a snap shot of part of the photo exhibit that was on the palace grounds. If you click on the image you can read some of the text in the photo. The main line translates into "...it is preferible to make me die as a rebel and to not live as a slave."
Photo 4
That is me standing infront of a giant silhoutte of Augusto Sandino, an image which has been erected on that hill where Somoza´s palace once stood. The image was designed by Ernesto Cardenal, who is a famous Nicaraguan priest, poet, activist and writer. Look him up if you want to read about an interesting character.
Photo 3
Here´s a photo of that wall in the park I described in my first post. The barrels sticking out of the cement are rifles, mostly AK-47s, that were used during the most recent civil war. The wall, and park that is is located in, were built as a symbol of rememberance for those who were killed and hope for a more peaceful future. Unfortunately, the park grounds are no longer maintained by the city government and the site has fallen into disarray...hopefully not a sign of things to be repeated.
Photo 2
Here is part of that hill top view from the former Somoza palace grounds in Managua. The body of water is the Lago de Managua. I´m posting these photos in separate posts cause that seems to be the only way they will load at all.
Photo 1
Here´s a picture of the country flag, in case any of you geo-challenge game nerds out there always miss that one, flying in a plaza in Managua. Now let me see if I can get more to load...
Friday, June 12, 2009
Una familia de músicos, desarollo sostenible y caballos de Granada
¡Buenas! I just returned from Managua. All of the students in our group met there today for a workshop on grant writing, which looks like pretty tidious work. But the venue was interesting, our class was held in a small private room at La casa de los Mejia Godoy, a full time restaurant and local music venue.
The Mejia Godoy is a famous nicaraguan family of musicians (http://www.mejiagodoy.org/). Their reputation began with two brothers, Carlos and Luis Enrique, who made a career of performing traditional nicarguan music, in addition to writing and performing countless songs of political protest during the Somoza regime...and people have told me they lived and acted on what they sang. They also continue to be politically active, criticizing the current president, Daniel Ortega, for succumbing to the common mold of politicians by speaking in one regard and legislating in quite another. Many people here regard the music of Carlos and Luis Enrique as central to modern nicaraguan history and culture. So it was neat to see the restaurant and performance stage, decorated with musical paraphernalia and photos of various sorts.
The grant workshop we had there was very detailed oriented. As a focus of our time here with FSD, each intern is expected to at least attempt implementing a program or activity, in cooperation with our host organization, which will help improve the effectiveness and/or efficiency of that organization´s services to the local served community. Sounds easy, maybe? There´s certainly a long list of basic material goods that the hospital here could use on a daily basis, but the catch to our project is that is has to be "sustainable."
What exactly does that mean? Well, it can certainly have different definitions depending on the application. With our specific case, it means we have to develop a project that the organization has agreed that it needs and will use. The project must have a potential for lasting impact that continues in our absence and wont deflate once there is no external funding to support it.
This means we have to utilize what few resources there are here, and we must involve the community´s interest and values so that they are equally involved in the proposal, planning, and creation...and then fully capable to carry on the project into the future once the interns leave. For the instances where there is some additional funding needed to get the project up and running, FSD offers a grant program that we can apply for. However, the application is no easy task and requires that the plans for our project are written out in fine detail and have demonstrated adequate community involvement and investment.
With all of that said, you can understand the difficulty of coming up with ideas for a project in an underfunded nicaraguan public hospital. Nothin´worth doin´is easy, right? That´s what I try and tell myself at least, otherwise it´s easy to just become overwhelmed and walk away. One idea I am looking at is to try and start a peer health education program here, which is something that the hospital has expressed interest in and could possibly conform to this sutainability model. I need to wait until next week to start looking at more specific details, and if it´s not doable, then back to the drawing board. On top of trying to figure this material out, I came down with a cold over the weekend that I spent Monday and Tuesday at home trying to recover from. Then Wednesday and Thursday were pretty hectic in the emergency department...but here it is Friday and I´m still kickin´.
The past weekend was eventful at least. Our student group went to the city of Granada, which is about a 20-30 minute bus ride east of Masaya, right on the edge of the Lago de Nicaragua. We arrived in Granada late Saturday afternoon, which gave us some daylight to walk around the city. It is a very beutiful place, with lots of the colonial style architecture and buildings still maintained. There is a large central plaza and numerous cathedrals, museums, coffee shops and handicraft stores to peek in. However, in contrast to the other cities I have been to in Nicaragua, the atmosphere is quite different. There is lots of tourist activity and foreign or expatriate run stores and restaurants. Even a lot of the menus for places were in English and the prices of food and things is much more comparable to prices back in the United States, albeit less expensive. All of that just made it seem much less representative of the impoverished conditions you see elsewhere in the country.
