I wasn’t really sure what to expect from the LACS 20 course. Would it be a standard history class?  A typical discussion-based course? An extended series of training sessions? In reality, LACS 20 was a combination of all three elements, but it was so much more than simply an information-based series of lessons. During the term, LACS 20 pushed me to question my values, my motivations, and my approaches to implementing solutions to issues in communities that I am not familiar with. It encouraged me to reevaluate what I considered “problems” to begin with, and if my noble ideas would actually have the intended effects. Through the course readings, Skype-sessions with Nicaraguans, guest speakers, class discussions and final projects, I learned about the importance of cultural sensitivity, collaboration, and establishing goals with clear objectives. Of course, I was enlightened with very relevant historical context on Nicaragua and information on technical skills (for the Clinical Health team), but what surprised and pleased me the most was the emphasis placed on the “Ethics” portion of the “Politics and Ethics of Development” title that is attributed to the course.

Overall, I’m incredibly excited to travel to Nicaragua (next week!) and use the knowledge and insight I have obtained during my time in LACS 20 to shape the service– or more appropriately, collaboration– I will be a part of while at the clinic in Hormiguero. As the Clinical Health leader, I’m well aware of the time, resources, and energy that is devoted to putting something like the Nicaragua CCESP together, so I expect that everything will proceed safely, smoothly, and efficiently while in-country. I am especially looking forward to seeing how everyone’s individual projects will be implemented and learning about the results they obtain. And of course, I absolutely cannot wait to have conversations with the community members and hear about their stories, as Professor Martínez has encouraged me to do (you can hear/read about my interview with her under the “Oral History” tab). After all, the essence of the CCESP lies in the fact that it is not a one-sided effort, but rather a shared effort between us outsider volunteers and community members, ensuring that the service projects can eventually be independently managed by the community itself.

In Professor Martínez’s words, “lo único que busque es alguien se siente a tu lado y te escuche…Y estar presente. Y para ellos, significa todo”. 

“The only thing that they look for is that someone sits next to [them] and listens to [them]. And is present. And for them, it means everything.”

Leah, Valentina, and Kate had a very thorough and engaging presentation. The extensive use of statistics effectively supplemented the information they presented regarding mental health, the abortion ban, postpartum depression, and more. I was particularly intrigued by the crossover of maternal and mental health (“baby blues”)–something I had not given much thought to before–and the use of the term “structural violence” to describe psychosocial and hormonal factors surrounding maternal health. Moreover, I appreciated the connection with the DHMC Women’s Health Resource Center, and the interactive materials that were brought back (e.g. the booklet, polaroids, etc.) as this provides effective resources upon which practical solutions can be developed. Near the end of the presentation, Leah, Valentina, and Kate proposed a very well thought-out project that has a lot of potential, and I look forward to seeing its results when implemented in Nicaragua.

I’d also like to discuss Amrit, Charly, and Sydney’s presentation, as it also examines maternal health– though through the perspective of the Zika virus. I appreciate the fact that they began the presentation with a detailed (though not overwhelming) explanation of the biological basis of the virus (its classification, life cycle, transmission, etc.). They effectively countered established facts with uncertainties regarding the virus, such as “how long virus persists in men who had zika”, setting the stage for a possible discussion on how to approach treatment and prevention with these uncertainties in mind. I also was impressed with the concrete, multi-step initiative that they plan on implementing in Nicaragua– which includes providing handouts and surveys, and engaging in ethnographic interviews. Given the high proportion of projects that focus on maternal health, it should be interesting to compile and analyze the results from each of the surveys/interviews that are components of these projects.

