May 30th is Mother’s Day in Nicaragua, which means a
month-long nationwide women’s health initiative. Over the next five weeks, the
health centers will be holding women´s health fairs to promote various
preventative measures, hosting parties at the casas maternas* to honor mothers
and soon-to-be mothers, and offering more specialty services such as
ultrasounds and PAP smears. We kicked off our own activities with a small party
for our pregnant women on Friday, and a big health fair in one of the municipality’s
many communities. After nearly three weeks of backroom activities (research,
mural making, materials design), these events felt like my first real go at
volunteerhood: I led small activities, gave health presentations, and even
helped out (if only a tiny bit) at the health post in their vaccination station
and pharmacy. The days were long and exhausting, but I finished each feeling
more satisfied than I’ve felt since arriving at site. With only two days to
prepare, the activities and presentations were a bit rougher than I would have
liked, but I have four more weeks to refine the process.
A few fun (not really) women’s health-related facts:
Nicaragua offers a variety of family planning options,
all of which can be obtained without cost at any neighborhood health facility.
Many women in Nicaragua do not use any form of family planning method. However,
among those who do, the three month injection remains the most popular form of
birth control. Why is this all important?
- Because family planning methods remain underutilized and sexual activity is often initiated at an early age, Nicaragua experiences a relatively high rate of teenage pregnancy. Larger families are also the norm. It is not uncommon for a woman to have her first child by 15 or 16, and to have four children by her mid- to late twenties.
- In the same vein, the underutilization of condoms has led to increased rates of sexually transmitted infections. While Nicaragua is fortunate to have a relatively low rate of HIV, the same cannot be said for Chlamydia, Gonorrhea, Syphilis, Herpes, and HPV. What makes the situation harder is the fact that women often refuse to get PAP smears; Nicaragua does not offer tests for Chlamydia, Gonorrhea, or Herpes; and the test for Syphilis is not free.
- Come September, my municipality’s main source of the three month injection will disappear. Our supply will be greatly diminished moving forward, leaving a large number of women without their preferred method of birth control.
- Doctors, nurses, and community health promoters will have to work hard to promote alternative and unpopular forms of birth control, such as the IUD and sterilization. This will mean tackling cultural and religious beliefs that discourage the use of birth control (or even talking about the use of birth control), and correcting misinformation that has contributed to disinterest, distrust, and fear (especially around the use of the IUD).
Nicaragua’s Ministry of Health works hard to try to
provide a full range of health services. But the fact is that resources are
limited. Supplies run out (or may not be available to begin with), technology
is unavailable, and trained medical professionals are stretched thin. So what
we may think of as basic in the United States may not be so basic here. Like
PAP smears. Or ultrasounds. Or mammograms.
Coffee is huge in Nicaragua. Nicaraguans drink highly
sugared coffee morning, noon, and night. They do not, however, drink much
water. Fellow volunteers have told me that most Nicaraguans would tell you that
by afternoon they had not urinated more than once since they had woken up.
People are that dehydrated. What does this mean for women’s health? Yeast
infections, urinary tract infections, and kidney disease.
And finally, a lesson learned. When you promise people
a piñata, you’d better deliver. Because when people show up to a party or a
health fair expecting a piñata, and there is no piñata to be found, people will
be pissed. And because they will then be hanging around waiting for health
services for the next few hours, you will be hearing about how pissed they are.
A lot.
Please note that I had nothing to do with neither the
promise nor the lack of delivery. I only got the earful of complaints. Which
leads to a second lesson learned: do not try to placate the people by pointing
out that, at the very least, there is a doctor present on site. You may then be
forced to explain with your still inadequate Spanish skills that you were only
stating that it was worth their time to show up, not suggesting that they use
the doctor as a piñata.
*Apologies for never explaining what a casa materna is
up until now! Casas maternas house pregnant women from rural areas in the weeks
leading up to delivery. Located in the more urban areas (such as department or
municipal capitals), they provide easy access to health services and thus lower
the risks of maternal child mortality associated with poor, rural childbirth.
Women are usually given a bed and basic food supplies.
If resources are very limited, however, women might need to supplement with
their own food, and may need to share a twin sized bed with another equally
pregnant woman. If there is a designated support staff member on site, this
woman will cook and clean for the women. Otherwise, they are responsible for
cooking and cleaning for themselves. Once women check into the casa materna,
they are not allowed to leave until they give birth. There is very little to do
in the casa materna other than eat, rest, and watch TV. Women must also leave
their families behind for several weeks. Consequently, women often refuse to
show up, or flee after a few days. They are then hunted down by health center
staff and dragged back (for their own good of course). One of my jobs as a
maternal health volunteer is to find (cheap to free) ways of entertaining these
bored, homesick women. Please feel free to send suggestions my way J
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