Sunday, April 26, 2009

Jornada de Vacunación – The Great Vaccination Campaign




Well, I’ve arrived in my “site” for the next two years, and what better way to be welcomed into a community than with a Tetanus shot?? Not for me, but for all the youth in the municipality. Every April marks the annual Vaccination Campaign in Nicaragua, something that the Ministry of Health despite its lack of resources and organization, does quite well. The Health Center staff is divided up into groups of two to four and “take-on” each small village at a time. There are 24 communities in my municipality, so they do three to four villages a day. After the past nine days of doing this (there are still two more to go), I am exhausted – and I’m not even vaccinating! The Ministry of Health workers have really amazed me with their energy every day, their care in giving the vaccines, and their attention to detail. The records system here consists of old notebooks marked with faded pencil. The dates of past vaccinations are frequently illegible, and often we come across a child whose mother doesn’t remember when he was born, or a child who has not been recorded in the national census. These health care employees have been working for this Health Center for years, if not decades, and they practically can recite the names of all the children in the surrounding villages; no small feat in Nicaragua where women have children almost annually.

So every day, starting promptly at 8 am (in “Nica time” that means about 8:45) all of the workers fill up the American Red Cross donated coolers full of anti-polio drops, Tetanus, DPT, dT, MMR, Rotavirus and Pentavalente vaccines, grab a disposable cardboard sharps container (donated by Norway), paperwork listing all the children and “MEFs” (women of “fertile” age), anti-parasite pills and Vitamin “A” drops. We all climb in the back of the Health Center pick-up truck and take-off for that day’s communities. As we weave along the dirt roads up into the mountains of the north of Nicaragua, we all find ourselves clutching to whatever object is closest to avoid falling out: a shoe, a leg, a shoulder, a vaccination cooler… Crossing small rivers, stopping for cows to cross, and occasionally picking-up a hitchhiker, the trip is anything but uneventful. I really enjoy looking around and seeing all the flora of Nicaragua. Mangoes, bananas, coconuts, limes, oranges, and corn abounded. If we were lucky, some of the mothers or village health care volunteers, “brigadistas” would gift us some of these summer treats. Note from my experience: mango can be a very messy fruit that permanently tints anything it touches (face, hands, clothes) bright orange. Should be avoided when one does not have soap and water…
We are gradually dropped off in our vaccination teams, and we head to the house of the brigadista who is in charge of that year’s vaccines. Ideally, ideally, that brigadista will have already notified all the parents in the village of the date and time that they should come to the vaccination house, and the parents will arrive punctually and with their child, who is no doubt, ecstatic about the thought of receiving his vaccine. But of course, being the real world, sometimes parents wouldn’t come to vaccinate their children, because they forgot, or also because they, like their children, don’t like vaccines. There is a lack of education about preventative medicine in Nicaragua, and most parents avoid the vaccination campaign, not knowing that they are ultimately hurting their child. My role during the vaccination campaign was to support the nurses and doctors doing the vaccinating and tabulating of children. I gave out anti-parasite pills, handed out balloons, helped hold down screaming children, explained to parents what each vaccine was for, and also gave mini-talks about diarrhea, malaria, purification of water, etc.
After we had spent the morning at the designated vaccination house, it was time to track-down those children who hadn’t come to receive their vaccines. This wasn’t always easy since streets here don’t have names, houses don’t have numbers, and people are more peripatetic (yes, I used it in a sentence!) than Humpback whales. This was the part that wore me out usually, since we had to hike up and down windy roads in the 94F heat to search out a lone house which contained perhaps just one four-year-old child who needed her anti-polio drops. However, as one of the nurses told me as we hiked, “We have goals to complete!” (Each municipality has Ministry of Health determined numbers of vaccines given they try and reach). Often, we found ourselves wandering the village, asking passing children if they knew where “Doña María González” lived, and if they knew if her “niño” was with her, only to be met with blank stares or a shrug of the shoulders. We usually ended up returning to the Health Center at 4 pm or so, to do the entire process again the next day in another far-flung village.
Although the heat and the long hours of waiting for mothers to arrive with their children took a toll on me, I really enjoyed getting out into the small communities to see how people live in my municipality. There are 6,000 people living in the immediate town where I live, and 16,500 in the entire municipality. What I saw and heard during the vaccination campaign really helped me gauge the health of the municipality. In some communities, people barely had latrines, and pigs and cows wandered loose, their feces littering the yards of the houses, causing danger for the barefoot children who constantly played in the dirt. Other health volunteers in the villages told me of contaminated well water which they believed was making the children sick. They said that people were bathing in the well and washing clothes, infecting the water. In other communities however, I saw glimpses of hope: mothers that were “planning” (using a method of birth control), children who looked healthy rather than hungry and full classrooms at the elementary school.
I’ve yet to tell you though my favorite memory of the vaccination campaign. One evening, I was at the Health Center making a bulletin board about vaccinations to put up in the Center, when my counterpart realized that we had yet to announce to the city that we were vaccinating tomorrow. “I almost forgot!” she exclaimed, “Let’s get the megaphone quick!” I would have burst out laughing, but I was already familiar with what was coming. In Nicaragua, when you need to announce something to a large group of people (say, a town of 6,000 like mine), you do so not by radio or poster, but by a huge megaphone strapped to the roof of a vehicle with a microphone attached, and you drive all over the city saying what it is you need to announce. “Come on Penny, I need your help.” She beckoned towards the truck. Her voice was almost inaudible because of a bad cold, so I knew it would be me who would be doing the announcing. Great.
We hooked up the microphone to the Health Center pick-up and started sounding the emergency alarm of the vehicle to announce our presence as she pulled us out of the Health Center and down the streets of the city. She had advised me on what to yell: “Attention! Attention! Mothers of children! Tomorrow we will be vaccinating all children under 5 years old at the brigadista’s home in your sector, the house of Don Luis Cruz. After 9 am bring your child with their vaccination card to be vaccinated. There will be candy, clowns and balloons! If you do not bring your child, we will come and find you!” It’s a pretty funny, but actually a very successful way of getting a message out, since most Nicaraguans are always at home with the doors open, chatting with neighbors or watching TV. I can just imagine them thinking, “Where did that gringa come from and where is her voice coming from?” as we drove around the city for about an hour, my voice becoming hoarse by the end.
I’m looking forward to sleeping-in after this whole campaign is over, but I feel pretty satisfied, even if I’m just borrowing the glory of the dedicated Health Center employees. If there remains any child in Nicaragua who has yet to be vaccinated by the end of this campaign, it won’t be because we didn’t try!

