Sunday, March 29, 2009

Alaska and Nicaragua: Could there really be similarities?

I know what you’re thinking – Alaska and Nicaragua couldn’t appear to be more different places. In one, some schools in the north don’t cancel recess until the temperature reaches below -20 F. In the other, people refer to the weather as “freezing” when it dips below 70 F. However, during my approximately two months here “in-country” I have been noticing too many similarities between these two places to not write a blog entry about it. Overlooking the many nuanced differences in culture, demographics, government, physical location, climate, etc. I have observed quite a few similarities between my home state and my host country.

The first similarity I noticed was in the rural life and remoteness of many Nicaraguan and Alaskan regions. Some Peace Corps volunteers have been placed in sites that are up to 12 hours away (by bus or boat) from the capital of Managua. Even in my own site, in the north of Nicaragua (and readily accessible from Managua) people often must travel to the Health Center from the surrounding communities, walking up to three hours on foot or by horse. This instantly reminded me of Alaska. I was born in a community that only had float plane access and weekly ferry service. In the “bush” of northern Alaska the situation is much worse, especially in the winter, and snowmobile and small plane use is often the only means of transportation. In both Nicaragua and Alaska, residents of these rural, small villages need to buy their groceries and daily necessities during bi-weekly or monthly trips to the regional hub – a trip which may take up the entire weekend. Although I don’t think that Nicaragua has a Costco or Sam’s Club to stock up on bulk items like we tend to do in Alaska :)

Alaskan pregnant women who live in the isolated small communities have to come into the larger city where the Health Center or Hospital is located weeks before their due date to ensure a safe delivery, as the medical personnel and supplies are limited in their home village. My own mother had to first travel by float plane out of our small fishing community with a population of a few hundred, and then by jet to give birth to me in Washington. I was surprised to learn when I arrived in Nicaragua that they actually have special “Maternal Houses” in most departmental capital cities where these pregnant village women can live while they are awaiting a birth for free. (Maybe this is something Alaska could consider!)

I’ve also noticed that in Nicaragua, just as much as in Alaska, people in these small, remote communities have very strong ties to one another and their family and friends are held close and relationships are not superficial or sporadic. People have known each other’s family’s for generations. There are no secrets in small towns, as we Alaskans well know, and perhaps even more so in Nicaragua this is true. In Nicaragua, families often are “extended” to the point of up to twelve people living in a two-bedroom house. Children are raised just as much by their Aunts and Grandmother as they are by their Mother or Father. Cousins, second-cousins, adopted brothers and sisters of all ages are common and the word “family” often includes half of the town you live in. I think this is true of some Alaskan villages just as it is here in Nicaragua. Since isolation and lack of stimulation are common to both places, it is logical that family members would support and be involved in the lives of each other.

Another similarity I have noticed is in the economic situation of the rural communities. Alaskan villagers are struggling to heat their homes as the price of fuel rises, and this affects everything else that is brought in by barge, plane, or vehicle to the community including food. Nicaragua is a poor country (2nd poorest in the western hemisphere I believe), but in the Nicaraguan rural villages, this poverty is augmented by a lack of job opportunities, limited access to electricity and running water at times. Compared to those who live in the larger cities, such as Managua in Nicaragua, or Anchorage in Alaska, the economic situation of rural villages is strikingly different. The health of the community is correlated with this, and more respiratory illnesses, diarrhea, maternal and infant mortality, etc. is seen in the rural areas.

Nicaragua, like Alaska, has a strong presence of Non-Governmental Organizations (NGOs) that are doing the work the government cannot or will not. Alaska has the highest per capita number of NGOs per person, and in Nicaragua I see a similar situation. Development workers from Japan, Spain, Germany, United States, and Denmark are the most common. Unlike Alaska, many of the projects are infrastructure-related rather than socially-oriented. However, the culture of development, the target-audience in the small communities, single mothers, and homeless persons, are the same.

The diet in Nicaragua also resembles rural Alaska. Junk food and soda replace fruit and vegetables more than they should (although they are readily available here in Nicaragua). In both places, Type II Diabetes rates are high in both places, and childhood obesity is rampant. And in both Alaska and Nicaragua, this disease has disproportionately higher levels in the Indigenous populations.

Some of these comparisons should be taken with a grain of salt, since I realize that Alaska is part of a developed nation and these similarities may be more superficial than I have seen them to be in the past two months. Being able to see these similarities has helped me tie my work here as a Health Volunteer back to my previous life experiences, and I can think of strategies and reasons for behaviors that may be similar. When I go out on a “salida al terreno” (a visit to outlying communities) to go house-to-house to administer health surveys, it helps me to think of the family I talk to as being not that different from an Alaskan rural family. Replace the chicken and cheese they are eating with moose meat and herring eggs. The chickens running around the yard with sled dogs. The horse grazing nearby with a snowmachine (as they both are used for transportation). While some Nicaraguans must collect their water from a community well, many Alaskans who live in “dry” cabins without running water must do the same, although they usually haul it in their pick-up truck rather than by donkey. The husband who works seasonally in the coffee here in Nicaragua could be an Alaskan man going to fish, or to work in the oil fields on the North Slope for weeks at a time.

So it seems, although I’ve traveled halfway across the Americas, I can see glimpses of familiarity in my new country.

