AIMNA

I want to give everyone a better idea about what my job here entails. I work in the administrative branch of the main health center. As Bluefields has an urban area of about 50,000 people, there are several small health centers and one centralized health center that contains administrative offices that oversee the whole municipality, which includes the rural area as well. That is where my department is housed. There is also a hospital in Bluefields. And it should be noted that this is the ONLY hospital in the entire RAAS. In other municipalities in the RAAS and in the rural health posts in the Bluefields municipality, some of the health posts have beds in that they can provide very basic hospital care (ex: women can give birth there or if you needed an IV because you were severely dehydrated due to diarrhea you could get it). Within each health center are teams of doctors and nurses called equipos basicos (it means basic team in English for my non Spanish speaking readers) and each team is assigned to care for one neighborhood. The Nicaraguan Ministry of Health calls this model of healthcare delivery, MOSAF (and right now I can’t remember what the acronym stands for, modelo….something something). Therefore, all patient records are kept according to the neighborhood a patient lives in. Ideally, one of the ways the MOSAF should function is that in case a pregnant woman doesn’t come in for one of her scheduled prenatal visits, then within 48 hours the equipo basico has to go to her house and find her. This same process would also be the same for children and vaccination appointments.

The name of my department is Attencion Integral de la Mujer, Niñez y Adolescente, AIMNA. In general, we monitor pregnancies, nutrition and vaccination of children under five years of age, and use of family planning services among adolescents. Right now I’d like to take the opportunity to mention that almost 40% of all pregnancies in Bluefields are girls 19 and younger. Dang! Talk about a problem, right? A big part of my job right now is working on the Censo Gerencial, which is a census of all the pregnant women in the municipality, rural and urban. An effective census relies heavily on the equipos basicos keeping up with their pregnant patients. As I have mentioned in previous posts, the RAAS has the highest maternal deaths in the country. Having a census such as this is one way of monitoring pregnant women and identifying those who are high risk so that the number of maternal deaths might be reduced.

In addition to keeping up with a bunch of data, we also do health promotion. For example, we give workshops to community health volunteers, midwives, and medical residents among others on various women’s health related themes. Most recently, I gave a workshop on domestic violence to a group of community health volunteers. In a few weeks we are going to the rural health post in San Francisco to promote Plan de Parto, a nationwide program from the Ministry of Health that encourages pregnant women to make a birth plan, specifically rural pregnant women. This is something that American women find compulsory, but is quite a new concept here in Nicaragua. This program encourages women to give birth at the health post or hospital instead of at home and aids them in saving their money for the trip there. It also helps them plan who will care for their other children while they are away and recovering thereafter.

Many rural pregnant women might live several hours on horseback from the nearest health post not including another two hour or more boat ride to Bluefields if they need to come to the hospital. Therefore is it of utmost importance to encourage them to plan ahead so they are prepared in case of emergency. It could save their life! This program is another activity designed to reduce maternal deaths. Most of the maternal deaths that occur are among rural women who attempt to give birth in their home but are then faced with an obstetric emergency and cannot get proper help in time.

The reduction of maternal mortality is part of Millennium Development Goal Number 5. The Millennium Development Goals are a set of eight goals aimed at reducing poverty and the unnecessary deaths and illness that result from it around the world by 2/3 by 2015. If you want to read more about them or see the world’s progress, go here www.un.org/millenniumgoals I find it reassuring to know that the Nicaraguan government has taken the goals very seriously, specifically the reduction of maternal mortality as they are making every effort in their capacity to reduce it. And not just because it’s a statistic that indicates a certain level of development, but because a woman should not have to lose her life in order to give life to her child.

As I have said before my job here will shift and change over my two years and as new projects develop and old ones wrap up, I will do my to keep my blog updated.

BLUEFIELDS!