As I am researching traditional approaches to women’s health in Nicaragua for my final project, I am particularly interested in the integration of traditional methods and biomedicine. According to Carrie, Mackey, and Laird, in 2007, 143 member states adopted the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) reflecting widespread recognition by the international community to the individual and collective rights of indigenous peoples. UNDRIP Article 24 affirms the fundamental rights of indigenous peoples to their traditional medicines and health practices, and to all social and health services. While legislation has clearly been enacted recognizing the importance of such integration, biomedical providers often have an advantage over traditional healers in their authority and use of treatments. In a 2009 study, traditional medicine care was primarily used at the discretion of biomedical health care providers as part of their own therapeutic treatment or alternatively by a traditional healer called in only to care for those who suffered with ailments outside of the general scope of biomedicine. Hence, such healers (who specifically belonged to the Miskitu ethnic group) were used as a marginalized complement mostly when biomedicine failed.

Research suggests that it’s important integrate traditional medicine and modern medicine– not only from a cultural perspective– but also to address broader public health and patient safety concerns that may arise from uncoordinated use,  such as abuse, overdose, toxicity or poison risk, and potential for adverse events. Possible solutions to this issue include employing doctors of Miskitu descent (or some other indigenous group familiar with traditional practices), or implementing institutions like Casas Maternas, which bring professional healthcare resources and technology to rural communities on a non-intrusive scale.

In this post, I’ll be discussing the film “Dreaming Nicaragua”, produced by the Fabretto Children’s Foundation. The film addresses serious issues such as alcoholism, domestic abuse, teenage pregnancy through the perspectives of different children (Yuri, Nauri, Josef, Izabel) who attend Jefet’s art class; doing so makes it easier for viewers to intake these issues. At the same time, this technique establishes a stark contrast between the innocence of the children presented and the extent of the difficulties they must face, effectively emphasizing the severity of these issues. I was particularly struck by Nauri’s interview with a fellow 10 year old girl, who solemnly shares her experiences witnessing domestic abuse and alcoholism.

Overall, the film has a somewhat hopeful tone, as we learn about the children’s dreams and ambitions, though it is not unrealistically euphemistic either. Hence, after two years, we learn that some children are better off, like Izabel’s younger brother who has his skin condition treated, while others face new challenges, as is the case with Yuri and her pregnancy. Overall, I think the documentary fairly depicts these families without exploiting and dramatizing their miseries, as many service-based films tend to do.

Ethnography is strictly defined as the study of people in their own environment through the use of methods such as participant observation and face-to-face interviewing. The value of this format of research lies in the fact that it provides a level of intimacy and understanding that cannot be produced by statistics. I believe that it is much more appropriate and accurate to obtain information from individuals that actually belong to the community being studied, as opposed to gleaning over objective statistics or plainly inaccurate information from a textbook or article. Ethnography provides great way to reach to behind surface answers outsiders often receive, allowing the research to gain an insider’s perspective; moreover, a  variety of sources that can be used: interviews, videos, journals, etc. which can help to produce a more complete, intimate, and personal understanding of the community.

Critics of ethnography may suggest that it is susceptible to bias from both the investigator and the subject studied, providing a problematic barrier; however, analyzing these idiosyncrasies can reveal complex perceptions and mentalities that the subject has towards the interviewer, and other individuals in the community, and vice versa. The beauty of ethnography lies in its bidirectional nature, in the way it enables social learning to take place across both parties.

In my opinion, the component of a service organization that most effectively ensures sustainability and stability is that of a partnership between those providing service and the community being served. It is not possible to enact mindful and efficient change without a constant flow of feedback and information between both parties, as one’s idea of what qualifies as “development” likely varies from community to community. Therefore, what I truly appreciate about organizations such as Compas de Nicaragua and Bridges to Community is that they extensively incorporate Nicaraguans in all facets of the projects, whether for it is for administrative/organization-related duties (as is the case with the individuals we skyped with), or for collaboration with URACCAN students, or for the actual implementation and execution of the project itself (such as with the latrine project).

I also think outsiders who volunteer in such environments can use their position of privilege to provide alternate perspectives on solutions to different issues; for example, I thought it was interesting that Michael Boudreau possibly alleviated a case of domestic abuse by reporting the man to the police– an action that likely would not have been taken otherwise.