Women's Foundation trip to Quilali for Treatment

On January 18, Hannah accompanied a group of women to the Hospital in Quilali, as part of her work on behalf of the Women’s Foundation. Quilali is another municipality in the department of Nueva Segovia, 2-3 hours from Jalapa on bumpy dirt roads. We transported the women in one of the converted Land-Rovers that are the Jalapa ambulances.

FMJ coordinates with the Nicaraguan Ministry of Health (MINSA) to bring women who need pap-smear follow up and cervical cancer treatment to the gynecologist in Quilali, as there is not a gynecologist in Jalapa. Women also go to Ocotal, Esteli, and Managua, in extremely grave cases. For the Quilali trips, the Jalapa hospital donates an ambulance to bring the women to Jicaro, a neighboring municipality about an hour and a half away. Ramon Iban, the director of Jalapa’s hospital, coordinates with the hospital director in Jicaro to use one Jicaro’s ambulances for the second leg of the trip.

When we arrived in Quilali, the hospital was nearly empty so they attended to us right away. We were luck with this, as women from the foundation told me stories of waiting up to 5 hours in the hospital before being seen. . . We were also lucky, because the 5 women who went that day didn’t need any major treatments- some just needed a consult on their most recent results, and/or follow up paps. Everything went well; we were blessed with all good news!

Although I am a stranger and not technically part of FMJ, I felt the women lean on me for support, as I checked them in at the hospital, helped them read (and explain) their results, and had to track down the hospital director in Jicaro, who forgot to tell his staff we could take the ambulance- never taking “no” for an answer- even when I had to personally go to his house and pull him out of bed on a Sunday morning. That is another story in itself, but each step of the way, walking in FMJ’s shoes, I realized how much of a difference their work makes.

Everyone was relieved on the long ride home, and we passed the time telling stories and discussing our experiences. The women agreed that FMJ’s work was invaluable to their comfort dealing with their health problems, and that they felt personally cared for by the foundation, who hunt them down, making sure they know when their appointments are, and ensure they arrive for them, and coordinating with MINSA to make getting there easier.

ISLA VISIT

We spent the last two weeks working almost exclusively with the Women’s Foundation of Jalapa (FMJ), in anticipation of one of ISLA’s quarterly visits. ISLA (Interfaith Service to Latin America) is another NGO that works in Jalapa, and they do cervical cancer screening follow-up for Jalapeña women, as cervical cancer incidence is very high here, due to a largely untreated HPV epidemic. Cervical cancer is often preventable if women follow-up on abnormal paps. ISLA’s medical goal for the visit was to perform 500 paps, and administer care for women whose previous paps were abnormal.

To meet this goal, ISLA called upon the Women’s Foundation to mount an advertising campaign in 139 communities, some 20 km or more outside of Jalapa, on bumpy, washed out dirt roads, off of bus routes. The Foundation arranged ads with radio stations, and made and posted hundreds of posters (using their own $$ to pay for supplies and transportation) inviting women to come. They travelled by bus, moto, bicycle, taxi, and on foot, walking around communities, asking business owners to let them hang posters. Since the women of the foundation are all small business owners themselves, they must close their shops to do this work. Dan and Hannah decided to pause other FCP operations for the week to help out, so the women would only have to sacrifice 1-2 days each, as they would also be closed to work with ISLA the following week.

We also delivered normal results from ISLA’s October visit (See 10/19 blog for a full report) and “citas,” for follow-up to women with abnormal results, from both ISLA and MINSA, (the Nicaraguan Ministry of Health). Since addresses here are, “from the Catholic Church, 30 paces north,” etc. finding women can be tough, but it’s generally possible. If you ask around, people point you in the right direction.

When ISLA arrived on 1/15, we had a lovely dinner and meeting at Cafetin Mama Chunga. We created a work plan for the ISLA medical team, FMJ, and the FCP reps for the week. In addition to the pap drive, FMJ and ISLA coordinated a series of educational Charlas, or “Chats,” about cervical cancer screening, in hopes of mitigating the fear and embarrassment that prevents women from coming in. FMJ planned each Charla to occur before a captive audience- at Preindustrias, or tobacco processing centers, as women worked.

Beginning the 16^th, part of the medical brigade worked at Jalapa’s hospital, and 2 other groups piled into the back of a big truck, with trunks full of gear, and headed to different community health centers to bring services to people who live out of town. FMJ women took patient data, answered questions, and checked people in. Hannah worked as a “floater,” so each day was different. She spent time alternately checking people in, taking patient data and translating for the ISLA doctors as they administered paps, and one day attended a Charla in one of the tobacco barns.

