A Bridge to Saint Peter

On 3/6/08, Dan and Hannah followed up on their November visit to San Pedro (see below). We went by moto, reducing the trip from 5 hours by mule to about 2 ½ hours. We left the bike at a pulperia (convenience store) about an hour’s walk from San Pedro and surveyed the trail as we went.

We met at Juan Quintero’s home, where we stayed in December, and met with several of his family members and the Alcaldito, or “Little Mayor,” of the town, who is San Pedro’s CPC representative at the Municipal Assembly. We discussed our ideas and expectations, and we were surprised to hear that many people expected us to build a highway- rumors are circulating that the Danish want to fund a real road between Jalapa and San Pedro. They assumed we were a part of this, as the first NGO people to visit San Pedro in 10 years or more. We clarified that we intend to focus only on what they reported as the “most grave” section of trail. We want to reduce the river crossings from 3 to 1, and construct a primitive mule-wide bridge that would clear the high water mark and make the trail passable during the rainy season. This disappointed them but they admitted it would be an improvement, since with the current trail they are cut off from Jalapa for several months during the rains.

They told us it’d be cheaper do the construction with machines from the mayor’s office, but we’d need 5 barrels of gas- at a cost of about $700. When asked where they’d get this money, they said they expected us to bring it. They were surprised when we told them that we don’t have that kind of funding, and we proposed doing raffles and other fundraisers, but they said they were “too poor.” We had assumed that the town would donate the labor (as all other communities have with FCP’s past projects) to build the bridge and gather raw materials (wood, stones, etc.), and when we proposed this, they again replied “we’re too poor;” they wanted us to give them money for gas or pay for their labor.

This was frustrating- whenever we proposed that the community share a stake in the investment, they responded, “we’re too poor.” I wanted to shake Don Juan- who we are relatively close with at this point- “are you telling me you’re too poor to donate a couple of work days from your nonexistant schedule build a bridge, so that your children won’t drown crossing the river; so you can bring your sick to the hospital; that will connect your town to commerce and provide (literally!) a road out of poverty?!” Instead, I took some deep breaths and explained this in calmer terms, adding that we chose this community only after they reached out to us, and so far, they have shown great organization, cohesiveness and motivation for progress. I also reminded myself that people here are used to receiving projects part and parcel, with no personal investment. Many orgs actually pay people to work on their own projects. This was the case in San Pedro when the the school was built 10 years ago, so they had reason to hope for it. We left town feeling disenheartened but as we thought through it, we realized how valuable FCP’s Huertos program is. Most communities are like San Pedro at first- completely disempowered by poverty, waiting for NGOs to bring them projects-- paying them to work . . . and feeding them. . . for 6 months while the project happens. We don’t experience this with new projects in the Huertos communities- they already understand that if they want something they’ll have to work for it- unpaid. We bring an initial investment of seeds and tools, and (with educational workshops) expect the beneficiaries to do the labor themselves. If they don’t follow through, their garden fails and we take the tools back. People learn that from a single seed, things can grow- this is the great metaphor of the Huertos. This seems to be very eye-opening whole communities, and facilitates work on future projects, as people understand that our role is to provide a seed that they will nurture and then reap. Not having gone through this in San Pedro, we are beginning well, at the beginning.

We scheduled another meeting for mid-April; we will invite all of the leaders and prominent families in town. We took names from Juan and we hope the ideas we planted on Friday will grow and that people will begin to think creatively about what they can contribute, enabling us to move forward with the project. At best, we were each certainly confronted with the realities of our conflicting assumptions, and all parties left the meeting realizing that some major reevaluation would have to take place to reach the compromises that will make this project happen.

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.

Huertos- Worm Composting Workshop

On 1/29, Karla gave a workshop in Santa Rosa on worm composting. Dan and Hannah attended to support her and to learn about the process. Karla discussed the characteristics and basic biology of the worms, and referred to a sample that she brought, of both the dried compost and the live worms in their moist, poopy environment. She talked about how to care for one’s worms, and noted dangers from common barnyard predators, such as chickens and ants, as well as easy preventions. Some of the people in the group had experience with worm composting, and offered other advice about how to handle and prevent predator attacks.

The worm farmer must check her worms daily; if not, she could return the following day to find them all dead! For example, one can give worms banana peels to eat, but don’t give them too much, or ants will sense the sweet sugar in the rinds, and invade the worm-box, eating the peels and worms alike. Additionally, one must give water and fresh “food” to the worms regularly, so they stay comfortable and happy. Interestingly, if one gives them too much food, they become lethargic and their compost productivity (ie eating and digesting) goes way down. One must be diligent to reap the full benefits of a worm box.

Karla ensured that everyone would have their worm boxes ready for her to deliver a “starter batch” of worms the following week, with elevated, covered wooden boxes in the shade to put the worms in. The people of Pasmata, where FCP did the pilot Huertos program a couple of years ago, donated the worms for this community to get started.

The workshop was well organized and informative, and people were eager to learn about the benefits of worm composting for their Huertos, and excited that someday they could sell the compost, bringing income to their households. There was even discussion of coming together to form a worm cooperative, once the worms reproduce and fill everyone’s boxes. A healthy worm box can produce over 200 pounds of compost every month, if managed correctly, which can be sold at a very good price, as it is rich in nutrients that help with foliage, fruit and root development.

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.