The main reason I had gone to Granada though was to see the hípica of Granada, which is essentailly an annual celebration where the town closes down the main plaza and roads to car traffic for a horse parade. There is also lots of music and other activites going on as the mounted horses parade through town. It was led by a young boy mounted on a bull the size of a small bus (an adult man did have the reins of the bull as he walked along side the bull). The bull´s horns were painted in bright striped colors and there were lots of impressive horses on parade. It´s also the first time since being here that I have seen large livestock that looked sufficiently fed, without ribs or pelvic bones showing grossly on the skins surface.
That about sums things up from my end. I do have photos from my first week here which I am trying to download onto this blog page, but with these slow connections I am not sure if it is going to work since an earlier attempt failed. But Ill try again tomorrow is I can´t make it work tonight, otherwise you´ll have to settle once again for text only.
Good night all...peace be with you.
The Mejia Godoy is a famous nicaraguan family of musicians (http://www.mejiagodoy.org/). Their reputation began with two brothers, Carlos and Luis Enrique, who made a career of performing traditional nicarguan music, in addition to writing and performing countless songs of political protest during the Somoza regime...and people have told me they lived and acted on what they sang. They also continue to be politically active, criticizing the current president, Daniel Ortega, for succumbing to the common mold of politicians by speaking in one regard and legislating in quite another. Many people here regard the music of Carlos and Luis Enrique as central to modern nicaraguan history and culture. So it was neat to see the restaurant and performance stage, decorated with musical paraphernalia and photos of various sorts.
The grant workshop we had there was very detailed oriented. As a focus of our time here with FSD, each intern is expected to at least attempt implementing a program or activity, in cooperation with our host organization, which will help improve the effectiveness and/or efficiency of that organization´s services to the local served community. Sounds easy, maybe? There´s certainly a long list of basic material goods that the hospital here could use on a daily basis, but the catch to our project is that is has to be "sustainable."
What exactly does that mean? Well, it can certainly have different definitions depending on the application. With our specific case, it means we have to develop a project that the organization has agreed that it needs and will use. The project must have a potential for lasting impact that continues in our absence and wont deflate once there is no external funding to support it.
This means we have to utilize what few resources there are here, and we must involve the community´s interest and values so that they are equally involved in the proposal, planning, and creation...and then fully capable to carry on the project into the future once the interns leave. For the instances where there is some additional funding needed to get the project up and running, FSD offers a grant program that we can apply for. However, the application is no easy task and requires that the plans for our project are written out in fine detail and have demonstrated adequate community involvement and investment.
With all of that said, you can understand the difficulty of coming up with ideas for a project in an underfunded nicaraguan public hospital. Nothin´worth doin´is easy, right? That´s what I try and tell myself at least, otherwise it´s easy to just become overwhelmed and walk away. One idea I am looking at is to try and start a peer health education program here, which is something that the hospital has expressed interest in and could possibly conform to this sutainability model. I need to wait until next week to start looking at more specific details, and if it´s not doable, then back to the drawing board. On top of trying to figure this material out, I came down with a cold over the weekend that I spent Monday and Tuesday at home trying to recover from. Then Wednesday and Thursday were pretty hectic in the emergency department...but here it is Friday and I´m still kickin´.
The past weekend was eventful at least. Our student group went to the city of Granada, which is about a 20-30 minute bus ride east of Masaya, right on the edge of the Lago de Nicaragua. We arrived in Granada late Saturday afternoon, which gave us some daylight to walk around the city. It is a very beutiful place, with lots of the colonial style architecture and buildings still maintained. There is a large central plaza and numerous cathedrals, museums, coffee shops and handicraft stores to peek in. However, in contrast to the other cities I have been to in Nicaragua, the atmosphere is quite different. There is lots of tourist activity and foreign or expatriate run stores and restaurants. Even a lot of the menus for places were in English and the prices of food and things is much more comparable to prices back in the United States, albeit less expensive. All of that just made it seem much less representative of the impoverished conditions you see elsewhere in the country.
