Friday, December 10, 2010

World AIDS Day activities

According to UNAIDS, in 2009, 33.3 million people worldwide were living with Human Immunodeficiency Virus (HIV), and there were 2.6 million new infections. Since the beginning of the epidemic, more than 60 million people have been infected with HIV and nearly 30 million have died of HIV-related causes. In Central and South America, 1.4 million are infected with the virus. This number is minimal when compared with Sub-Saharan Africa where there are 22.5 infected, but HIV/AIDS is a rising problem, increasingly being spread by men who have sex with men (who do not necessarily identify as homosexual), and youth who do not use condoms and have multiple partners.

December 1st marks World AIDS Day and this past month, I have been teaming with local health volunteers, nursing students and youth health promoters to plan and execute HIV/AIDS educational sports tournaments in billiards and volleyball.

The billiards tournaments are a way to educate men (billiards halls are not a place that women are usually welcome in) about HIV/AIDS and condom use while involving something that they like (pool) with another thing they like (prizes). The first time I helped out at an HIV/AIDS pool tournament was during Peace Corps training, during my first three months in-country back in 2009. I thought it was a neat idea: participants sign-up beforehand and pay an entry fee; during the tournament they have to listen to brief educational talks about HIV/AIDS and condom use; in the last round, the final two players have to respond correctly to a question from the talks they received in order to get their points whenever a ball falls into the pocket. What kept me from organizing a tournament in my town was the fact that organizing one would require me to go into a billiards hall at night and voluntarily surround myself with machista Nicaraguan men. Not exactly on the top of my to-do list. However, after our recent President’s Emergency Plan For AIDS Relief (PEPFAR)-funded workshop with men, I felt more empowered to work with this population. I also had two male leaders from my community that I had brought to the workshop who were revved-up to work in HIV/AIDS education and who really wanted to put on a billiards tournament. So, with their help we put together my town’s first billiards tournament at the end of November.

It was a success – although we only had eight participants in the tournament (we had wanted 16), there were easily 30-40 men standing around listening to the information and observing. We had the support of the billiards hall owner who was present at the tournament, which made all the men mind their manners and respect those organizing the event a little more. A nurse from the Health Center and the Small Business Development Peace Corps volunteer who also shares my site also accompanied us and helped out.

World AIDS Day was December 1st, and I requested funding from Peace Corps to organize the same type of tournament-style HIV/AIDS educational event, but this time with volleyball. Volleyball is a very popular sport in my town (you may remember from previous blogs that I was on a team for my first seven months in-site). I knew that using volleyball to spread HIV/AIDS education would let us reach the youth population and catch their attention, drawing spectators to watch the event and learn.
Eight teams (four male and four female) signed up, ages 14-24. The youth health promoters that I work with through the non-profit Plan International helped me write the proposal for the funds, organize the budget and give the informational talks about HIV/AIDS in-between the volleyball rounds. Two nurses from the Health Center and a Master of Ceremonies to play music and control the microphone also assisted. Another Peace Corps volunteer came from the city of Estelí to help me out as well. (Above, two of my favorite nurses and I at the tournament).

I was pretty nervous in the days before the event since all eight teams had not yet signed up. Was anyone even going to show up the day of the tournament? Would it rain? Would the electricity go out and we would be without music? I was worried that everything would fall apart – Nicaraguans are notorious for promising to help you with something, but at the last minute they fall through. We announced the tournament the usual way, via loudspeaker driving around the town two days before the tournament, calling for teams to sign-up. This did the trick and at 6 PM the night before, the final team had signed-up.

We also announced the tournament using a cloth banner hung in the street (another common way to spread news here). The youth promoters and I cut a couple hundred red ribbons for pinning on shirts for all the players and Health Center staff to signify solidarity for people living with HIV/AIDS. Before coming to Nicaragua, I had never actually met someone infected with HIV. After working as a community health volunteer here for a year and a half, I have had the opportunity to meet several HIV positive Nicaraguans who work in local HIV/AIDS support organizations and who fight for the rights of those who are living with the virus. After my experiences with them, I truly know the meaning of that red ribbon and what it means to wear it on December 1st.

The tournament came together at the last minute, as most Nicaraguan events do. A large amount of what we needed to put the event on (sound system, tent, extension cord, pick-up truck, Health Center staff, and the volleyball net) was donated by the Mayor’s Office and Health Center.

Peace Corps funds mainly paid for the food, educational materials, and the street banner. Plan International donated two large trophies complete with inscribed plaques, and 12 backpacks filled with school supplies for the two male and female winning teams. Teams that placed second received a volleyball (also a valuable prize since sports supplies are a luxury and not provided by the schools) All participants received a certificate of participation - Nicaraguans love those! (Below: the prizes and the two winning teams).

Many spectators turned out to watch the games and listen to the information about HIV/AIDS. The nurses handed out condoms, and the health promoters played a basketball game with youth on the side of the court – if they got the ball in the bucket, they had to answer a question about HIV and they got a candy if they answered correctly. The six games flew by – the players paid close attention to the HIV/AIDS information and were able to answer all their questions correctly in order to move on to the next round. Loud reggaeton music blasted over the town as the soundtrack to our tournament thanks to our DJ. That is one thing that worked to my benefit that day; Nicaraguans never complain about noise.  Below: the youth health promoters that helped out with the event.

Immediately after the tournament ended and we had handed out the prizes (the kids were thrilled), I took off in an express bus to the capital of Managua. My Peace Corps group had our “Close of Service Conference” the next day and I had to be there early. We are officially the oldest group in-country and will be the next ones to leave. I will finish my Peace Corps service in April 2011. I know that my time is limited and the days are flying past. I’m trying to savor each day I have left in-site since we often have to run back and forth to Managua in these last few months doing administrative and medical Peace Corps activities, as well as helping train the new group of health volunteers that arrive in January and will be replacing us.