Sunday, April 19, 2009

Officially Volunteers!

Last Tuesday “Nica 49,” as my Peace Corps group is called, (the 49th Peace Corps group in the country) was sworn-in as official volunteers. We are no longer trainees! Our two years of service have now begun. The ceremony was very nice, held in the best hotel in Managua, with all of our host families present. The U.S. Ambassador Robert Callahan was present to lead us through the oath in English, and the Director of the Nicaraguan Ministry of Health Dr. Solis was also there to do the oath in Spanish. The Peace Corps Country Director, George Baldino said some wonderful words, talking about the number of children who die each day in the world from things like malnutrition and preventable diseases. His words were sobering, but he told us that the only way we can react to shocking statistics is community by community, person by person. This is why, he told us, we are here as Peace Corps volunteers in Health. These behavior changes and community education are often the most successful when done on an individual basis. The U.S. Ambassador also told us that we are the real face of the United States that Nicaraguans will see and know. We aren’t Hollywood actors – we are real Americans who will exchange our culture with Nicaraguans. The three goals of Peace Corps are: To impart technical skills to countries that request Peace Corps services, for Americans to learn more about other cultures, and for the host country nationals to learn about the U.S.
As I start my service, I will keep these three goals in mind. Part of that, actually, is this blog you are reading. I know that friends and family back home in Alaska, and perhaps in other states and countries may read it, and they might learn a little more about Peace Corps, public service and Nicaragua. I am also participating in a Peace Corps program in which I periodically correspond with an elementary school classroom in the U.S., telling them about my daily life, projects, etc.
Our swearing-in ceremony was bittersweet, since it meant that the twenty volunteers in my group finally had to say goodbye to each other. After three months of training, we have become rather close, and we are each other’s sources of comfort when we’re going through tough times or just need to talk. Now, we are going to be spread out across the country, some volunteers being placed up to 10 hours away from Managua by bus. We will see each other periodically for Peace Corps trainings and conferences, but I was definitely sad to see us all split-up. However, no one is more than a phone call away, or a weekend visit perhaps. We all made the best of swearing-in day; dressing up like it was senior prom, and going out dancing afterwards. It will probably be the last time we get dressed-up for quite a long time.
And so it begins. Another plus: now that I’m officially a volunteer I start accruing my two vacation days/month!

