At the beginning of every aspiring Peace Corps
volunteer´s training, there is a period of time in which the staff provide an
overwhelming amount of information about life in service, rules and
regulations, the host country, and potentially relevant health concerns such as
injuries and illnesses. This orientation may leave the volunteer-to-be
confused, distressed, and/or exhausted; inevitably, the majority of the
information will not be absorbed at this time and must be relearned later.
My introduction to Chagas was in the volunteer medical
handbook, distributed during this orientation period. I vaguely remember
experiencing a moment of horror as I skimmed the two page description of the
disease, but I was too generally overwhelmed at the time to dwell on it. I paid
much more attention the second time around, when I read article about Chagas in
our volunteer newsletter.
Chagas has been endemic throughout Latin America for
more than 100 years. It affects 10 to 12 million people and kills more than
15,000 each year. There is a substantial body of knowledge on the life cycle of
the parasite (Trypanosoma cruzi) and
vector (insects of the family Triatoma);
we know how to identify and treat the disease, as well as how to prevent (or at
the very least, control) it.
So…why had I never heard of Chagas before coming to
Nicaragua?
Because Chagas is a disease of the poor. It rarely is
found in so-called “first world” or “developed countries.” Celebrities and
politicians do not become champions of Chagas elimination. Pharmaceutical
companies do not invest significant resources in developing new treatment
methods or vaccines.
Chagas is also a silent disease. The initial phase in
which symptoms (fever and chills, loss of appetite, headache, tiredness, and
painless swelling of the site of entry) may present only lasts 30 to 60 days.
After this acute phase, the infected individual spends years living
asymptomatically, while the parasite causes extensive damage to the circulatory
system, digestive system, and nervous system.
Anyway, back to the newsletter.
The article outlined a Chagas prevention campaign that
focused on community-wide bug hunts. Primary school students are given basic
information about Chagas disease, and are taught how to identify and collect
the insects that transmit the parasite. Collected insects are brought to the
local health centers, where they are tested for the presence of the parasite.
In this way, health professionals can identify and treat infected community
members, and prioritize communities for activities such as health education and
fumigation.
Chagas frightened me, and the campaign sounded like an
interesting activity, so I decided to implement it in my community. I wrote up
extensive plans, spoke with my health director to organize activities, and
spoke with the local school delegate to receive permission to work in the
schools. I scheduled trainings for the community health workers and
presentations in the local schools. I hounded MINSA and SILAIS for materials to
use, and developed my presentation. Finally, after several weeks of
preparation, I was ready.
And then reality set in. Programmed trips out to the
community were canceled at the last moment. Community health workers did not show up to
scheduled trainings. Schools were closed for teachers’ meetings, local
holidays, or other reasons that I have yet to discover. After a month, I had
accomplished very little and was left feeling extremely frustrated and cynical.
How was I ever going to get this campaign off the ground? Why couldn’t anything
work out as planned? Was I doomed to failure in all of my work efforts?
So I took a step back. I talked with other volunteers,
and I did a lot of thinking. Finally, I let go of my anger and impatience. I
made a new, more realistic plan and managed to implement it with relative
success in a three week period. The future of this project suddenly looks a
little bit brighter, although I don’t think it will ever match what I had
originally envisioned.
I’m okay with that.
Lessons learned:
1. Don’t try to go it alone. The chances for success
and sustainability improve greatly when your counterparts are involved and
invested from start to finish.
2. Counterparts unwilling or uninterested in
collaborating with you? Try to figure out why. It may be that you haven’t
identified the right people for the project. However, you may also come to find
that the project itself isn’t right for the community. Your ideas of what is
good and necessary may not match those of your community, and ultimately your
community’s opinion will determine the success of the project.
3. Flexibility is key. So is creativity. Have a plan
B. and a plan C.
4. Make sure that any plan (whether it be A, B, or C) is
realistic. Don’t try to do everything at once, or set goals that are impossible
to obtain. It can sometimes be helpful to do a small “test run” to get a better
idea of your plan’s feasibility and chances for success before expending a lot
of time, energy, and resources.
5. Learn from your mistakes, and accept that there are
some things that you simply cannot predict or control.
At this point I feel it necessary to confess that I
have not completely stopped worrying. I still have my moments of pessimism and
frustration, and I am not sure if I will every be able to fully embrace chaos
and just go with the flow. But I’m getting better, paso por paso.
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