For Christmas, I am going to visit my good friend Alana who is from my hometown in Alaska and is currently serving as a small business development volunteer in Peace Corps Peru! I have never been to South America and am looking forward to seeing Machu Picchu. A blog on my trip is soon to come!

Sunday, November 28, 2010

Backyard mystery

Recently I’ve found a mystery hole in my backyard. It looks like a burrow of some sort, a few feet from my latrine. I’ve never seen any type of animal or insect going in or out of it. I put a rock over it the other day, thinking that if it was a mice or snake hole (do snake even use burrows?) that the rock would keep them from entering my yard. See photo below of rock over hole:

The next morning, I awoke to find the rock moved, quite a few inches from the hole (see photo below of moved rock, with my hand for scale). I immediately placed the rock back over the hole, and the next day found that the same thing had happened.

Now I have become very intrigued as to what is living in this hole and has the capability to move this rock. I really have no idea what it could be. Have any ideas? Help me solve my backyard mystery!

Saturday, November 20, 2010

Our Daily Tortilla

Nicaraguans call themselves “children of the corn,” and for good reason. As I have mentioned in previous blogs, corn – more specifically “maize” – is a large source of income for many rural families and is literally in about every bite of food that Nicaraguans eat. Maize can be used in powdered drinks, main dishes, puddings, desserts, and candy. The most common (and my favorite) way of eating maize is in the traditional tortilla.

Nicaraguan Señoras wake up as early as 3:30 or 4:00 AM to start making the day’s tortillas. The more rural the family, the earlier they wake up to prepare breakfast for their husband or sons who go out to the field to work at 5:00 AM. There are certain houses in town known as the “tortilla houses” where you can buy them - my neighbor makes 200 tortillas daily! To prepare tortillas, the maize is cooked the day before, usually in gray ceniza (ash) to help strip off the outer layer. The cooked maize is then set aside to cool until the next morning. Below: cooking with ash (the color isn't too appealing, right?)
The maize is rinsed and taken early in the morning to the nearby mill. There are dozens in the town located in people’s homes or garages, and they start up at 4 AM every day. If you’re up early enough, you can see women venturing out into the morning mist with buckets of cooked maize on their heads, going to the mill which will grind the maize into a smooth pulp for .14 cents/pound. Below: maize pulp ready to make into tortilla.
After grinding the maize, the women trek back home and start up the kitchen fire. A small ball of maize is rolled and a circular sheet of plastic is used to shape the tortilla without sticking to the wooden kitchen table. Experienced tortilla makers can whip out a perfect circular and uniform-width tortilla in less than 10 seconds. People like me take a good minute or so to do the same (although I earn quite a few points for even trying. “You won’t go hungry!” the Nicaraguan women praise me for my oval, misshapen tortilla). As they are pounding out the circular shape, they use the left hand to shape the edge, while the right hand comes down in a repetitive smack, rotating the plastic sheet to continually smooth out the surface (wet your hands first to avoid sticking). If you’re out walking early in the morning, you can tell which family makes tortillas by listening for the radio music, looking for smoke coming from the kitchen, and the telltale “smack, smack, smack” of the tortilla pounding. Once the fire is hot, you can use a ceramic or metal frying pan to cook the tortilla – some have holes in the middle (for air movement maybe?). After the tortilla has been formed, it is thrown on the hot pan for a minute or so, and flipped twice. Experienced tortilla makers use their bare hands to flip it – expertly maneuvering between simultaneously pounding out tortillas and cooking them. Nothing is added to the ground maize, and no oil is used on the pan. Just plain maize + fire = hot and fresh tortilla. My favorite breakfast here (besides oatmeal, of course) is a soft, hot tortilla with boiled red beans. In my community, you can buy tortillas for anywhere from .05 cents to .09 cents/each. Later in the morning (after 6:00 AM) you can observe another exodus of women taking to the streets with cloth dishtowels, on their way to their daily tortilla provider to buy their family’s daily “bread.” My host family, which had about 10 people in it would go through about 40 tortillas in a day. They are served at every meal and accompany soup, beans, meat, cheese, or in a pinch can simply be served with a sprinkle of salt.

After repeated bacterial and parasitic infections, I’ve had to cut down on my tortilla consumption since it isn’t the cleanest food in the world (lots of contact with unwashed hands and dirty water), but they remain one of my favorite Nicaraguan foods. Lucky for me, for most Nicas they are too.

Saturday, November 13, 2010

Leptospirosis Outbreak

Since the beginning of my service, I’ve seen the Nicaraguan Ministry of Health (MINSA) handle several public health emergencies: the fight to prevent swine flu (whose name was later changed to H1N1 Influenza), Dengue fever (a viral disease spread by mosquitoes with symptoms similar to malaria), and Chagas disease (a parasitic infection transmitted by a small bug known in Nicaragua as chinche through its infected feces deposited on the skin and later rubbed into the eyes, mouth or a wound). For each of these outbreaks, MINSA has had to mobilize their community health volunteers, organize educational campaigns and depending on the disease, distribute medicine and vaccinations to those who most need them. Often, those who suffer most from these diseases are the most poor who live in the dirtiest conditions and lack the education to prevent infection. In the past month, a disease already well-known among developing countries and Latin America – Leptospirosis – has surged with 510 cases nationwide, 16 deaths and 17 hospitalized patients. Below: educational posters in the health center about Chagas disease, Influenza H1N1 and Leptospirosis (I made the last one) :) Leptospirosis is a bacterial disease which affects humans as well as a variety of animals – most common in Nicaragua domestic animals (cats, dogs), cows, pigs, donkeys, mules, rats and mice. It is transmitted to humans through contact with infected water, soil or food through an open wound or through ingestion. Because of recent heavy rains due to intense tropical storms, rivers have overflowed, homes have been flooded, and fields washed away. All of this extra water only facilitates the transmission of this disease as wells become contaminated with animal urine and feces and people walk barefoot through rivers. Most diseases increase during the rainy season, such as diarrheal diseases, mosquito-borne illness and respiratory infections – Leptospirosis is no different.

