By Madysen Kovac and Sonia Ros
Passing through Las Pilas
Cock-a-doodle-do! What is the best way to start your morning, you ask? What is better than a wake-up call from a rooster at five am! Roosters freely roam around the hotel we are staying at and they made sure we were up and ready for our trip to Las Pilas. In Las Pilas, we visited the local clinic where there are two nurses and a doctor to serve 2,500 people. Here they do general consults for pregnant women and other types of preventive care for the remainder of the population. Just as in the clinic at Tola, this clinic works with the community leaders on health prevention. One of the communities that this clinic services is called Guacalito. This community is incredibly isolated as it is surrounded by resorts and they have been forced into isolation because they refuse to sell their land to other companies seeking to build resorts. For this reason, they are hesitant to let people into their tiny 9-house community.
This clinic sees anywhere from 10 to 50 patients a day, and just
like in Tola, this clinic has a quota of patients to see per month. Nurses must see 100 patients a month and doctors must see 410 patients a month. This can be stressful because the nurses are already stretched so thin seeing patients. On top of that, they are also responsible for completing administrative work. Additionally, it is difficult to get to work itself, as the nurse who was speaking with us takes a bus to Tola and then hitches a ride the rest of the way. The only time the bus comes is at 6am or 10am, so there is not much flexibility.
Across the street from the clinic in Las Pilas is an elementary school. Here, we were able to use one of the classrooms to do a health presentation for the community. Two of our Emory students presented on the topic of nutrition and taught the children about the MyPlate initiative in the United States. The presentation was interactive with the children and the kiddos seemed to know their stuff. Two other students presented a language nutrition program from the United States called, “Talk to Me Baby.” This program encourages mothers to start talking to their babies in utero and continuing to use complete sentences and new vocabulary to speak with the baby. This has been proven to help their neurodevelopment and vocabulary acquisition.
La Casa of the Community leader
We were welcomed into the home of the community leader in Las Pilas with open arms, and when I say open arms, I literally mean, open arms. She hugged each and every one of us as we stepped over the threshold into her home. She made sure everyone was comfortable with a place to sit before she began telling us stories about her life as a former Midwife and current community leader.
In her role as a Midwife, it was evident that she had seen it all. In the past, midwives had no formal training, but trained generation to generation through the passing down of knowledge. This is no longer the case as midwives are required to have formal training. She still incorporates many of the things passed down from previous generations in her practices; however, she recognizes the importance of the formal training. For example, traditionally, a woman was only supposed to give birth on her knees and this was the only accepted birthing position. After MINSA trained her about the dangers of that, she was able understand why other positons should be used.
Another interesting story that came from her tales about being a midwife involved her role in the revolution in Nicaragua. During this revolution, she was both a soldier and midwife. She told a story, creating an impressive mental image in our heads, of how she had her ammunition strapped to her waist, her firearm on her back, and her boots on. But at the same time, she was delivering babies. Dr. Quitana, who has known her for many years, speaks highly of the bravery of this woman during the revolution.
As a community leader, she and other volunteers, called brigadistas, go out into the community and collect blood samples, give medicine, and spread knowledge about the importance of health prevention and immunizations. Being a community leader is not a paid position. However, there is much responsibility associated with it, and for that reason, it is a highly-respected role in the community. Those who become community leaders have a reputation that precedes them and are trusted implicitly.
Student Reflections and Funny Moments
The community leader in Las Pilas asked us what our favorite thing about Nicaragua had been. A fellow student was pleasantly surprised at the willingness of the nurses and the people in the community to come together and make such a concentrated effort towards health. The student was mostly surprised because she felt like that was not something that commonly happened in the United States. Another student spoke about the natural beauty of Nicaragua and how clean the country appears, compared to other experiences in developing countries.
While we were visiting with the community leader in Las Pilas, there were many animals roaming about freely. I spotted dogs, ducks, hens, roosters, pigs, turkeys, and even cows. As I looked out to admire the view, I saw 3 baby ducks with the mom duck being chased by a pig. In what was faster than a blink of an eye, there were only two baby ducks. The pig had eaten the baby. Many of the students who saw it were surprised and I certainly wasn’t expecting it and in the moment! I gasped! I suppose that’s just the circle of life. Speaking of animals, our instructor Gladys milked a cow. She almost got peed on by the cow, but emerged triumphantly with a few drops of cow’s milk.