Getting our feet wet....literally

Friday was a wonderful day. The first three teams headed out on the adventure that is field work – Destination: La Flor. We were told that it would take at least an hour and a half to get to the health post of Guayabo by vehicle, and from there we would have to walk at least 45 minutes to the community of La Flor. Our driver got us to the health post 45 minutes after we left, after crossing over several small rivers. We began the muddy climb up to the houses in the area, splitting into three teams: one for the lower regions, one for the middle of the mountain, and one that would go all the way to the top. Josie and I volunteered to trek to the top and we were pleasantly rewarded with beautiful vistas and a sense of accomplishment. Most of the families we encountered were willing to participate in the survey, and the household with 10 children even offered us warm fresh bread called ‘semita’– ¡Qué rico! The local health workers who came with us helped to introduce us to the families and intervened when we had trouble communicating in Spanish. The three teams reunited at the health post, and though everyone was worn out from trekking to every house in La Flor, we were energized as we recounted our stories from the day.

While we waited for the truck to pick us up it began to pour, and there were murmurs from our local counterparts about the rivers growing bigger and potentially becoming impassible. The wild ride back proved the tremendous driving skills of our fearless truck-driver. We huddled in the back under a tarp, bouncing over ruts created by the rain, and catching glimpses of the emboldened rivers we had crossed, grateful for our safe passage to the other side. The rain let up as we entered town, and we thought it was over. But it turns out that it starts raining in the mountains and then passes through town, so we caught the rain twice….but at least the second time we were happily showered and eating dinner in the Casa Blanca. We reviewed any survey issues that came up with the group and talked about the schedule for the following week.
The effects of Hurricane Alex came through and turned the streets into rivers that night, and it rained for most of the weekend. Several of us stayed in El Sauce for the weekend, and attended the 6th Annual Youth Talent Competition – young hopeful Sauceños dancing, singing, and reciting poetry for the chance to represent El Sauce in the larger competition in Leon in August. The kids were so cute (!) and we were happy to get a taste of the rich culture of the region.

Getting to know El Sauce

The heart of El Sauce lies at the center of the El Sauce municipality, within the province of Leon in the Northwest Region of Nicaragua. The municipality of El Sauce is comprised of 11 health sectors, and has a population of about 30,000 people.

El Sauce is a quiet town with cobbled streets and bicycle taxis; friendly people and stray dogs; a beautiful church and a delicious ice cream shop; a busy clinic and brand new hospital under construction. It is still quite a shock to be living in a place that is so different from Sahsa – from the hotel we are staying in to the internet cafés we are frequenting. Though El Sauce center has many of the amenities of a Nicaraguan city, the health infrastructure still lags, and most of the people in the surrounding towns live in impoverished rural areas with limited access to health care. We were able to deliver some basic medical supplies to the Health Center in El Sauce town, and the doctors and nurses there were thrilled to receive the much-needed supplies that medical professionals in the US certainly take for granted. The ‘Sauceño’ health workers were most excited about the goggles and gowns, saying that they knew they were supposed to be using such things, but that they had not been available.

The UNC team worked hard on the survey for many days – piloting, adjusting, translating, and learning from each other and the Nicaraguans who have been graciously aiding us in our endeavor. Though at times the process of finalizing the survey was taxing, the result of our hard work and endless scrutiny is a product we are proud of. We look forward to getting out into the field and using the skills we have practiced to engage the community of El Sauce in a project that we hope will eventually bring more health resources to the area. And, of course, we are excited for the opportunity to improve our ability to speak Spanish.

Rolling with the punches ... a new frontier!

The rollercoaster ride that is this summer wouldn't be complete without a big TWIST in the middle...

Due to strikes and protests in the North Atlantic Autonomous Region, the location of our project has been moved from isolated multiethnic area of Sahsa to Leon Province's poorest sector of El Sauce. While we likely would not have been particularly unsafe had we remained in Sahsa under current conditions, the potential roadblocks and other transportation issues would have made it difficult for us to evacuate the area had the situation escalated or had there been some other kind of medical emergency or natural disaster.
Though I am terribly disappointed that we will not be able to work the population in Sahsa, I am happy that we will at least be able to continue our work in another area of Nicaragua that can use our help. UNAN already identified El Sauce as an area where a health surveillance system should be developed, and we will be helping the University in their endeavor. We plan use the same health surveys we developed for Sahsa (with a few tweaks to suit the new population) and we will work with the administrative health staff in El Sauce to set up educational charlas on reproductive health and sexual health issues. We plan to send some of the medicine and medical supplies we purchased to Sahsa with an UNAN representative, and we will also purchase more medical supplies for El Sauce depending on their needs. This is an exciting opportunity for us and for El Sauce, as the area has been identified as needing improved health infrastructure and better data on the health issues in the area. We are ready and willing to help.

More info on El Sauce to follow....