Leptospirosis presents flu-like symptoms (fever, chills, body pain, and headache), also bleeding out of the nose and other orifices, vomiting, diarrhea, and dry cough. If untreated, the second stage is characterized by renal failure, meningitis, and liver damage. Antibiotics are used to treat the disease such as amoxicillin and doxycycline. The latter can also be used as a prophylaxis – when taken weekly, it can prevent the disease. MINSA has been working on educating the public and distributing doxycycline to the entire population above 2 years old. I have been helping in this effort as we go out to every one of the 24 outlying villages of my community walking house to house giving out medicine and explaining to residents what Leptospirosis is. Below: two girls in a village waiting for their medicine. They were VERY interested in me and my tattoo.
The Police, the local cabinets of “Citizen Power” and all the Health Center personnel have been helping in this effort. Every day a group takes off in the Health Center worn-down pick-up to forge rivers and drive down unpaved roads to deliver the medicine to every last house. Since the outbreak began, MINSA has distributed prophylaxis to 2,828,512 individuals and also rodent venom to 167,950 families. The nurses here are assigned to different villages and they know their assignments well. I look out at the hills and see nothing but green, but they can tell me where every house is, how many children live there, and what the best way to walk there is. When we show up at their house, most residents already seem to be expecting us. Although they may not have a television, most families have a radio and have been following the spread of the disease religiously. Everyone dutifully takes their medicine – even the young children. Nicaraguans have come to expect this treatment from their socialized medicine system – healthcare that comes to your door. Below: a baby hanging out in a hammock in one of the communities - what a face!
I give quick talks to the families about precautions they should take (tie up domestic animals outside of the house and do not let them near water sources, avoid walking barefoot or bathing in rivers and pools of water, clean-up debris in and around the house to avoid creating places for rats and mice to hide, and washing hands with water and soap. They nod diligently, but I know that most of these suggestions will go in one ear and out the other. When they have no running water – it is much easier to bathe and wash clothes at the river rather than hauling water from the well, and how can they move the entire herd of cow that is living right outside their front door? Where would they move them to? I see many barefoot children running around the yard, playing with the dog – I tell them they should get some shoes on, but I normally get an odd look. “What is this crazy gringa telling me to do?” but a stern look from their mother usually gets them to do it. Yesterday all the parents were buzzing about something they had heard on the radio that morning – a three year old had recently died in the neighboring municipality from Leptospirosis. Now they knew it was serious.

The community health volunteers of the villages are always willing to help. I have mentioned them in previous blog posts. They are community leaders who have been trained by MINSA to give educational health information, give injections, provide basic first aid and support MINSA activities. They accompany us on the doxycycline rounds and give us the inside information on the community and who is at risk. Although they receive no pay and frankly, very little support from MINSA, they are always at the ready and a valuable asset.

MINSA’s reaction to the Leptospirosis outbreak has been swift, and hopefully prophylaxis will suppress the numbers of people who contract the disease. Most of MINSA’s normal activities have been put aside (as they were in the H1N1 outbreak) to devote all resources to Leptospirosis. Although there have been no confirmed cases in my municipality, people are operating on red alert. Everyone in Nicaragua is talking about Leptospirosis. I do realize the importance of this disease, but at the same time I wish that the same attention could be given to other public health issues, such as HIV/AIDS or teen pregnancy. I have no doubt that if all government, public communications and MINSA resources were mobilized to distribute family planning and educate the public house-to-house, it would make a substantial dent in those high statistics. Of course, swallowing a pill is an easier solution, a less complicated behavior to change, and more culturally acceptable than limiting sexual partners or using a condom – which is what would be required on a national level to cut down on HIV levels.

Friday, November 5, 2010

Camping Trip with Youth Health Promoters

Since the beginning of my service I have been cooperating with a non-profit organization in my community called Plan International. Plan operates in communities in 48 developing countries working to promote children’s rights, and increase the quality of life of the world’s poorest children. They also have a child sponsorship program. Specifically, they focus projects in education, health, water and sanitation, domestic violence, economic security, emergency relief, youth civic participation, and HIV education.

For a year and a half, Plan has been working in my community training youth sexual and reproductive health promoters. They started this project at about the same time I began my Peace Corps service, so it has coincided nicely, especially since one of the Peace Corps community health project’s goals is the education of youth and adolescents in HIV/AIDS prevention and teen pregnancy prevention. Ten youth (ages 14-19) were chosen to be trained in sexual and reproductive health promotion from five of the villages in my municipality – I helped in choosing some of the kids, asking local leaders and teachers about who would be best. Some came from rural areas; others livedin the urban center. All were identified as potential leaders among their peers. Below: the promoters and I at their "graduation" ceremony.
Throughout the training program organized by Plan, the youth have been trained to be competent sexual and reproductive health educators. They go to the departmental capital city monthly with the forty other promoters from nearby municipalities for training from Plan staff in self-esteem, human rights, civic participation, youth development, leadership, HIV/AIDS, STDs, teen pregnancy, anatomy, and condom use. Each promoter has to form their own youth group of ten kids and replicate these learned topics to their group. I help the promoters in perfecting their presentation techniques, helping them research topics, lead meetings, and of course play games.
I have seen the ten promoters from my town grow and learn throughout this project – they have increased their self-esteem and are now more likely to participate in their community and take on leadership roles. One young promoter was so shy at the beginning of the project that she couldn’t even say the word “condom” out loud in public, but after undergoing youth promoter training and being around other self-confident peers that aren’t ashamed to talk about these topics, she has increased her knowledge and self-assurance and those days of shame are long gone.