Hannah and Dan attended a Charla in San Judas, (about 10k south of Jalapa) with Heather Danckwart, a med student at The University of Minnesota. We arrived feeling lost, but we checked with the supervisor and he allowed us to enter and “do whatever we wanted,” as long as we didn’t interrupt the work. We wandered into the dark structure, lit by fluorescent lights and sparse, small windows, and were immediately stunned by the dense, musky, presence of mountains of dried tobacco. It was unlike anything we’d ever experienced-- though Dan is an avid smoker—there was a thick chemical quality to the air that penetrated one’s lungs, as if we were inhaling raw gasoline fumes.

From the middle of the room, Heather discussed HPV and cervical cancer. She encouraged women to come in to get screened. Hannah translated and afterword, they took questions. The women were shy at first, but they warmed up to us as we walked around. We were aware of how important it is to have someone from FMJ at these events, as women are more comfortable asking questions to people who share a common background and culture. Just the same, we felt like we reached a lot of women, many of whom had never had a pap before.

In the end, the brigade did over 475 paps, as well as many colposcopies and general consults. The ISLA doctors were very pleased with FMJ, and continue gaining confidence in their integrity and organization as a group, as this is a relatively new relationship. They noted that the trip’s success was largely due to FMJ’S work, and they were also very grateful for Dan and Hannah’s help.

Workshops, Elections, Pause.

We spent much of the second half of October 2008 in the office, discussing logistics, creating a quarterly budget proposal, and Karla continued to show us her work system and give us background on FCP’s current projects and community engagements. We also met with some of the many organizations that FCP works with in Jalapa, and we are realizing that we have a lot of work ahead; that the need here pervades most conceivable sectors of life, from basic things like food and water, to other, less obvious issues like access to community activities, art and cultural events, health care, and education.

On 10/27, we went to Champigny for a meeting with community leaders. This is a barrio in Jalapa that is notoriously divided and with whom FCP has had issues working with in the past. We planned to meet with several people, but few came. Ultimately, we confirmed that there is a lot of burning anger in the community, especially within the leadership. There are also problems with the water system, and service is intermittent. We feel some responsibility to this community, though FCP’s work formally ended when we completed the water project. One of the people we met with pushed for a community-wide assembly to discuss the issues, and we suggested revisiting this option after local elections on 11/9, when the political situation would hopefully be calmer.

We share hope with Champigny because while this community is divided and disorganized, there is a tangible interest among people to improve the situation. During our meeting, people crowded around the windows of the Casa Comunal to see what was going on, adding insight to the conversation. We’re not sure what we can do, but we hope that we can facilitate something
positive, working with the leaders to build bridges between the many “islands” of influence here— to help them work together to facilitate the changes their community longs for.

Dan now attends classes four afternoons a week with Javier Aguilar, ISLA’s in-country coordinator. We met Javier through our work with ISLA and the Women’s Foundation (FMJ). Javier speaks excellent English and shares this knowledge with Jalapeño youth by offering English classes Monday through Thursday. Dan helps the students with pronunciation of English words, and in turn, they help him to learn Spanish. He comes home from each class with a homework assignment!

On 10/29, we met with Don Isidro Traña, the head of UNICAFE, an Nica org. that works to improve conditions for small coffee producers in Nicaragua. UNICAFE hopes to liberate cafeteleros from dependence on unpredictable coffee markets by diversifying their income base and improving the quality of their coffee to bring a better price. UNICAFE’s work in Jalapa is currently focused on Santa Rosa and another community, as the needs are most profound there. Since Santa Rosa is also a Huertos community, it is natural that FCP would work with UNICAFE
to serve the joint ends of both organizations.

Don Isidro invited us to a coffee-quality workshop the next day in Santa Rosa. There were representatives from UNICAFE, CATIE, CCAJ,and Café Nica, as well as 20ish campesinos from Santa Rosa and other communities. We learned about standards for coffee production and quality rating in Nicaragua. Some producers gave samples of their coffee to Café Nica earlier, and the rep. from Café Nica went over the quality report for each of the samples and described how to improve quality. We did a coffee tasting that took about 2 hours. Overall, the workshop was very informative, and it was exciting to see campesino a campesino (a methodology based on horizontal learning, where people exchange knowledge, instead of learning from lecture) in action.

On Friday, Karla and Hannah went to a women’s health/STD workshop with FMJ. We learned about HIV/AIDS epidemic, HPV, and how people can protect themselves. There is an ever-growing movement here, mostly directed at youth and women, to promote better sexual health practices and raise awareness about the risks posed by STDs.

On 11/3 and 11/4, Karla went to a workshop on behalf of FMJ in Matagalpa. This workshop was the last of 5 workshops , hoping to educate organizers on different themes, enabling them to more effectively work in their world. The program is specifically focused on women’s groups, as they often become targets for sabotage and are attacked as “money launderers” for receiving the funding they do while employing imperfect accounting practices. In many ways, Nica women suffer prejudice- the more empowered they become, the more trouble they recieve from machista men who are threatened by them. The people giving the workshop invited FMJ to participate, in hopes of augmenting the workshops they give to the women of Jalapa. These workshops remain pending.