The main reason I had gone to Granada though was to see the hípica of Granada, which is essentailly an annual celebration where the town closes down the main plaza and roads to car traffic for a horse parade. There is also lots of music and other activites going on as the mounted horses parade through town. It was led by a young boy mounted on a bull the size of a small bus (an adult man did have the reins of the bull as he walked along side the bull). The bull´s horns were painted in bright striped colors and there were lots of impressive horses on parade. It´s also the first time since being here that I have seen large livestock that looked sufficiently fed, without ribs or pelvic bones showing grossly on the skins surface.
That about sums things up from my end. I do have photos from my first week here which I am trying to download onto this blog page, but with these slow connections I am not sure if it is going to work since an earlier attempt failed. But Ill try again tomorrow is I can´t make it work tonight, otherwise you´ll have to settle once again for text only.
Good night all...peace be with you.
Friday, June 5, 2009
Cárceles políticas, un hospital con una falta de fondo y la gripe porcina
¡Saludos! Today is Friday, June 5th. Another week has passed since posting my previous entry and there has been plenty to write about, but from the start I must apologize again for not having any original photos or video to present. I have a small digital camcorder with me that seems to be a little too much for the older computers I´ve used here. The disposible film cameras I have are yet to be developed, but that will change soon once I find a developer. In the meantime you´ll just have to settle for my half-witted descriptions starting from where I left off. This entry is a little long so I´ve divided it into three parts, don´t hesitate to read some and come back later.
PartI
Last Sunday, the four FSD students living in Masaya (including myself), and one student from Jinotepe, met up in the afternoon to walk around and get to know this small city better. We walked around the central plaza, el parque central, to the northern outskirts, crossing the highway leading to Managua, despite its fast paced traffic. Enduring the dust, fumes, and language reserved for "gringo" foreigners on a busy roadside, in addition to the countless packed school-type buses with operators yelling "¡Managua Managua Managua!," as they headed towards the capital 26km away, we soon arrived at the base of a hill with a single road leading up to our destination. The destination was the Fortaleza de Coyotepe, also known plainly as Coyotepe. After walking up the steep climb that most people chose to taxi through, we were greeted at the main gate of the fort by a Nicaraguan adult boy scout leader, who collected out $1 per person entry fee and welcomed us in to enjoy the hilltop view of Masaya below and the miles of green countryside, lakes and volcanic peaks that could be seen at varying distances for 360°.
The word coyotepe literally means "coyote hill," as there apparently used to be many coyotes here when the hill was named, although I´m not sure how many exist here currently. Being the highest point in close proximity to the city of Masaya, a fortress was built here in 1893 by the President of the time, José Santos Zelaya. The fort was then taken over in 1912 by Nicaraguan conservatives, witht he aid of U.S. Marines (representing one of the major U.S. military interventions in Nicaragua).
In the 1930´s, Anastasio Somoza (Nicaraguan dictator who came to power with the aid of U.S. intervention), converted the fortress into a political prison. Thus, while the building appears like an old military fortress from the outside, once you enter the underground detention levels you can see the harsh conditions Somoza used to detain those in opposition to his rule.
One of the younger Nicaraguan scouts walked us through the underground levels to provide information, answer questions, and guide us through teh dark unlit passages. The outter ring of the first underground level, which actually had narrow slit window openings that permitted daylight and a view of the outside, was reserved for the less threatening dissidents of Somoza, were they would be held indefinitely in cramped, unsanitary conditions with a concrete floor to sleep on. The inner circle of this level, which we entered afterwards, was reserved for the more threatening/serious dissidents or active conspirators.
This inner level permitted no views of the outside world, and little or no daylight entered, depending on the specific room. There were places for complete isolation in darkness, and other areas designated for various forms of torture and interrogation. There is also an additional lower level(s) to the prison, but reported tunnel collapses mean it is no longer accessible. Our guide said it is likely the dead, due to torture or disease, were likely disposed of below. He also said there is no reliable data to know exactly who or how many people "disappeared" in Coyotepe during Somoza´s rule.
In 1979, the last phase of the Somoza family dictatorship, Coyotepe was used as a location to mortar some of the rebel strong hold neghborhoods of Masaya below. But the Sandanistas eventually fought for and took control of the hilltop prison, freeing the remaining survivors. However, even once the Sandanistan government took control, Coyotepe was used to imprison the former captors. Reportedly, some of the same forms of torture used on the previous era inhabitants were then used on members of the ousted regime. After several years of Sandanistan use, the prison was abandoned for whatever reason and it sat vacant for years.