It’s not all work, however. Plan also gave sports equipment to each of the youth promoters to play volleyball, basketball and soccer at the youth group meetings. Kids won’t come to meetings if they know they will only be working – these meetings are supposed to be different from school – more fun and engaging. The promoters organize energizing games throughout the meetings to keep the kids attentive and interested.

The project is coming to a close now – all of the meetings have been held, and each group has written a community action plan; identifying community needs and how they can meet them using local resources. To celebrate the finalization of the project, Plan organized a four day leadership-building workshop trip to a camp in the mountains of the department of Jinotega (“heen-oh-tay-guh”). Below: "Welcome to Jinotega. The best business for Nicaragua is food production." (Jinotega is an agricultural hub of the country - on the bus I saw cabbages, carrots, potatoes, peppers, coffee, and beans growing and for sale on the side of the road). The promoters from my department came, along with promoters who were doing the same project in the western department of Chinandega. In total, there were 130 kids. Another Peace Corps volunteer from Chinandega and I were invited to chaperone and help facilitate the camp.
I had never been to Jinotega before and was surprised at the cold climate. During our stay, the temperature varied from the low 60s F (perhaps even the high 50s!) to the low 70s F. The showers (unheated of course) were the temperature of ice water. The constant presence of rain, clouds and fog – rather than depress me (as it did to the kids) – actually made me think of my hometown in Alaska. I felt like I had been transported back to Sitka for a few days and enjoyed not sweating for a change.
The retreat was held at the VidaJoven (YoungLife) Nicaragua ranch. YoungLife is an American non-denominational Christian organization that works with youth. YoungLife exists in my hometown, but I was unaware they worked internationally until going to this Nicaraguan camp. A common practice for the youth members of YoungLife is going to a ranch retreat (either in the U.S. or abroad to do a volunteer project) in the summertime to build leadership and spirituality. The ranch in Nicaragua has a small lake with canoes, hiking trails, ropes course activities, a baseball field, basketball court, and auditorium. Needless to say, the Plan promoters were thrilled to be there.

I was in charge of a dorm room of 15 girls – so it goes without saying that I didn’t sleep much. Many of these youth had never left their home overnight before. These kids were very different from one another; some were relatively well-off, living in the urban center – they wore newer clothes, had lip gloss and perfume, and fancy cell phones. Others came from more rural areas and wore patched hand-me-downs, spoke with the rural accent and were more reserved. Some of the boys were openly gay, some promoters were very young (13), others were on the older side (22). However, despite their differences the kids formed a strong bond during those four days. I remember being so amazed at these young leaders – I hardly remember what I was doing at 15 years old, but it sure wasn’t talking about HIV, condoms, and community action in front of my peers! Below: each community made a mural, this one says "Adolescents and youth for a different generation."
The days were busy, but we still found time for fun. During the retreat, a “radio station” was formed by a few kids and they provided the soundtrack for our meals and were DJs at the dance held on the last night. A talent show was held one night and the kids danced traditional as well as reggaeton dances, recited poetry, sang, and did theater. One day we split into groups to tackle the outdoor maze and ropes course leadership activities. I was assigned a group and wore myself out as we raced through the challenges to be the first group to finish: running through the hiking trails, getting lost in the maze, climbing walls, pushing oxen carts, and paddling canoes. None of the kids had ever been in a canoe before and it was entertaining watching them figure out how to steer the boat – bumping into the lake shore and going in reverse more than forward.
The promoters shared ideas, strategies for community action and made fast friendships. When it was time to say goodbye there were several tearful goodbyes and exchanges of e-mails and phone numbers. The experience empowered the youth to keep working, hopefully even after organizations like Plan or Peace Corps leave, and the funding dries up. Looking at every one of those 130 youth, I could see that each one had a special kind of leadership. I am happy to be a part of this project and see each one of the promoters from my town grow and learn. I know I have learned as much from them as they have from me and hope to keep in touch with these kids far into the future – they’re going places!

Wednesday, October 13, 2010

President’s Emergency Plan for AIDS Relief (PEPFAR) Workshop Working in partnership with host nations, over ten years PEPFAR plans to support treatment for at least 3 million people; prevention of 12 million new infections; and care for 12 million people, including 5 million orphans and vulnerable children. To meet these goals, PEPFAR will support training of at least 140,000 new health care workers in HIV/AIDS prevention, treatment and care. In the fiscal year 2009, $897,000 was given through PEPFAR to three organizations to work in HIV/AIDS prevention in Nicaragua. Peace Corps was one of those organizations - the others were the Centers for Disease Control and USAID.
In Nicaragua, the second-year Community Health Peace Corps Volunteers (PCVs) are allotted PEPFAR funding according to their regional area to carry out workshops with a population of their choice. I am living in the northern region of Nicaragua, and together with the seven other health PCVs that also live here, we decided to focus our HIV/AIDS workshop on adult men. In Nicaragua, approximately 97% of all HIV transmission occurs through sexual contact – the majority between heterosexuals. There often exists the belief in Nicaragua that AIDS is only something that affects homosexuals or prostitutes, but the group most affected by the epidemic right now is actually housewives. Their husbands leave the home, town, department, or even country to work cutting coffee or in other agricultural labor such as beans or maize, and are away from home for days, months, or even years at a time. On their journeys, they inevitably have sex with women who are not their wives without using condoms. It is not uncommon for one man to have several girlfriends, or to frequently use the services of sex workers. When he returns home, he will refuse to use a condom with his wife – “What, do you not trust me?!” – and transfer any STD he has acquired to her. The wife will most likely do the test for HIV the next time she gets pregnant (it is common procedure during a pregnancy to avoid transmitting it to the baby), and will find out that she is HIV positive.