The early days of November were slow, with Karla in Matagalpa for the workshop, and Dan and Hannah out of town for about a week to catch the US presidential election with other American friends on holiday. The two days following our return were consumed by the local elections, which are critically important to Nicaraguans, and only occur every five years. Sandinista caravans have been blazing the streets at all hours bearing flags, music blaring, and trucks, bikes, motos, cars, horses, and all other imaginable modes of transportation laden with excited people triumphantly declaring victory. To look at it, one would never know that the election in Jalapa was actually very close.

At any rate, we look forward to getting busy again tomorrow.

İBIENVENIDOS A JALAPA!

When we arrived in Jalapa on October 8, we were greeted with more pomp and circumstance than we could have expected! Our local board, Pueblos Unidos, came together to throw a magnificent welcome party, complete with traditional Nica music and dancers, and delicious food- enough to feed a small army. We were made to feel very at home and welcome, from the outset.

We spent the past two weeks with Karla, (FCP’s in-country Nica rep), exploring the Jalapa Valley, meeting the communities that FCP works with, getting acquainted with current FCP projects, and discussing needs and ideas with beneficiary communities. Karla updated us on her work for the last 10 months, and we’ve been amazed by all she has done; keeping everything running smoothly, and initiating new connections and projects! She participated in a nutrition workshop this week, as part of her ongoing collaboration with FEDICAMP (another local development organization), on top of all her work with us.

The Huertos (family gardens) project is currently in pause because of the rainy season. The heavy rains wash away newly-planted seeds and bring plague to mature plants, so people are waiting until mid November to plant again, when the rain subsides.

On Monday, we met with the Guitar Cooperative and discussed thoughts on a fair-trade market for their (beautiful, AMAZING) hand-made guitars. We also met with the leader of a dance troupe that provides free dance classes for Jalapeno youth. It is really exciting to learn about the great things happening in Jalapa, and start thinking of ways that FCP can support them. We are looking forward to getting things moving, after this introductory phase.

This week ISLA (Interfaith Service to Latin America) arrived with a brigade from Minnesota. Cervical cancer is rampant in the Jalapa Valley because for many years, women didn’t receive regular pap-smears, and when they did, necessary follow up was limited. There is a high incidence of HPV (Human Papiloma Virus, which can lead to pre-cancer) here, and many cases that could be mitigated become cancer. To help with this problem, ISLA gives free pap-smears and follow-up treatment to Jalapeña women.

Karla and FCP work with the local women’s foundation (Fundación de Mujeres Jalapeñas- FMJ) to support these brigades by ensuring that women arrive for their appointments, and by delivering the results when they come in. FMJ also provides education and outreach to underscore the importance the entire process.

FMJ is a volunteer group of women who came together when the previous system proved inadequate in addressing women’s health issues and providing ISLA support during these invaluable visits. FMJ also works with the Ministry of health toward accountability and effectiveness in the gynecological sector. FCP’s former representative, Tamara Cyzyzk, helped with the formation of the foundation and FCP continues to provide some funding and general support for their work.

This work is long and difficult for many reasons. Many of the women who come for pap-smears and treatment live far from Jalapa and are nearly impossible to contact as they don’t have phones or specific addresses. FMJ must go directly to the communities and ask for the women by name, to ensure that they come for their appointments when ISLA is in town. There is still a lot of stigma and shame surrounding women’s health issues, and FMJ has been working for the last year to educate women about the dangers of cervical cancer and put them more at ease with prevention and treatment processes. The foundation provides counseling for women when their results are abnormal and assistance if they need immediate care, arranging for them to get the treatment they need in a supportive and nurturing environment.

It’s been inspiring to work with this group and to see the progress they’ve made. We were continually impressed by everything they’ve done and by their collaboration with ISLA to make their own work more effective.

One day, as Hannah and Karla worked with ISLA at the hospital, Dan went with the rest of the brigade (ISLA runs two other projects in Jalapa, aside from the women’s health program- more info at: http://isla.cc/index.html) to a coffee plantation (finca) in the mountains. They hiked through a virgin forest with giant Oak trees bearing giant acorns. These trees shade the coffee plants on the steep hillsides. There is an international movement to promote this type of coffee production, called “Café de Pajaros,” or Coffee of the Birds, because it is less intrusive to the environment, and preserves habitat for a milieu of rare and beautiful birds. Four varieties of Tucan live in the hills in and around the finca that Dan and ISLA visited. The owners of this finca wish to develop a sustainable eco-tourism base here, and with Dan’s trail building experience, he found this possibility particularly interesting.

Hasta Pronto, Da Repzzz.