More recently, a Nicaraguan boy scout troop has taken responsibility for the site and they are attempting to turn it into a historical museum, which seems just. There was certainly a lot to take in internally and externally from that hilltop...sorry if you don´t like all of that history, but I think it´s pretty relevant.
Part II
Monday morning was my first taste of what I´ll be doing here primarily for teh next two months. I arrived at Hospital Humberto Alvarado, which is the only public hospital in the city. It has an employed of staff of around 400 people, and located on teh east side of Masaya, close to the Managua highway. It´s also only about three blocks from my host family, which means I can easily walk to and from the site.
I was introduced to the senior doctor at the hospital, who showed me around briefly and introduced me to the staff, who were generally pretyy friendly and conversational. At the hospital, my goal is to learn as much as possible about public healthcare in Nicaragua, using this facility and the staff here as a primary reference. I am being given the chance to work in most of the major departments at the hospital while I am here, and as my personal inclinations go, I drifted to the mergency department as my introduction to working here, where I will be for the next two weeks before moving on to other departments.
Given Nicaragua´s recent and current economic status, I really was not expecting much in the form of medical resources before coming here. From a distance, things did not appear to bad. The hospital is an old, relatively small, one story building made of brick and concrete, with numerous wings and outdoor covered hallways leading from one department to another. Some of teh departments have functioning airconditioning while the building power is on, someimtes it cuts off, and other departments are at the mercy of the weather, which is usually hot.
Once I got to work in the emergency department, I came to appreciate the little resources I am used to having in hospitals in the U.S.. Here, for example, gloves come in one or maybe two sizes on a good day, so if they are to big or to small, you have to make due. There is also a general shortage of clean linen, so we only change the bed sheets between patients if the sheets are obviously saturated with blood or other bodily fluids (a little blood is okay if you flip the sheet over, right?), and when the sheets run out we do our best to clean the bed with soap, water, and gauze, or sometimes bleach if we have it. I guess I could go on and on about the basic things we don´t have that I´ve been accustomed to in the U.S., such as clean paper towels to dry hands, needles in appropriate sizes, beds with side rails to prevent falls, more than two blood pressure cuffs for an entire department, etc., not to mention anything more technologically advanced like an MRI or CAT scan. The docs here have to rely on more mnaula methods such as palpation and auscultation to diagnose (although we do have a functioning x-ray machine at the moment!). But I should also say that the nurses and doctors here seem committed to doing the best they can with the government funding they have. One doc summed it up whe he told me on my first day there; "Aquí, aprende a trabajar con clavos." Meaning, here you need to learn to work "with nails," with difficulty, with few resources.
Part III
When I arrived in Managua in May, the swin flu had not yet been indentified within the borders of Nicaragua. As arriving passengers exited their plane in the airport, they were each screened individually in front of a thermal scanner to identify anyone with an elevated temperature. But on Tuesday of this week, a case was confirmed in Managua. Then on Wendesday a case was confirmed here in Masaya in a nearby neighborhood.
Although the outbreak here is not receiving nearly as much press as it did in the U.S. back in April/May, there is still some alarm and the government health department is taking measures to hopefully reduce the spread. For example, today in the hospital, anyone presenting with fever or respiratory symptoms was screened in an outdoor make-shift assessment center to rule out the influenza strain before they were allowed to actually enter the hospital. all of the staff, including myself, are also required to wear surgical masks (which we do have a limited supply of) and safety glasses to avoid contagion. So we´ll see how things develop. I´m not to worried about the swine flu in its current form, since most people seem to recover without to much problem, but there´s always the chance that the virus will become more virulent. Given the ease of transmission, it would cause much harm if that happened, but I think at some point you just have to aknowledge that you´re not in control and if you get sick and die, you can still be thankful for the time you did have, ¡hoka hey!
Tune in next week for "Caballeros de Granada," or "Ticky Ticky Goes Boom Boom"...´hope all is well at home, wherever home is for those reading this. And I apologize for any typos, but if I am going to post this today there´s no time to proof read.
