Reflections on El Roblar
by Ankur Asthana on August 3, 2009
GlobeMed at Rhodes College was founded in the fall of 2008. A team of four members traveled to Nicaragua for three weeks this summer to work on-site with A Ministry of Sharing Health and Hope (AMOS), a grassroots organization that focuses on primary health care issues in communities throughout rural Nicaragua. One of the ways AMOS addresses these issues is by training community health workers, or “health promoters”. The team worked on a number of on-site projects including: helping with a community-based census, developing health promoter training materials, conducting a needs assessment to identify future long-term projects, and filming a short video to bring the experience back to the rest of the chapter. In this article, Shannon Fuller shares her reflections on her trip.
The community of El Roblar is entirely inaccessible by car. Situated atop a mountain, the only way to get there is by foot. Areli, the health promoter for El Roblar, had made the descent alone so she could catch a ride to Managua for a three-day training workshop with eighteen other health promoters across AMOS’ network. Areli is a twenty-four-year-old woman with the equivalent of a third grade education, and one of the brightest and most dedicated health promoters.
Alongside AMOS staff, our team from GlobeMed at Rhodes helped develop a variety of training materials for the workshop. We also made booklets in which health promoters could record the weights of all children under five years old on a weekly basis to monitor malnutrition and catch the kids who were particularly at-risk.
After the training workshop, our team decided to visit Areli in her community. As we approached El Roblar’s school, fatigued from the long ascent, we immediately livened up when we saw a line of mothers and babies waiting for Areli, who was adding the first entries to the new weight register we had distributed a mere two days earlier.
Every morning from about 9am to noon, Areli travels to different homes throughout the community to check on patients; however, she may only get to four or five families during that time since houses are spread so far apart and terrain is difficult. On top of her job as a health promoter, she teaches general adult education classes in the community every afternoon.
We had the opportunity to accompany her on home visits. The first stop was the home of an elderly man who had recently lost functioning of his arms, legs, and speech. Areli checks in on him every other day to take his blood pressure and provide comfort for him and his family.
Knowing about our chapter’s media project, Areli asked the man if we could take pictures or video. His head nodded ‘okay’, but the camera hung limp around my neck. Areli’s six-year-old daughter, Angelica, must have sensed my hesitation. I felt a gentle tug at my arm. “Chanita,” Angelica said, calling me by my new nickname, which had begun to stick. She asked if she could try using my camera, and after a quick tutorial she marched up to the bed to compose her shot. To my horror, she stretched her arms over the bed and positioned the lens less than a foot away from the man’s face. Fortunately the flash was disabled. Yet to everyone’s amazement, as soon as the shutter closed she pulled the camera away and angled the screen towards the man, pressing the playback button to display him the photo.
Angelica took picture after picture of her mother caring for the man on the bed. Every time, without fail, she would lean over, gently touching the man’s arm, and watch his reaction as she made the picture appear on the screen. Then she would jump up and run over to us, with the biggest smile on her face, proudly presenting the photo to everyone in the room. She also took pictures of the man’s family and the inside of his home, making rounds after every shot.
She carried the camera around her neck all the way back to her house, taking pictures of trees, passersby, and the backs of our legs as we trekked up the trail. When we arrived at her house, we asked her to take pictures of people and places of importance to her. A photograph can be a compelling way to share experiences and convey ideas, but it also provides a unique insight into the eye behind the lens. Now we had a collection of pictures capturing what our eyes saw during our three week stay in addition to the perceptions of a young girl in the community.
Over the course of the whole trip, and especially that day with Areli, I began to fully understand how health promoter training programs encompass so much more than the teaching of one individual. Areli trained others both formally in her class and informally through observation. By watching her mother during these home visits, Angelica had clearly started to pick up on some of the same best practices, like the healing power of human touch, that make her mother such an effective health promoter.
It was amazing to see all the connections between our work and the daily activities in the community. From creating the health promoter training materials, to seeing them in use, to following health promoters on home visits, the entire trip was simultaneously humbling and empowering. To know that our chapter along with the entire GlobeMed Network played a role fills me with tremendous pride, but also leaves me with the feeling that we have so much more to do. And I know that we have the power and passion to make it happen.
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