Besides the fact that they are often a mobile population and often have multiple partners, men are a vulnerable group for HIV infection in Nicaragua also because of machismo, that Latin phenomenon which most men here embody. Machismo creates a man-focused society – marginalizing women’s contributions, shunning feminine attitudes, and above all being non-feminine and very macho. This usually manifests itself in high domestic abuse rates, men having multiple sexual partners, a strong discrimination against homosexuals, strong gender role differentiation, and the marginalization of women in public life. Women are often in a vulnerable position, powerless to request that their husband or boyfriend use a condom. It is the man who usually makes these decisions, and he is often not willing to oblige.

Every PCV invited three to four adult men from their communities to participate in our two-day PEPFAR workshop. In addition to second-year community health PVCs, we also included four other PCVs from different sectors (Agriculture and Small Business Development). From my community I invited a policeman, a nursing student who was doing his practicum in my health center, and a community health volunteer. Other PCVs invited students, migrant workers, youth leaders, businessmen, transsexuals, and gay men. As you can see, there was quite a variety. There were participants who came from urban areas as well as the most rural and isolated communities. Many of them knew nothing about HIV; although some were well-versed in the epidemic and were already working in preventative health. Every invitee was chosen by the PCV in their community because they were leaders and worked in some capacity with the PCV, and would possibly be interested in future HIV/AIDS educational activities. Below: a couple of my invitees and me.

Our workshop started out with reviewing/learning the basics of HIV and AIDS: how it affects your body and immune system, how it is transmitted, and how to prevent it. We also did a condom demonstration relay race, dividing the men up into teams and having them all put a condom onto a cucumber using the seven correct steps we had taught them. (Cucumbers were used in lieu of wooden penises since most PCVs forgot to bring theirs - they are usually common at health centers and standard issue for PCVs for use in condom demonstrations). Below: the relay race.

The Laboratory Technician from my health center – Xiomara - came to facilitate the session on the test for HIV. She is a very dynamic person and did a great job explaining the test – which with the new fast technology, takes only about 20 minutes to see results. A male PCV volunteered to go through the steps of the test in front of everyone; even having the blood taken from his finger using a lancet to show how easy it was.

On day two we had guest speakers discuss sexual diversity and sexual and reproductive rights. You could tell many of the men were uncomfortable discussing these topics, and there were quite a few snickers and sideways glances. However a few men voiced their opinions that these topics were “very important” and “should be discussed more, especially starting in the home.” The transsexual and gay members of the group appreciated this session I think and felt validated by the facilitator leading the session.

The next session was given by a Nicaraguan organization called “Men Against Violence,” and they discussed machismo and violence towards women and how they affect the current AIDS epidemic. The participants became very animated and everyone had something to say. Most of these men probably grew up in households where they saw violence towards, or at least mistreatment of women, and they probably had never thought about its impact on HIV/AIDS before. While all the men agreed that violence against women and female subordination was the norm in Nicaragua – they also agreed that this was hindering the fight on HIV/AIDS and they could each start with individual change by being positive examples in their own lives and in their own families.
Next, I co-facilitated a session with another PCV regarding behavior change, focusing on men and their adoption of healthy sexual practices such as condom use, limiting their number of sexual partners, and doing the HIV test. We reviewed the five steps of change: pre-consciousness, consciousness, preparation and intention, action, and maintenance. We also discussed what influences our behavior changes: role models, culture, learned behaviors, habits, rewards, consequences, and social norms. The men were all very participative in the session; thinking about men in their own communities and if they are or are not practicing healthy sexual behaviors, why, and how to overcome these obstacles to behavior change.

To culminate day two, we hosted an evening billiards tournament at a nearby pool hall. This was no regular pool tournament however; it was an HIV/AIDS educational tournament. We divided the men up into groups and each group was responsible for giving a short talk between the rounds of pool on various HIV-related themes: how HIV and AIDS work, how it is transmitted, how to prevent it, the HIV test, and correct condom use. The men themselves would play in the tournament as well as facilitate the educational talks in-between the rounds. In the last billiards round, the two final players had to answer correctly a question about HIV/AIDS; otherwise the ball would be taken out of the pocket and placed back on the table – losing their points. So, in order to win the tournament, the players not only had to be good at pool, but they also had to know their HIV/AIDS information. The men really enjoyed it – pool is a popular pastime for men in Nicaragua and billiards tournaments are an effective way to educate men about HIV/AIDS and condom use while having fun.