First Impressions of Sahsa

Aside from traveling on my birthday, the flight from the US to Managua, Nicaragua was uneventful. I spent the next few days meeting with collaborators at the University of Nicaragua in Leon, and quickly ran into my first complication - due to strikes, I would not be able to do a preliminary trip to Sahsa to check out the living quarters and pilot the survey our group so diligently developed. I was crushed and worried that I wouldn't be able to properly finalize the survey and would have nothing useful to report to the other UNC students arriving in June. But, as I soon learned, plans change all the time, and by the next day the strikes had ended and we planned to fly out to a town nearby Sahsa, called Rositas.

It would be no fun if it was that simple though, right? From now on, I will employ the imagery of a roller coaster ride, because that is what this experience has been so far. In keeping with that theme - we found out that flights to Rositas were booked for the time period we needed to travel. Finally, we settled on flying into Puerto Cabezas, with a return flight out of Rositas. Hooray!

Myself, Dr. Rodolfo Peña, and another doctor from the University of Nicaragua, flew in a toy-sized plane to Puerto Cabezas (Bilwi) on the northeast coast of Nicaragua. Another loop in the rollercoaster turned out to be that La Costeña (the only national airline) purposefully did not send our luggage with us, but did not inform us of that fact. We spent a few hours in a sweaty comedor waiting for our luggage to arrive on the next flight. Thus began the adventure....

We traveled out to Sahsa in a comfortable truck, over unpaved roads with immense potholes, animal crossings, rickety bridges, and inundated streams. We passed vast areas of deforested land and after three and a half hours of spine-compressing travel, we arrived in the town of Sahsa, and met other collaborators on the project as well as UNAN medical students who were working in the clinic. The 'casa' where UNC students are supposed to stay is a sprawling property with bunk-bedded bedrooms, toilet and shower facilities, and a detached kitchen. UNAN staff have set up a surveillance system in the surrounding area, which involved numbering the houses and conducting a census in each town.

I spent the next couple days reviewing our health survey with a local representative and the UNAN doctors who have been working in Sahsa for many months. I also piloted the survey in a few of the neighborhoods in Sahsa. The pilot was successful and provided me with useful information to finalize the survey. The survey components include questions about reproductive health, pregnancies, antenatal care, vaccines, diarrhea, unintentional injury, and social networks. People were very willing to talk to me about these topics, and were very friendly in general. Sahsa and its neighboring towns are severely under-resourced, with limited health infrastructure, few teachers, poor water quality, and dirt roads that become impassible during heavy rains. I believe that UNC's and UNAN's continued involvement in supporting this region's health sector will be important for the people living here, and I look forward to moving forward with our group's work this summer.

Project Description

The Collaborative Sahsa Health Initiative (CSHI) was established in 2008 as a cooperative team of students and faculty from UNC-CH and the University of Nicaragua in Leon (UNAN-Leon) interested in serving the population living around the town of Sahsa in rural eastern Nicaragua. Over the last two years, UNC students have worked with UNAN students to collect epidemiological data in Sahsa in the areas of maternal and child health. This summer, I will join an expanded team of 10 UNC medical, public health, nursing and geography students in cooperation with UNAN medical students to continue assessment efforts and to implement new basic health interventions.

Since CSHI was developed in 2008 through the partnership of UNC and UNAN students and faculty, group members have shown their commitment to forming a sustainable project in the Sahsa area. Though the UNC team is only in Nicaragua for 6-8 weeks out of the year, we spend much of the school year planning and fundraising in order to build on the good work of previous missions. This year we plan to improve the existing health infrastructure by empowering local health leaders with educational materials they can use to increase awareness of health issues and remedies in the community. In this way, we hope to promote sustainable changes in health-related decision making. In addition to the advances we can make through health promotion activities, the data we collect can be used by UNAN and the Nicaraguan Ministry of Health (MINSA) to stage more focused health interventions in the North Atlantic Autonomous Region (RAAN) of Nicaragua . For example, we can use the Geographic Information System (GIS) technology, using GPS units purchased by last year´s group, to map areas of low vaccination coverage. We expect that this will help MINSA acquire sufficient resources and support to immunize children in RAAN and make plans for reaching remote areas. Moreover, UNAN has significantly invested in the Sahsa Clinic, making it the site of a clinical rotation for medical students to maintain a year-round healthcare presence, and a base for health interventions. Our team will support the clinic this summer by collecting reusable medical equipment donated by MedShare, Atlanta and MEDWorld, Chapel Hill and delivering them this summer. Our team is further dedicated to recruiting a new team of student volunteers to visit Sahsa in the summer of 2010. I intend to return with the group next summer to evaluate the hopefully positive effect our efforts have had on the health of the population there.

Our main point of contact at UNAN is Dr. Rodolfo Peña, the Director of UNAN's Center for Research in Demography and Health (CIDS). His input and advice have been extremely helpful in enabling UNC to work effectively in Nicaragua. Dr. Douglas Morgan, the Faculty Mentor for the UNC group going to Nicaragua, has been working with Dr. Peña over the past several years to strengthen the partnership and solidify UNC's commitment to supporting CIDS research efforts.