PartI
Last Sunday, the four FSD students living in Masaya (including myself), and one student from Jinotepe, met up in the afternoon to walk around and get to know this small city better. We walked around the central plaza, el parque central, to the northern outskirts, crossing the highway leading to Managua, despite its fast paced traffic. Enduring the dust, fumes, and language reserved for "gringo" foreigners on a busy roadside, in addition to the countless packed school-type buses with operators yelling "¡Managua Managua Managua!," as they headed towards the capital 26km away, we soon arrived at the base of a hill with a single road leading up to our destination. The destination was the Fortaleza de Coyotepe, also known plainly as Coyotepe. After walking up the steep climb that most people chose to taxi through, we were greeted at the main gate of the fort by a Nicaraguan adult boy scout leader, who collected out $1 per person entry fee and welcomed us in to enjoy the hilltop view of Masaya below and the miles of green countryside, lakes and volcanic peaks that could be seen at varying distances for 360°.
The word coyotepe literally means "coyote hill," as there apparently used to be many coyotes here when the hill was named, although I´m not sure how many exist here currently. Being the highest point in close proximity to the city of Masaya, a fortress was built here in 1893 by the President of the time, José Santos Zelaya. The fort was then taken over in 1912 by Nicaraguan conservatives, witht he aid of U.S. Marines (representing one of the major U.S. military interventions in Nicaragua).
In the 1930´s, Anastasio Somoza (Nicaraguan dictator who came to power with the aid of U.S. intervention), converted the fortress into a political prison. Thus, while the building appears like an old military fortress from the outside, once you enter the underground detention levels you can see the harsh conditions Somoza used to detain those in opposition to his rule.
One of the younger Nicaraguan scouts walked us through the underground levels to provide information, answer questions, and guide us through teh dark unlit passages. The outter ring of the first underground level, which actually had narrow slit window openings that permitted daylight and a view of the outside, was reserved for the less threatening dissidents of Somoza, were they would be held indefinitely in cramped, unsanitary conditions with a concrete floor to sleep on. The inner circle of this level, which we entered afterwards, was reserved for the more threatening/serious dissidents or active conspirators.
This inner level permitted no views of the outside world, and little or no daylight entered, depending on the specific room. There were places for complete isolation in darkness, and other areas designated for various forms of torture and interrogation. There is also an additional lower level(s) to the prison, but reported tunnel collapses mean it is no longer accessible. Our guide said it is likely the dead, due to torture or disease, were likely disposed of below. He also said there is no reliable data to know exactly who or how many people "disappeared" in Coyotepe during Somoza´s rule.
In 1979, the last phase of the Somoza family dictatorship, Coyotepe was used as a location to mortar some of the rebel strong hold neghborhoods of Masaya below. But the Sandanistas eventually fought for and took control of the hilltop prison, freeing the remaining survivors. However, even once the Sandanistan government took control, Coyotepe was used to imprison the former captors. Reportedly, some of the same forms of torture used on the previous era inhabitants were then used on members of the ousted regime. After several years of Sandanistan use, the prison was abandoned for whatever reason and it sat vacant for years.
More recently, a Nicaraguan boy scout troop has taken responsibility for the site and they are attempting to turn it into a historical museum, which seems just. There was certainly a lot to take in internally and externally from that hilltop...sorry if you don´t like all of that history, but I think it´s pretty relevant.
Part II
Monday morning was my first taste of what I´ll be doing here primarily for teh next two months. I arrived at Hospital Humberto Alvarado, which is the only public hospital in the city. It has an employed of staff of around 400 people, and located on teh east side of Masaya, close to the Managua highway. It´s also only about three blocks from my host family, which means I can easily walk to and from the site.
I was introduced to the senior doctor at the hospital, who showed me around briefly and introduced me to the staff, who were generally pretyy friendly and conversational. At the hospital, my goal is to learn as much as possible about public healthcare in Nicaragua, using this facility and the staff here as a primary reference. I am being given the chance to work in most of the major departments at the hospital while I am here, and as my personal inclinations go, I drifted to the mergency department as my introduction to working here, where I will be for the next two weeks before moving on to other departments.
Given Nicaragua´s recent and current economic status, I really was not expecting much in the form of medical resources before coming here. From a distance, things did not appear to bad. The hospital is an old, relatively small, one story building made of brick and concrete, with numerous wings and outdoor covered hallways leading from one department to another. Some of teh departments have functioning airconditioning while the building power is on, someimtes it cuts off, and other departments are at the mercy of the weather, which is usually hot.