Sunday, April 12, 2009

To be or not to be (a tourist, that is)…




This past Thursday-Sunday was the famed “Semana Santa,” or “Holy Week” for many Latin American and Catholic countries. What this translates to in Nicaragua is a long weekend full of cooking, going to the beach with family and friends, watching religious processions, and basically relaxing. The tourist hubs in Nicaragua (León, Granada and San Juan del Sur) apparently spill over with visitors from both Nicaragua and abroad. My host family didn’t have anything very special planned for the weekend, and I finally convinced my partially introverted, quiet, yet very sweet 22 year-old host sister, Mercedes to accompany me to visit the city of Granada. She had only been there once previously, for a school trip, although the picturesque church-filled city is just a 45 minute bus ride from her town, situated on Lake Nicaragua. Granada is supposed to be “the oldest city in Central America,” and is famed for its colonial atmosphere, the 364 little islands “isletas” that are right offshore, and also for its many cathedrals and churches. I had heard of Granada from fellow Peace Corps volunteers and other tourists passing through and knew that there were some nice hostels to be found there (with free internet, hammocks and coffee) and also a delicious restaurant with the inviting name, “Kathy’s Waffle House.”
Mercedes and I planned to stay just one night in Granada, and we stayed at a nice hostel called “Hostel Oasis.” She was the only Nicaraguan in the entire hostel. We met some of the dirtiest backpackers I’ve ever seen (no wonder people from Central Americans think that us Westerners don’t shower). They hailed from France, Denmark, Poland, Russia, England, and Panama. Hostels were virtually on every corner of the city, and I felt myself walking around and seeing more “gringos” than Nicaraguans - for the first time since I’ve left the states! It was a surreal trip, and it was quite a contrast to the “pure” Nicaragua that I have been experiencing during training, and the living conditions that I’ve been used to. I overheard Americans complaining about the horrible diet of Central Americans, how Nicaragua was just like Costa Rica (they obviously had not been outside of Granada), complaining about the heat, the beggars, the men, and also marveling over how cheap everything was. This was pretty funny to me since now as a volunteer, I am paid in córdobas, not in dollars, so my view of money and reasonable prices has drastically changed. The prices in Granada were astoundingly higher than in most of Nicaragua, although to an American they would be very thrifty: $10/night in a hostel, $4-5 breakfast at that Waffle House, $1.50 iced coffee, $1 for a loaf of whole wheat bread.
However, despite the huge differences, it was clear that I, as an American who is used to traveling, staying in hostels, and meeting people from different countries was without a doubt more comfortable in Granada than my host sister, despite being in her own country. When we first arrived at the hostel, I had to explain to her how to use the luggage locker, and also how to climb up and down her bunk bed since it was her first encounter with one. “It’s so weird not to hear my own language in the streets here…” she mused as we walked down the street, being passed by Americans and Germans talking animatedly about a boat tour they were planning on taking later. For the first time, I felt like I knew more about our surroundings than she did. I found myself, for a change, doing a lot of the talking and business transactions wherever we went, while she simply gazed around, wondering, I think, if she was still in Nicaragua.
This says a lot about Nicaragua. For one, most Nicaraguans don’t travel much outside of their home town, because of money, and lack of curiosity. Mercedes has all she needs in her home town, attends the university once a week in a nearby city, and in her spare time, she helps around the house and gets ice cream with friends. None of her friends were doing anything as “adventurous” as us for Semana Santa. Secondly, Nicaragua has not yet felt the shock of mass tourism. This is supposedly one area that the government and universities are trying to push in the future, especially “eco-tourism” which is so popular in Costa Rica. Travel here is not popular due to safety and security issues, lack of transportation, and frankly, an environment that is not always welcoming to the westerner. It would also be very difficult to travel down here without knowing the language.
Although Mercedes and I were both “tourists” this past weekend in Granada, I, strangely felt more at home than she did. I came away from the weekend feeling refreshed after speaking a little bit of English, eating some real granola, and not being the only blonde in the city. I think our little trip disturbed her a bit, making her feel out of her element, and “different” – something that most Nicaraguans never feel in their own homogeneous culture. However, I think the trip has sparked her interest for traveling more in her home country, and opened her eyes to the fact that these foreign countries that oftentimes feel so far away and separate from Nicaragua, are actually more accessible than once imagined.
I am reminded, as I write this, of a man that some other volunteers and I met in a café one evening a few weeks ago. He was English, and alone, and as we started into conversation, I was shocked to find out that has been traveling with his wife and three children in Central America for the past three months. The children’s ages were 12, 9, and 1. (Wait, it gets better) And they didn’t speak Spanish when they came. Yes, he was backpacking with a one-year-old infant in developing countries. He was extraordinarily nonchalant about the whole thing (as English people tend to be), saying that the trip has been pretty uneventful in the sense of emergencies; that they had only been robbed once, and the baby had only suffered a minor rash for a few days. The other volunteers and I were left with our mouths open. Was he crazy?! This country felt dangerous enough to us at times, let alone traveling with children. In one sense, I simply shook my head and wished him luck as he winded-down his trip, but also I was left with a sense of jealousy. What did he have that most people didn’t? He and his wife seemed to possess some sense of adventure, of wanderlust, or perhaps craziness that the majority of the world doesn’t. I really admired their attitudes and also their determination.
So, on one extreme we have my host sister, Mercedes, and on the other, this English guy and his wife. Where do I fit? Somewhere in the middle, although unquestionably more towards the adventurous couple…