On the last day of the workshop, we had a testimonial from a man who is HIV positive. He came from a Nicaraguan organization of people living with HIV/AIDS. He has had the virus for 15 years, and has still not acquired AIDS. He had been participating in the workshop for the previous two days, and none of the other participants had any idea he was HIV positive; I think it shocked a few men to hear his story. He explained how he had never been educated on sexual and reproductive health as a child and his younger sister had had to explain sexual intercourse to him since he didn´t receive the information from his parents or teachers. He only found out he had HIV when he decided to do the test on a whim while in the Health Center testing for an STD. Although he said it still hurts deep inside and he struggles daily to cope; he finds hope in the fact that he is working for an organization which strives to educate Nicaraguans about HIV/AIDS and how to prevent it, and for those who are infected – how to live a long, healthy life and ensure their human rights are respected. At the end of his session, the man formed a ribbon on the ground with candles (to represent the red HIV/AIDS ribbon which represents solidarity with HIV positive persons), and he sat in the middle. We all encircled the ribbon of candles, listening to his story and taking in the moment. A few tears were shed. Many of the men had gotten to know this HIV positive man throughout the past two days of the workshop and were shocked and saddened to find out his tragic story.
At the beginning of the workshop, the participants had been asked to write down on a piece of paper the first word that came to mind when they thought of HIV/AIDS. Their answers ranged from “fear,” and “danger,” to “remorse,” “pity,” and “sadness.” At the end of the workshop, however, their answers were quite different. Now many of them wrote “solidarity,” “compassion,” “collaboration,” and “unity.” Each of the men who attended the workshop was changed. They left fired-up to work in HIV/AIDS education along with the PCV in their community. They had learned so much and felt empowered and able to educate other men in their community. The men from my community who attended the workshop with me planned a few activities to carry-out back here in-site. We are planning to do HIV/AIDS workshops with local migrant workers, male sports team members, and male health volunteers. They also pledged to support my HIV/AIDs volleyball tournament which is coming up on December 1 for World AIDS Day, and we’re planning an HIV/AIDS billiards tournament of our own. I was happy to be a part of such an excellent workshop and a great Presidential initiative. Thanks PEPFAR!

Saturday, September 25, 2010

Potters for Peace

Every 15 seconds, another child dies from lack of clean water and sanitation.

One sixth of the world’s population does not have access to potable water.

Statistics like those didn’t really mean anything to me before joining Peace Corps. Now that I am living in Nicaragua, I realize that turning on the tap to a clean, strong stream of cold (or hot) water is a luxury that few will ever experience. Getting water is a daily battle here; many rural residents have to haul it from unclean wells, or collect rain water for daily tasks. Water-borne illnesses are common and other diseases are spread by the lack of hygiene resulting from water scarcity.

One of the organizations that I’ve had the opportunity to work with while in Peace Corps is “Potters for Peace,” or in Spanish, Ceramistas por la Paz. Their goal to provide safe drinking water to those who lack it is also one of the United Nations Millennium Development Goals: “To halve, by the year 2015, the number of people who are unable to reach or afford safe drinking water, and the proportion of people without access to safe sanitation. By 2025, to provide safe water, sanitation and hygiene to all.” (Below: making the ceramic filter).
PFP makes and sells ceramic water filters to purify water. The filter is a simple porous clay container with a coating of colloidal silver that is reported to remove 99.98% of turbidity, parasites, and bacteria, including e-coli, vibrio cholera, giardia, streptococcus, cryptosporidium, and total coliforms. Since I have become sick from at least four of the aforementioned organisms, I was particularly interested in this project. (Below: a x-ray look at one of the filters).

In the urban center of my community, we have running water through a central system (well, on a good day). The water comes from a pump that is next to a small river. In the surrounding smaller villages (they are still considered part of this community), there is no running water and the residents use shared wells, sometimes located far from their homes. In the urban center the water goes out for several hours daily and when we have hard rains and the river floods it can turn a dark brown color.

After trying to drink tap water for a few weeks, I have now realized that it’s like playing Russian roulette. Sometimes you won’t get sick, but more often than not, you will. I buy purified water which cost U$1.25 for an 18 gallon container. I have to cart these large containers four blocks to my house from the store they are sold at. Needless to say, it’s quite annoying. Most families in the urban center buy these purified water jugs as well – sometimes up to 5 per week. Others that do not have access to purified water can use chlorine or boil their water, but this is often too time consuming, expensive, or simply not deemed necessary.

Recently PFP offered to partner with interested Peace Corps volunteers to provide filters and educational materials for free. I contacted them and soon received a personally-delivered donation of 17 filters (the whole set includes a plastic bucket, spigot, water filter and cover). They also donated coloring books for children that addressed water sanitation issues, crayons, education posters, a “Ceramic Filters for Sale Here” sign for use in a store, and water testing materials to test for bacteria and parasites. Two of the filters I donated to local organizations for public use: the Health Center and a non-profit which works with special needs children. The rest of the filters I have been selling out of my home and at a local store. With the money earned, we will buy more filters – hopefully creating a sustainable cycle and a way to earn money for businessmen who choose to sell them for a profit at their stores.

The only problem that I’ve found with the filters is their price. They are C$575 córdobas, (about U$28) which for most families is a substantial amount. However, local health promoters and I have been trying to promote the filters as a way to actually save money. For the average family who buys filtered water jugs, the price of one ceramic filter would buy them 23 jugs. When you do the math, the ceramic filter pays for itself quickly. That long-term vision is a little difficult for most Nicaraguans to grasp- most would rather spend a little bit now rather than a lot- no matter what the long-run savings is. No one has a large amount of petty cash just lying around (there’s a reason that you can buy single eggs, single-use baggies of spices, and single cigarettes in the stores here). We have been working with local stores letting people pay for the filters in 2-4 payments.

PFP is in 21 countries in the world. They train locals to learn how to make the ceramic filters; creating jobs and providing income for the most poor. The filters are long-lasting – PFP told me that one woman had the same filter for 10 years and it was still working for her. They also make sense; local artisans work with clay and stone, so these filters are not such a new idea. The health center has often done projects with rock and sand water filters – a less sophisticated version of PFP.

I am very grateful for the donation by PFP. The water filters are selling – slowly, but surely. Locals are very interested in how they work and how they can possibly save them money. I have recently purchased a filter as well – no more lugging around purified water for me! When so many Nicaraguan children are affected by diarrheal diseases, hopefully this project can reduce sickness and infant and child mortality. I encourage you to check out their website at:

Tuesday, September 7, 2010

Mid-Service Crisis (a blog post from 8 months ago)

NOTE: I recently found this blog on my computer. I wrote it quite some time ago, in January 2010. It expresses the feelings of anger and insecurity I’ve had in my site; the other side of Peace Corps that volunteers don’t often talk about. I’m feeling much better now than when I had written this blog- I think my kickboxing DVDs help me a bit! I guess I forgot to publish this entry to my blog, so I’ll do it now:

So, not all is well in my site. I’ve been trying for the most part to keep my blog positive (I mean, who wants to read something that just makes them sad?) but recent events have pushed me over the edge. I’m having a mini “mid-service crisis” I think and am struggling with deciding how to approach both my work and personal lives.