Once I got to work in the emergency department, I came to appreciate the little resources I am used to having in hospitals in the U.S.. Here, for example, gloves come in one or maybe two sizes on a good day, so if they are to big or to small, you have to make due. There is also a general shortage of clean linen, so we only change the bed sheets between patients if the sheets are obviously saturated with blood or other bodily fluids (a little blood is okay if you flip the sheet over, right?), and when the sheets run out we do our best to clean the bed with soap, water, and gauze, or sometimes bleach if we have it. I guess I could go on and on about the basic things we don´t have that I´ve been accustomed to in the U.S., such as clean paper towels to dry hands, needles in appropriate sizes, beds with side rails to prevent falls, more than two blood pressure cuffs for an entire department, etc., not to mention anything more technologically advanced like an MRI or CAT scan. The docs here have to rely on more mnaula methods such as palpation and auscultation to diagnose (although we do have a functioning x-ray machine at the moment!). But I should also say that the nurses and doctors here seem committed to doing the best they can with the government funding they have. One doc summed it up whe he told me on my first day there; "Aquí, aprende a trabajar con clavos." Meaning, here you need to learn to work "with nails," with difficulty, with few resources.
Part III
When I arrived in Managua in May, the swin flu had not yet been indentified within the borders of Nicaragua. As arriving passengers exited their plane in the airport, they were each screened individually in front of a thermal scanner to identify anyone with an elevated temperature. But on Tuesday of this week, a case was confirmed in Managua. Then on Wendesday a case was confirmed here in Masaya in a nearby neighborhood.
Although the outbreak here is not receiving nearly as much press as it did in the U.S. back in April/May, there is still some alarm and the government health department is taking measures to hopefully reduce the spread. For example, today in the hospital, anyone presenting with fever or respiratory symptoms was screened in an outdoor make-shift assessment center to rule out the influenza strain before they were allowed to actually enter the hospital. all of the staff, including myself, are also required to wear surgical masks (which we do have a limited supply of) and safety glasses to avoid contagion. So we´ll see how things develop. I´m not to worried about the swine flu in its current form, since most people seem to recover without to much problem, but there´s always the chance that the virus will become more virulent. Given the ease of transmission, it would cause much harm if that happened, but I think at some point you just have to aknowledge that you´re not in control and if you get sick and die, you can still be thankful for the time you did have, ¡hoka hey!
Tune in next week for "Caballeros de Granada," or "Ticky Ticky Goes Boom Boom"...´hope all is well at home, wherever home is for those reading this. And I apologize for any typos, but if I am going to post this today there´s no time to proof read.
Saturday, May 30, 2009
Arrival and Orientation
Hello to everyone reading this, my name is Richard Hackett and I am a junior BSN nursing student at the University of San Francisco (USF). This summer I volunteered to participate in a program which is a partnership between my university, the Foundation for Sustainable Development (http://www.fsdinternational.org), and gracefully funded by the Sarlo Foundation (http://www.sfjcf.org/endowment/grants/programs/sarlo/about.html).
As a participant in this program, four other USF students and I will be spending the next couple of months in Nicaragua, where we arrived last Sunday. We will be working with different community based organizations to learn about the history and social/economic issues from the people that live and work here, in one of the economically poorest nations in Central America.
I have created this blog as a way to keep people informed on my experiences here, if they are interested, and I will try to post a new entry at least once a week, give or take a day or two. Feel free to check up on me, post comments and/or questions, but please keep them somewhat professional! Also feel free to email me directly...whew! Now that all of that technical information is out of the way ¡empezamos!
The trip has gone well thus far, our group arrived in Managua on the afternoon of Sunday, May 24th, without any problems. At the airport we were greeted by some of the FSD coordinators, who helped us load our bags in a van and accompanied us on our way from the airport. Even our checked luggage showed up without a hitch! Which cannot be said for some of the other participants here from other schools. Exiting the airport the heat and humidity were apparent, as expected, so drinking enough water and getting enough electrolytes to stay hydrated is a constant necessity.
In the van, we headed for a small hotel, nestled in a residential nieghborhood in Managua, called Casa San Juan. We spent the rest of the day, and most of the following Monday, being oriented to the FSD program, Nicaraguan history and culture, and seeing some of the histroic sites in Managua. Managua itself, the capital of Nicaragua, is a large city of about 1.5 million people. We visited a large cathedral made mostly of concrete. We also visited the site of Anastasio Somoza´s (former dictator) hilltop palace, which little remains of, but it now hosts a monument to Augusto Sandino and the view of Managua from the hilltop allows you to see the expansive city in all directions, the large lake (Lago de Managua), and the surrounding hills and countryside. For a city of its size, Managua has relatively few highrise buildings, as most of them tumbled down in the earthquake of 1972, whose epicenter was in Managua. We also visited a city park, which now appears pretty run down, but has a monument dedicated to hope and a concrete wall filled with automatic weapons that were used during the civil war. The barrles of the rifles protrude from the wall like menacing tentacles and our guide, Francisco, spoke of how it saddened him that this monument has become run down and forgotten. He spoke of how the rifles in the wall had been used to kill countless numbers of people, and the monument should be remembered in their honor.
