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Nine members of the JB Grant International Health Society traveled to rural Nicaragua from January 3rd to 17th 2008 for a service learning project and collaborated with the Nicaraguan Ministry of Health and local community-based organizations. The group returned to the city of Ocotal, in the province of Nueva Segovia, in northwest Nicaragua. This was the second time a NCP group worked in Ocotal. Before the trip, the group worked with Hopkins faculty members Elli Leontsini and Holly Wilcox who provided training sessions on youth suicide and dengue fever. While in Ocotal, the group worked on two projects: Dengue Fever We worked with the Ministry of Health department in Ocotal on a continuing dengue fever surveillance project. The chief epidemiologist at the Ministry of Health helped us coordinate with the health brigadistas at the smaller Puesto de Salud in the neighborhood of Nora Astorga. This barrio was chosen because it is adjacent to the barrio that the group conducted the surveys on last year, and also because the Ministry of Health identified it as a higher risk community. Nora Astorga is about a 20 minute walk from the center of Ocotal, and it is significantly more economically depressed than the center. When we arrived in Nora Astorga, we split into five small groups with 1-2 brigadistas per group, and spread out throughout the neighborhood. The brigadistas are like community health workers, and know the community well and have experience in several health outreach projects. By visiting approximately every other household, we were able to administer 40 COMBI surveys to the heads of household that measured the knowledge, attitudes, and beliefs about dengue fever. Each survey took between 30 and 45 minutes to administer, and we completed almost all of them in one afternoon. We also observed different measures of water storage throughout the house (pilas, water basins, tires, pots and pans, etc) and tried to identify aedes aegypti larvae. We also talked to the heads of households about ways to reduce their risk of developing dengue. Youth Suicide In November of 2007, the concerned members of the Ocotal community formed a Youth Suicide Prevention Coalition. The Coalition was made up of the following, among other groups: SILAIS, Centro de Salud, CEPRESI, FUNDEMUNI, etc. When Rebecca, our of the 2007 NCP leaders visited Nicaragua in August, one of our contacts with the Centro de Programas de Comunicacion identified youth suicide as a growing problem in Nicaragua and suggested that our group try to develop a project with this in mind. Our group met with the coalition in January of 2008 to propose our ideas for doing informal focus groups with the youth in the area. Our intention was not to discuss “suicide” in these groups, but to discuss the perceptions the youth had regarding their community. Almost all members of the coalition were supportive and offered access to their various youth groups. We conducted 10 focus groups of youth aged 10-21 years. Questions were developed with local representatives of the community which would elicit risk factors relating to social factors (family, friends, community, education, etc.). During the focus groups, one of the Spanish-speaking members in our group led an informal question and answer session with the Nicaragua participants. Group size ranged from 5 to about 25 people. The format was basically the same at all of the focus groups, but the style varied based on the participants’ ages, confidence in sharing their viewpoints, gender, and experiences as well as the setting of the focus group. We did focus groups in community centers, parks, and community members’ homes. While one group member led the focus group, another Spanish speaking member took notes. We had 1 or 2 translators present to translate for the non-Spanish speaking members. Youth presented challenges they face concerning lack of employment, drugs, and crime. They also expressed different stories on where they go when they need someone to talk to, what services they are aware of and access, and offered us suggestions on ways that community organizations could better meet their needs. Each focus group lasted between 30 minutes and an hour and a half. At the end of each group, the participants were challenged with designing a visual representation of their community. Representatives from each group were invited to paint their designs on walls of the Adolescent Center on the last day of our stay in Ocotal. In addition to those groups, individual interviews were held with the various members of the community in order to better understand the plans the Coalition had for further addressing youth suicide. We interviewed journalists, psychologists, community organization leaders, and other individuals who work with young people in Ocotal. We tried to interview the mayor; unfortunately, he cancelled the meeting. At a final meeting with the Coalition, our group summarized findings from the focus groups and interviews. This meeting was unfortunately not as effective as we would have liked as only SILAIS and CIPRESI had representatives at the meeting. We presented strengths and weaknesses of how the youth suicide problem has been addressed in Ocotal up to that point. We also facilitated brainstorming session for future plans within the community and for future NCP trips. All of the information collected from interviews, focus groups, and our brainstorming session can be found in the binder. The group stayed with host families in Ocotal, and ate all meals with the families. While most days were spent on the projects, the group also had the opportunity to visit a nearby artisan community as well as a large mercado near the capital of Managua.
2007-2008 coordinators:
Lorena Chavez Rebecca Fertziger Dana Kindermann Thirteen members of the JB Grant International Health Society traveled to rural Nicaragua from January 14th-22, 2006 for a service learning project focusing broadly on sexual and reproductive health. The group was based in the town of Siuna, located in the North Atlantic Autonomous Region (RAAN), one of the poorest and most underserved areas in Nicaragua. The group took on three separate but complimentary projects which ran concurrently: - Peer Educator Training: A series of workshops targeted peer educators ages 12-18 years, who had been chosen by the community for their leadership skills, enthusiasm, and dedication. These workshops complimented previous trainings received by this group of youth, and focused on providing factual information on reproductive anatomy, HIV/AIDS and other sexually transmitted diseases, and contraceptive methods. The workshops also provided an environment in which the youth developed and applied life skills such as communication, decision-making, and self-esteem to reproductive health issues.
- Rural Health Worker Training: A separate series of workshops provided training in topics in maternal and neonatal health, family planning, and counseling skills as they relate to decision making and reproductive health. This series was targeted to a group of rural health workers and midwives from rural communities surrounding Hormiguero, a health post outside of Siuna.
- Adolescent Sexual and Reproductive Health Survey: A survey of adolescent sexual and reproductive health knowledge, attitudes, and practices was designed and piloted. This included the creation of a multi-day workshop in survey methodology and implementation. The goal of the survey is to provide an understanding of current knowledge and attitudes that will inform future public health programming.
The group partnered with Bridges to Community, Inc., a US-based NGO that has been promoting sustainable development through international service and cultural exchange in rural Nicaragua for over 10 years. “Bridges” is looking to expand their programming into the health sector, grounded in a grassroots, holistic model of community development. Bridges provided logistical support; with respect to programming, our group partnered most closely with the Siuna branch of Salud sin Limites (SSL), a British-based (but entirely Nicaraguan staffed) NGO that facilitates health education through peer educator programs, community workshops, and other health education programming. In addition to the service component of the trip, the group was able to visit several types of organizations within the public health system in Nicaragua. At the Center for Communications Programming in Managua (a sister institution to the JHUCCP) they learned of a reproductive health campaign that brought together such diverse stakeholders as educators, religious leaders, legislators, and parents under a highly branded campaign of safety, communication, and informed decision making. They also had the opportunity to visit both a regional hospital and rural health post, observing the primary channels through which Nicaraguans receive healthcare. The public health impact of this project was both significant and sustainable. We were able to design workshops and a survey that complimented the work of health professionals already targeting reproductive health issues in the RAAN. This contribution was one piece of a much larger puzzle, and the work in line with ongoing public health work in Nicaragua as well as the Ministry of Health’s (MOH) goals for the future.
For more information, please see our Web site:
http://www.hopkins-nicaragua.blogspot.com And see our blog on the Hopkins News Center:
http://www.jhsph.edu/publichealthnews/articles/2006/Nicaragua/index.html
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Cristina Cardemil
Erika Linnander
Cynthia Fisher
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