Sunday, March 15, 2009

HIV/AIDS breaking down my reservations

Before my Peace Corps training here in Nicaragua, I wouldn´t have been able to summarize with much eloquence what HIV/AIDS was. Thanks to hours of training in just that topic however, I have made leaps and bounds in my comfort level in talking about these subjects and have even done things, (in the name of education) that I would never thought I would do in my life.
When Human Immunodeficiency Virus (HIV) enters the body, usually through unprotected sex (at least here in Nicaragua), it begins attacking the body’s immune system. The white blood cells are overtaken and slowly killed as the virus multiplies, and over the years debilitates the immune system and develops into Acquired Immune Deficiency Syndrome (AIDS). Once a person has developed AIDS (it can take anywhere from 5-15 years from the initial infection date), they are easily susceptible to opportunistic diseases such as tuberculosis and pneumonia, or even the flu, which attack the greatly weakened state of the immune system and cause death.
The past week, my training group was immersed in five days of intense HIV/AIDS training. We began learning about NGOs present in Nicaragua and their diverse target audiences and mediums. Some NGOs were funded by USAID and had different agendas from, for example European, or World Bank-funded organizations. We saw NGOs using soap operas and radio shows to get out the information, youth groups, conferences, health care worker trainings… For all of this training, my group traveled to the Department of Chinandega, which is in the north of Nicaragua and due to its border with Honduras and port location, this department has the highest rate of HIV/AIDS in the country. Despite being in the north, it is also famed for being the hottest department of Nicaragua, and after sweating constantly for the entire time we were there even after taking two showers a day, I can now attest that that is true.
Our training group was split up into teams of 3-5 and we gave educational talks at high schools on STDs and HIV/AIDS prevention, and also to a much more intimidating audience; sailors at a naval base. Men are the “target” audience here in Nicaragua to talk about HIV/AIDS since they are the transmitters of the virus. They are the ones having extramarital relations and bringing HIV back to their wives. They are the ones who refuse to wear condoms, and don’t believe in getting tested. At the naval base, the sailors were full of machismo, scowling, wearing their uniforms, and not excited to hear what we had to say. Needless to say, it was a tough crowd.
Talking to these men about the difference between HIV/AIDS and how to avoid infection is one thing, but then there is the practical application piece of the presentation. Could I stand up in front of a group of people and show them how to use a condom on a wooden dildo? No thank you… However, it’s not really a choice in Peace Corps. This is practical information that these people need to have. If they saw embarrassment or unwillingness on my part, they may be less likely to use one themselves. We have been told that many Nicaragua men and women simply don’t use condoms because they don’t know how to use them, and they are too embarrassed to ask. If these demonstrations will help reduce the number of STDs, HIV/AIDS infections, and unwanted pregnancies….well, then I guess I can do it.
After observing quite a few demonstrations by other volunteers and staff, and memorizing the “seven steps to using a condom,” I finally felt ready during our Chinandega trip to give it a try. What the heck, I’ll probably never see these people again, right?
The first one I gave was actually an impromptu decision I made to get it over with while we were at a billiards tournament aimed at increasing HIV/AIDS education in older men. It was held at a billiards hall (picture this: florescent lighting, smoke, beer, rum, and men of all ages yelling and laughing over pool. No women in sight.) Sort of like an Alaskan bar actually… All of us trainees were gathered there to observe a pool tournament that a current Peace Corps volunteer was organizing. He would give talks about HIV/AIDS in between the rounds of pool, and when the final two players were left, they had to answer questions about the previous presentations in order to win. A local NGO had agreed to donate the prize money, which was USD $100 - more than most people make here in a month. Needless to say, the men were all riled up about the tournament and really engaged in the talks that were being given and in the games that were being played. During the last round you could hear a pin drop in that room of 100 drunk men as they stopped their yelling and listened intently to as the Peace Corps Volunteer asked “What are the four fluids that transmit HIV/AIDS?” The winner was hoisted on men´s shoulders and the noise was audible for blocks, I´m sure.
At a nearby table, there were some representatives from a Nicaraguan NGO helping younger men learn how to put on a condom using a wooden dildo (an integral part of our Peace Corps tool kit). I walked over to observe and realized that they were doing it “wrong.” After a minute or so, I guess they noticed my puzzled expression as I watched them, and they asked me if I could show them how to do it better (in a sarcastic tone of course). I don’t know what got into me, but all my fear about working with machisto, cat-calling, intimidating Nicaragua men disappeared as I proceeded to go through each of the seven steps. From what I hear from the other trainees who were watching, it got quite a bit of attention, and surprisingly, the men didn’t give me a hard time, but they actually gave me a big round of applause when I had finished the demonstration and the NGO representative turned to a few of them and challenged them to do it as well as I had.
Sometimes, I wish I was a male volunteer here since they get more respect, people are friendlier, they are gossiped about less, and women come over to cook for them and do their laundry. However, this past week of HIV/AIDS education and practical application helped me not fear being an American woman and attempting to work with Nicaraguan men. I realized if you are professional and confident, they will listen to you, and with time, maybe respect you as well.
As our week of training went on, I could feel my reservations and nervousness about these intimate topics being broken down slowly with the support of Peace Corps staff, my fellow trainees, and hands-on experiences. As I acquire these skills, I also feel more self-confident, sure of myself, and empowered to facilitate behavior change in others. If I would have been told I would be doing a condom demonstration in a smoky bar, or talking about the female reproductive system in front of a group of middle school students before I came here, I probably would have laughed at you. However, I am in the second poorest country in the western hemisphere, surrounded by different problems, and I have realized that these problems are bigger than my embarrassment. If the end result will help this country to improve their health situation, then that’s my job as a health volunteer. Soon, I too will be the proud owner of a wooden dildo to give condom demonstrations to women and men, and will be talking about other embarrassing or sensitive topics such as puberty, spousal abuse, sexual rights, and adolescent pregnancy. If I can do all these things without blinking at the end of two years, then I will be ready for anything. Wish me luck!