Monday evening, we left the city and headed for Masaya, a comparatively smaller city of about 150,000 people located a 30 minute drive south of Managua. Masya is slightly cooler temperature wise because of an increased elevation and the atmosphere is a little more easygoing and friendly, even though there is still an obvious presence of poverty. It is common everywhere we have been thus far to see even children begging in the streets. We then spent the next three days in Masaya, learning about public health issues, local economics and politics.
One activity we completed during this time was called the "Two Dollars a Day" activity. In Nicaragua, close to 80% of the population lives with a family income of less than $2/day (Human Development Report 2007/2008). The local currency is called cordobas, and about 20 cordobas equal one U.S. dollar. So for the activity, we were divided into student pairs and given 40 cordobas and the details of what we had to try and buy for an average sized Nicaraguan family. My group assignment was to buy enough food for five people (two children, two adults and one grandmother), in addition to asthmatic medication and a special diet of fruits and vegetables that the grandmother required because of her medical condition.
Although it is true that one U.S. dollar generally goes much further here than in the U.S. (for example, I can take a taxi anywhere in Masaya for only 10 cordobas, or about 50 U.S. cents), it was not easy to come up with the required goods. We bought the least expensive asthamtic medication we could find in an amout that would only get her through the next 24 hours, and that was only after barganing hard with the pharmacist and explaining our medical necessity. All of the more effective medications would have been far out of our price range, so we spent 9 cordobas on 6 bronchodilator pills. That meant we had 31 cordobas left to buy enough food for five people. We searched for the cheapest dried rice and beans and bought one pound of each (the cost of meat made it out of the question). We then had 8.5 cordobas left to buy a small bag of fruit and vegetables for our grandmother´s dietary needs. I think we had enough to keep people from starving overnight, but not enough to keep malnourishment from becoming a long-term issue. I should also mention that our diector told us we still needed to buy a little salt and cooking oil to prepare the food we bought, but we did not have a cent left.
The activity helped to underscore the economic struggle many families face here on a daily basis. With such limited funds, money expenditures on things like books, writing utensils, and paper is seldom seen (and many schools do not have adequate funding to provide much in this regard either).
On Thursday, our group parted ways as all of the students were intorduced to the different host families we will be staying with during our time here. A few of the students will be staying here in Masaya, while others have been sent off to other cities, such as Jinotepe, Chagutillo, Esteli, and Ciudad Sandino. My family is located on the east side of Masaya, and they are very welcoming and accomodating, however, I am not at liberty to discuss their personal information in respect of their privacy. But they have helped me learn my way around the city, introduced me to family, friends, and neighbors. We are working at getting to know eachother as they help me with the language.
For now, I am just trying to familiarize myself with the new environment here since I have the weekend off to get laundry done, send emails, and prepare for meeting my host organization on Monday morning, which is Hospital Humberto Alvarado. There is one other USF student here who will be working in a smaller health clinic, and two other students from other universities who will be working with economic and educational organizations. I look forward to seeing how things go next week as I learn about the hospital here. I will provide an update next weekend if possible and will hopefully be able to include some photos or video...¡adios!
As a participant in this program, four other USF students and I will be spending the next couple of months in Nicaragua, where we arrived last Sunday. We will be working with different community based organizations to learn about the history and social/economic issues from the people that live and work here, in one of the economically poorest nations in Central America.
I have created this blog as a way to keep people informed on my experiences here, if they are interested, and I will try to post a new entry at least once a week, give or take a day or two. Feel free to check up on me, post comments and/or questions, but please keep them somewhat professional! Also feel free to email me directly...whew! Now that all of that technical information is out of the way ¡empezamos!
The trip has gone well thus far, our group arrived in Managua on the afternoon of Sunday, May 24th, without any problems. At the airport we were greeted by some of the FSD coordinators, who helped us load our bags in a van and accompanied us on our way from the airport. Even our checked luggage showed up without a hitch! Which cannot be said for some of the other participants here from other schools. Exiting the airport the heat and humidity were apparent, as expected, so drinking enough water and getting enough electrolytes to stay hydrated is a constant necessity.