I'm moving to BLUEFIELDS! Its located on the southeastern Carribbean coast of Nicaragua and is the capital of the southern autonomous region, R.A.A.S. I'm super happy and excited! Its a really interesting place because the culture there is completely different from the Pacific side of Nicaragua. It was used by Dutch and English pirates in the 16th and 17th centuries, hence how it got its non-spanish name. There are two additional languages spoken, Miskito and Creole English, and there are also people of African descent. The culture is definitely creole and I'm really looking forward to experiencing it and seeing the differences and similarities of the creole culture that I know in New Orleans.

Bluefields is very foreign to most Nicaraguans because of its inaccessibility. In order to get there from Managua, I have to take a 7 or so hour bus ride to a city on the Escondido River called El Rama, and then take a boat down the river, the rest of the way to Bluefields another 3 or so hours. Sounds like an an adventure, right? You could also fly, but Peace Corps won't pay for that. Traveling by boat is more fun anyway!

There is a lot of public health work to be done in Bluefields,especially in my sector. It had the highest number of maternal deaths last year and all but one were preventable. Because of this, I will be doing A LOT of promoting for the casas maternas.

Stay tuned for pictures because I am headed to Bluefields tomorrow morning and will stay until next Wednesday! Today at, "Counterpart Day" in Managua, I met my Nicaraguan counterpart and we discussed how I will spend the week getting to know my site. I'm super excited!

Trentino

We are spending this week in San Ramon, Matalgalpa for Practicum Week, which means spending time in a casa materna, meeting and talking with some brigadistas, as well as current volunteers in our sector.

On Monday, we left our training towns early in the morning to get a bus to Managua. However, there was a microbus strike due to high gas prices and therefore it took us way longer to get there because there were so few buses running. Finally, we arrived in Managua and received our first visit to the Peace Corps office! It’s really nice and is air conditioned. There is also a fabulous volunteer book exchange and library. I’ve already checked out 2 books. One of them is a Salmon Rushdie book about Nicaragua in the 80s. After receiving a few technical charlas from MINSA staff at the office, we left for San Ramon.

We are staying at a darling little hotel that has beautiful misty mountain views and free wireless. This town is the site of a health volunteer named Cassie. On our first day, she took us to meet one of her most active brigadistas who lives way out in a rural community called Trentino. Eduardo drove us there in the 4-wheel drive official Peace Corps truck. The road was insanely terrible and we had to cross two creeks.

We met with Doña Maria on her farm for a couple hours. She discussed her duties as a brigadista, which included providing health info to her community, acting as a liaison and contact person for her community for health related issues, and performing an annual census of her community for the government just to name a few. She’s also a midwife and her mother was a midwife too. She has given birth to 14 children! However, now advocates family planning to all adolescents in her community.

After our talk, she gave us a tour of her farm! There were a ton of chickens and lots of baby chicks. There were also a couple of noisy roosters that kept interrupting our health chat. There was a crazy looking hybrid duck with darling little yellow ducklings. Then she took us to her fruit tree field, which she informed us would be full of fruit during the month of august. There were orange, papaya, mango, sweet lemon, lemon, banana, and avocado trees. Doesn’t that sound heavenly? There happened to be a few lemons on one tree, so she took it upon herself to beat down a few and hand them out to us. Never have a smelled a lemon so rich in lemon flavor. Later that evening we squeezed them over our dinner.

Instead of hitching a ride back to San Ramon with Eduardo, we decided to hike back which took about an hour. We took a couple of shortcuts, one was through a pasture that had grass ten feet tall on either side of the trail, and another was up a river bed, where we intersected a man traveling on horseback. Living out in a rural community like Trentino, a horse would be great transportation.

The hike was beautiful with lots of expansive vistas of mountains and pastures and super green trees and bright orange flowers. I also encountered lots of trees with Spanish moss and was reminded of home! The tree in the picture above is covered in Spanish moss. So beautiful!

After lunch that afternoon, my group presented a charla on hygiene to the local casa materna which currently has only one pregnant woman staying there. However, last week there were seven pregnant women staying there, but six gave birth in one week. Ha! We are scheduled to give more charlas there tomorrow, but instead we are traveling to another community called La Dalia instead.