To begin with, at the beginning of December my house was robbed. (This is my second robbery. The first was the housekeeper in my host family’s house. She stole $50 from my room). The robber somehow obtained a copy of my front door key and they came in when they knew I was out of the house one night and stole my laptop, some earrings, my hairdryer, toothpaste... It was obviously just a small-time robbery, but it really shook me up and I am still recovering emotionally. What if I had entered the house while the robber was still inside? What if I was in the house when they tried to enter? My Christmas vacation back to the states was well-timed in that I was able to go home for a bit to relax and take a mental break from Nicaragua. The police here are well-intentioned, but due to lack of training and support, my case fell by the wayside and ultimately was closed. At least I had personal property insurance (thank goodness Peace Corps told me to get that!) so I was reimbursed for my laptop. What hurt the most about the incident was that it had been someone I knew (there is a strong suspicion that it was my old host brother) – someone who knew my movements and knew how to get a copy of the key. It was someone that I had placed my trust in and they had violated that trust. I felt sick to my stomach. Didn’t they know that I was here to help them? Didn’t they know how hard it is sometimes?

I changed my locks the very next morning of course, but my spirit was broken. Before the details of the robbery were known, every time I saw a young man in the street I would look at him and think, “Was it you?” I had to remember to take a step back and realize that there are larger systemic influences in effect. Poverty can make people do horrible things and I am probably looked at in the community as someone who has money (although trust me, my $190/month stipend from Peace Corps is nothing extravagant!)

After the robbery I was barraged with neighbors and friends giving me the “I told you so” speech. I was so sick of it. “Oh Penny,” they’d say, “didn’t you know you can’t trust anyone?” or, “You should know better!” I wouldn’t say anything in reply. Should I really have known better? Who should have told me? It seemed like after something bad happens here, you just can’t stop getting advice – but before the event actually occurs; no one has the courage to tell you.

My Christmas vacation made me feel much better about everything until I came back to town to discover that the barbed wire at the side of my house had been ripped down and someone had broken into my backyard. I think that they were just getting back there to steal mangos from my tree since nothing was stolen or messed with, but it still upset me and made me feel less safe. It was probably just some bored neighbor kids who knew I had mangos back there, but the fact that they broke-in so easily made me uneasy and worried. It makes me think of Maslow’s Hierarchy of Needs – it’s difficult for me to concentrate on ¨higher¨taskes such as work when I’m not feeling safe or secure.

This morning while on an early morning run, a young man on a bike passed me from behind and grabbed my butt as he whizzed by. Not just a passing touch, but a real grab. I started yelling profanities and running after him, but he sped up his cycling and disappeared. No one was around to help me. I was so upset by what had happened. Things like this happen every day: profane things are yelled at you in the street, men disrespect you… but I had never been touched before and it made me feel very vulnerable. Who did this punk think he is? I realize that the culture of machismo is strong here in Nicaragua and I have definitely had to chew-out a few “vagos” or “street punks” for getting too fresh with their comments or verbally harassing me. What bothers me is that I don’t know who that biker was and I’ll never be able to confront. I need to live with this frustration – take it out in other ways, channel it into something else. Maybe in my work with youth I can stress the importance of equality between the sexes, of respect, of morals and values. Maybe if these kids had better role models for behavior when they grew up they wouldn’t harass women on the street or steal from their neighbors (believe me, I’m certainly not the only person in my town that has been robbed this year).

I’m pretty upset about these recent incidents and I am finding it hard to concentrate on projects. My mind keeps wandering at work and I get upset. No, I get mad. At the same time I feel helpless, and I’m not used to feeling that way. I don’t know how to make these people stop treating me this way. And I guess the answer is that I can’t. This is their world and I’m just trying to function in it as best I can. Hopefully with time and with cultural insight and understanding I can make peace. I have to realize that these incidents are just singular events and singular individuals out of an entire town. I know many men who are respectful and friendly to me. I also know several other community members who have been robbed this year – I’m not as “targeted” as I might feel. This is going to take some time though and right now I’m just doing it one breath at a time. One deep breath at a time.

I’m sorry this post is so negative; I just really had to vent. I think it’s important that my blog show how real life is here. All Peace Corps volunteers experience things like this; lack of feeling safe, feelings of disrespect and harassment, complications adjusting to the culture… I feel much better after talking to fellow volunteers and getting advice. For the most part, my service thus far (9 months down) has been going well and I’ve been feeling positive. I think this is just the difficult mid-point. Peace Corps warns you about this, the “mid-service crisis.” Hopefully I’ll come out of this soon and get back to some positive blog posts…!

Tuesday, August 24, 2010

Mi Familia

The Gages came, they saw Nicaragua, and they left. I recently hosted my parents, Amelia and Steve and younger sister Rita for two weeks as we took a whirlwind tour of Nicaragua. I have been looking forward to this trip for some time, and even making an itinerary using a Google Documents spreadsheet (yes, I am that type of person). I wanted everything to go smoothly- this was my parents’ first time to a developing country, and my sister’s first time outside of North America. Needless to say, the capital of Managua took them by surprise. Managua isn’t exactly the most picturesque city- it was largely destroyed by an earthquake in 1972 and with the civil war in the 80’s and the country’s harsh poverty, little has been rebuilt.