In the van, we headed for a small hotel, nestled in a residential nieghborhood in Managua, called Casa San Juan. We spent the rest of the day, and most of the following Monday, being oriented to the FSD program, Nicaraguan history and culture, and seeing some of the histroic sites in Managua. Managua itself, the capital of Nicaragua, is a large city of about 1.5 million people. We visited a large cathedral made mostly of concrete. We also visited the site of Anastasio Somoza´s (former dictator) hilltop palace, which little remains of, but it now hosts a monument to Augusto Sandino and the view of Managua from the hilltop allows you to see the expansive city in all directions, the large lake (Lago de Managua), and the surrounding hills and countryside. For a city of its size, Managua has relatively few highrise buildings, as most of them tumbled down in the earthquake of 1972, whose epicenter was in Managua. We also visited a city park, which now appears pretty run down, but has a monument dedicated to hope and a concrete wall filled with automatic weapons that were used during the civil war. The barrles of the rifles protrude from the wall like menacing tentacles and our guide, Francisco, spoke of how it saddened him that this monument has become run down and forgotten. He spoke of how the rifles in the wall had been used to kill countless numbers of people, and the monument should be remembered in their honor.
Monday evening, we left the city and headed for Masaya, a comparatively smaller city of about 150,000 people located a 30 minute drive south of Managua. Masya is slightly cooler temperature wise because of an increased elevation and the atmosphere is a little more easygoing and friendly, even though there is still an obvious presence of poverty. It is common everywhere we have been thus far to see even children begging in the streets. We then spent the next three days in Masaya, learning about public health issues, local economics and politics.
One activity we completed during this time was called the "Two Dollars a Day" activity. In Nicaragua, close to 80% of the population lives with a family income of less than $2/day (Human Development Report 2007/2008). The local currency is called cordobas, and about 20 cordobas equal one U.S. dollar. So for the activity, we were divided into student pairs and given 40 cordobas and the details of what we had to try and buy for an average sized Nicaraguan family. My group assignment was to buy enough food for five people (two children, two adults and one grandmother), in addition to asthmatic medication and a special diet of fruits and vegetables that the grandmother required because of her medical condition.
Although it is true that one U.S. dollar generally goes much further here than in the U.S. (for example, I can take a taxi anywhere in Masaya for only 10 cordobas, or about 50 U.S. cents), it was not easy to come up with the required goods. We bought the least expensive asthamtic medication we could find in an amout that would only get her through the next 24 hours, and that was only after barganing hard with the pharmacist and explaining our medical necessity. All of the more effective medications would have been far out of our price range, so we spent 9 cordobas on 6 bronchodilator pills. That meant we had 31 cordobas left to buy enough food for five people. We searched for the cheapest dried rice and beans and bought one pound of each (the cost of meat made it out of the question). We then had 8.5 cordobas left to buy a small bag of fruit and vegetables for our grandmother´s dietary needs. I think we had enough to keep people from starving overnight, but not enough to keep malnourishment from becoming a long-term issue. I should also mention that our diector told us we still needed to buy a little salt and cooking oil to prepare the food we bought, but we did not have a cent left.
The activity helped to underscore the economic struggle many families face here on a daily basis. With such limited funds, money expenditures on things like books, writing utensils, and paper is seldom seen (and many schools do not have adequate funding to provide much in this regard either).
On Thursday, our group parted ways as all of the students were intorduced to the different host families we will be staying with during our time here. A few of the students will be staying here in Masaya, while others have been sent off to other cities, such as Jinotepe, Chagutillo, Esteli, and Ciudad Sandino. My family is located on the east side of Masaya, and they are very welcoming and accomodating, however, I am not at liberty to discuss their personal information in respect of their privacy. But they have helped me learn my way around the city, introduced me to family, friends, and neighbors. We are working at getting to know eachother as they help me with the language.
For now, I am just trying to familiarize myself with the new environment here since I have the weekend off to get laundry done, send emails, and prepare for meeting my host organization on Monday morning, which is Hospital Humberto Alvarado. There is one other USF student here who will be working in a smaller health clinic, and two other students from other universities who will be working with economic and educational organizations. I look forward to seeing how things go next week as I learn about the hospital here. I will provide an update next weekend if possible and will hopefully be able to include some photos or video...¡adios!
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