Baby steps in improving obstetrical health

Here I am, looking back on my 2-month internship with the Foundation for Sustainable Development in the rural community of Las Salinas in Southwestern Nicaragua. My internet access these past two months had been fickle and flighty at best, so I had not been able to update this blog until now.
For this internship, I was working at a public clinic which is staffed by one doctor and two nurses, and is in custody of five communities (some 4,000 people). the provider:patient ratio is quite staggering... on top of the fact that we do not always have the medicines that we need - we did not have acetaminophen for a good month and a half, which is sobering, considering fever is one of the most common afflictions in the community. During my last week here, a 23-day-old baby girl died of high fever in her home in the middle of the night - there were other complications, as she was born with sepsis - but even if she HAD been brought to the clinic, we wouldn't have had the medication to treat her. The community is a two-hour bus ride away from the nearest hospital, and the roads are really horrible, especially in invierno, or the rainy season, (which started about the time I arrived). The locals here tell me that in October and November, the roads are impassable; the water levels get so high that some have to leave their homes in search of higher ground (not to mention that the water is contaminated by all the garbage that is strewn all over the place - there is no garbage collection system, nor a landfill). A plethora of other problems plague the community - they only receive 8 hours of running water every day (on some days, there is no running water in the clinic)

In addition to helping with the daily functions of the clinic, I am pursuing a project called “Plan de Parto,” which aims to reduce the incidence of maternal and infant mortality in the community. This is an extremely important topic, as well over 80% of pregnant women in the communities have at least one or two risk factors for pregnancy complications (e.g. mothers younger than 19 or older than 35, high blood pressure, lack of access to health care facilities). We mobilized community members to form committees that oversee the organization of various activities concerning the health of pregnant women in the community. They are responsible for conducting a census of all the pregnant women in their respective communities and creating a map, so that local community health workers and midwives know exactly where the pregnant women live, in case of an emergency. We held educational workshops on nutrition during pregnancy, possible complications during childbirth, breastfeeding etc. I thought it would be more engaging to couple the health lectures with more tactile activities such as making our own healthy refreshments that were rich in the nutrients we had discussed during the workshop.

We also wrote a letter to the municipal office of the Ministry of Health in Tola to request visits from Ob/Gyns to give consults to the pregnant women in the community at least once every two months. Without this service, most women go without sonograms and other “standard” prenatal care procedures – they can get these at private clinics, but this expenditure is well out of the reach of almost all women in the community.
In order to make the activities of these committees sustainable, we have also been holding handicraft sessions, where the women share their skills in knitting, crocheting, embroidering and other crafts. Even before my internship ended, we were already selling these products in the community, and we hope to extend our market to local fairs and nearby hotels in order to generate a fund that will fund future activities of a similar nature (buying materials, etc) and serve as an emergency fund, in the case that a pregnant women needed to go to the hospital in Rivas but did not have the economic means to do so.

To integrate other community members into this endeavour, I also created a sign up list where people who could provide transport to the clinic/hospital or girls who could help out with domestic chores during the last trimester of the women's pregnancies could put down their contact information. Ideally, this would also generate some employment within the community..
All in all, I hope that these activities can build community and systems of information sharing between the people of all these different communities through the activities of "Plan de Parto"