Baby steps towards improving obstetrical health

Trip Start May 10, 2009
Trip End Sep 03, 2009

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Flag of Nicaragua  , Rivas,
Wednesday, June 17, 2009

For this internship with the Foundaton for Sustainable Development, I was working at a public
clinic in the rural community of Las Salinas, which is staffed by one doctor and two nurses, and is in custody
of five communities (some 4,000 people). the provider:patient ratio is
quite staggering... on top of the fact that we do not always have the
medicines that we need - we did not have acetaminophen for a good month
and a half, which is sobering, considering fever is one of the most
common afflictions in the community. During my last week here, a
23-day-old baby girl died of high fever in her home in the middle of
the night - there were other complications, as she was born with sepsis
- but even if she HAD been brought to the clinic, we wouldn't have had
the medication to treat her. The community is a two-hour bus ride away
from the nearest hospital, and the roads are really horrible,
especially in invierno, or the rainy season, (which started about the time I arrived). The locals
here tell me that in October and November, the roads are impassable;
the water levels get so high that some have to leave their homes in
search of higher ground (not to mention that the water is contaminated
by all the garbage that is strewn all over the place - there is no
garbage collection system, nor a landfill). A plethora of other
problems plague the community - they only receive 8 hours of running
water every day (on some days, there is no running water in the clinic). It's pretty amazing the things they let me do...for the last 3 weeks I basically ran the pharmacy, entering the reports for the medications we prescribed, dispensing medications; I also ran rapid HIV tests, gave some injections, even performed what my supervisor cheerfully told me would have been recorded as minor surgery AFTER the fact (my host sister's toe was clipped by a passing bike - not a pretty sight, and I had to fix it.), taking care of my fellow intern's host grandmother after she fell from her bed as a result of low blood sugar (she's diabetic... BOOYAH. how's that for those EMT skills)

In addition to helping with the daily functions of the clinic, I am
pursuing a project called “Plan de Parto,” which aims to reduce the
incidence of maternal and infant mortality in the community. This is an
extremely important topic, as well over 80% of pregnant women in the
communities have at least one or two risk factors for pregnancy
complications (e.g. mothers younger than 19 or older than 35, high
blood pressure, lack of access to health care facilities). We mobilized
community members to form committees that oversee the organization of
various activities concerning the health of pregnant women in the
community. They are responsible for conducting a census of all the
pregnant women in their respective communities and creating a map, so
that local community health workers and midwives know exactly where the
pregnant women live, in case of an emergency. We held educational
workshops on nutrition during pregnancy, possible complications during
childbirth, breastfeeding etc. I thought it would be more engaging to
couple the health lectures with more tactile activities such as making
our own healthy refreshments that were rich in the nutrients we had
discussed during the workshop.
We also wrote a letter to the
municipal office of the Ministry of Health in Tola to request visits
from Ob/Gyns to give consults to the pregnant women in the community at
least once every two months. Without this service, most women go
without sonograms and other “standard” prenatal care procedures – they
can get these at private clinics, but this expenditure is well out of
the reach of almost all women in the community.
In order to make
the activities of these committees sustainable, we have also been
holding handicraft sessions, where the women share their skills in
knitting, crocheting, embroidering and other crafts. Even before my
internship ended, we were already selling these products in the
community, and we hope to extend our market to local fairs and nearby
hotels in order to generate a fund that will fund future activities of
a similar nature (buying materials, etc) and serve as an emergency
fund, in the case that a pregnant women needed to go to the hospital in
Rivas but did not have the economic means to do so.
To integrate
other community members into this endeavour, I also created a sign up
list where people who could provide transport to the clinic/hospital or
girls who could help out with domestic chores during the last trimester
of the women's pregnancies could put down their contact information.
Ideally, this would also generate some employment within the community..

All in all, I hope that these activities can build community and
systems of information sharing between the people of all these
different communities through the activities of "Plan de Parto"


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