After the initial shock of the dilapidated and scorching hot capital, we rented a car (although this took some convincing on my part- my parents had heard horror stories of Managua drivers, no street signs, corrupt policemen, and unpaved roads. While we did encounter all of those things, we came out alive).

We stayed in my house in my community for three nights. Correction: three very hot nights in which the electricity went out for over 24 hours and we were without fans to keep us cool while we slept. Note: if your family is coming to visit you directly from Alaska, make sure you have either air conditioning or electric fans around at all times. Despite the heat and having to use my outhouse, they did quite well. My sister learned how to wash her clothes by hand, they ate gallo pinto (red beans and rice) until they couldn’t any more, went on quite a few “off-road” adventures, and tried numerous traditional foods including fried green plantains and a drink made from barley. I put my father to work; having him do a little hammer-and-nailing around my house (so great to have a man around to do these things), and he even visited a farm with me and milked a cow! My parents and sister surprised me at how well they did here. Since my father grew up in a semi-farm life with a pet cow, my mother washed her own clothes when she was young, and they´ve all been on many Alaskan camping trips with outhouses and mosquitoes, Nicaragua wasn´t too much of a stretch. My father did make me laugh though when he offered to buy me an air conditioner for my house here. I told him it wouldn´t work because 1. There is a large gap where air can enter between my ceiling and my walls, 2. Electricity is very expensive here, and 3. It would sort of defeat the purpose of Peace Corps – to live just like the people you are working with. Below: my parents in my bed protected by my mosquito net, teaching Rita how to wash clothes by hand in my ¨sink,¨and my father getting back to his roots.

Their favorite part of the trip was when we went to a rural community outside my town´s urban center for a pregnant women’s group meeting and to visit a small high school that I often work at. They met about every resident in town, handed out some baby toys to the pregnant women courtesy of my older brother, his wife and their two young girls, and got to pop in on an English class at the high school. All the students were very interested in my family. I had been talking-up the trip for weeks, and it was probably only about the third time they’ve seen Americans (besides Peace Corps volunteers). My family also got to see the world map mural that my site-mate Kristen and I have been painting with the students. We’re almost done! My father also brought some medical equipment to donate to my Health Center from the hospital he works at. The nurses were very grateful for the blood pressure cuffs, electronic baby scale, centrifuge, nebulizer, and vaccination thermometer. Our last day in my community, we took a tour of a local coffee cooperative. Although it’s not the cutting and processing season, we saw all the machinery and bought quite a few pounds of coffee (at a much cheaper price than you would find once it’s packaged and sold at places like Starbucks’!). They also saw how the traditional corn and cheese crackers, rosquillas are made in a town called Somoto, just a few kilometers from Honduras. Below: my family with the high school class they met.

After my site, we headed south again. In the town of Estelí, we explored the cigar factories, observing how they cut the leaves, ferment them in large humid piles, and roll the cigars (grown from Cuban seeds). We hiked out to a beautiful 36m waterfall and enjoyed being in the green mountains. I was glad they decided to visit during the rainy season (May-October) since everything is more beautiful and lush. Below: parents and Rita at the waterfall.

Next on our tour was the beach! We traversed the country to get down to the coastal town of San Juan del Sur, just 12 km from Costa Rica. Despite the rainy afternoons and blistering heat during the day, they enjoyed the more “touristy” vibe (they could order food in English). We went to Maderas beach for an afternoon and frolicked in the waves. My father said it was the first time he had ever swum in warm ocean water! Well, cross that off the bucket list now...

We dined on lobster, ceviche, and goji berry and spirulina smoothies. I felt like I was back in the U.S. for a few days – after all, this was my vacation too! My father and sister did a zip line canopy tour and saw howler monkeys and parrots. I didn’t go with them since I was feeling crummy with yet another bout of intestinal parasites. I think I’m going on about seven times now... Below: Dad on the zip line, and he and I on the beach at sunset.

Last stop on our trip was the colonial town of Granada, one of Nicaragua’s prettiest cities. There are countless churches, convents, and colonial-style buildings – all on the shore of Lake Nicaragua. It is one of the oldest cities in Central America, founded in 1524. We visited during their yearly patron saint festival. This involved carnival-style costumes and dancing, fireworks, street vendors, a horse parade, bull riding, and concerts in the park. It was a little overwhelming for my family since their eardrums have still not adjusted to the increased decibels in Nicaragua, and being surrounded by hundreds of drunk, Spanish-speaking people can make one feel a little disconcerted when they are worried about being robbed a little more than they care about watched the next dancing horse trot by. Below: us at Volcano Masaya, and my mother and I took a mosaic class and made a beautiful tile!

Overall I think my family really enjoyed the trip. They were very open-minded and easy-going throughout the trip, and did a great job putting up with me for the entire two weeks regulating their every move to make sure they didn’t get burned, swindled, sick, or robbed. They saw the beautiful, the good, the bad, the ugly and the sad. One amazing experience they found eye-opening was meeting a Nicaraguan civil war veteran in my community who had been forced to fight with the Contras and lost his leg and eye. He had undergone 19 surgeries in various countries, and amazingly still maintained a positive outlook and willingness to understand others’ perspectives. My family saw the most rural of rural and poorest of the poor when we visited small outlying communities; they forged rivers and got dirty; they endured heat and rain and lived like a real Peace Corps volunteer, which is basically like a real Nicaraguan. My mother said when she was leaving that now I didn’t feel “as far away” to her. It’s true, while Nicaragua may feel worlds away culturally; it really is just a two-hour flight from Los Angeles. My family found many similarities in the Nicaraguan people and in my life here to their lives back in Alaska. Saying goodbye was hard. But, it will be a short eight months until my service is completed. Hopefully I’ll have another visitor soon! (Hint, hint)