A Long and Winding Road

My last days in Nicaragua were spent adventuring deep into communities of the north atlantic coast. Cody was sent on a mission to inspect a small saw-mill operation in the pine wood savanna, and I eagerly accompanied him for a chance to explore and get out of the city. We boarded the sleek grey truck that virtually has no shocks left, leaving us bumping up and down the road as if we were in a truck pimped out with hydraulics in a live action hip-hop video. The road is bumpy, but our driver, Chaparo, is skilled at dodging the large craters that abound. It has been raining the past couple of days so at least the road is moist, no dust to cover us from head to toe, filling the gaps in our teeth as I have experienced in past adventures on the roads of the north atlantic coast. We wound our way through the grasslands, stopping to pee and realizing that the small yellow flowers that are populating the green fields were minuscule orchids. We head deeper and deeper into no-mans land. we pass communities from which women who have stayed at the Casa Materna live: Ena in Santa Marta, Tasba Raya, Tasba Pawni... At some point hours down the dirt highway we turn off and begin our ascent into pine, mahogany, and madrone covered hills with views of the mountains of Jinotepe in the distance. The scenery is breath taking. Eventually we weave our way up and down, over and through dark, earthy-mud to arrive at the saw mill. Now, i'm not the kind of girl that knows alot about saw mills...I leave that kind of knowledge of machines and engines to Cody...my interests are in health. What struck me the most about this saw mill and the small communities around it were how isolated they actually were. I finally understood the importance of a place like the Casa Materna. I could conjure up images of medical emergencies, sense the urgency, and palpate the despair of feeling trapped. What if someone cut their arm off on the saw mill? would they make it to the small clinic in Francia 1 hour away by vehicle in time? would they then make it to the hospital before it was too late? Just a few days prior a log (basically a tree) fell on one of the employees crushing him. A makeshift cot was made out of sheets and branches and then fashioned to the skidder (the only available vehicle) and he was then carried down to the health center, later to be transferred to the hospital. There are no emergency plans in place, and what happens if you have no access to any form of vehicle. I guess the answer was seen in my previous story of the man carrying his seizing wife on a bicycle to the medical post.

It was standing in a small community like this, drinking coconut water, and watching the women herding their many children when I really got it. I really understood how difficult it must be for a woman to a) make the choice to leave all her children, walk the 8 hours to the highway to then find a ride to Port, and then spend an indeterminate amount of time at the Casa Materna, or b)stay at home, birth her baby and pray that there are no complications. Access to healthcare is a common theme of discussion in the academic world of nursing/medicine, but we are usually talking about how to market medicine to encourage patients to engage in preventative health, or reach populations that are on the fringes of society (i.e. prostitutes, IV drug users, homeless, etc.); but in this case access to health is a strictly logistic issue. How on earth do you get to the hospital when you have a long and winding road separating you from it and no money to get there. How do you get medical care when your personal knowledge of risks, emergencies, and your own body is as limited as your access?

My last days in Nicaragua were spent in the lush tropical town of Waspam contemplating these questions. Waspam is the second largest city in the North Atlantic Coast. They have no super market, no gas station, they only sell tomatoes, onions, and cabbage in the market. What they do have is a fabulously long river that separates Nicaragua from Honduras with unknown quantities of indigenous people living along its borders. I had gotten to thinking back in Port about how we could provide better access to people, specifically women living out in these distant communities...Sonja and I had come up with a fabulous idea that has started to take more shape and became more important to me as I visited communities and sat in my hotel in Waspam listening to the rain patter outside. So the conception of our next project has taken place...it may be a pregnancy of more than nine months but it will be nourished and fed until the birth of Mairin Karna (Strong Woman) a one hour radio program on Women's Health is broadcast in Spanish, Miskito, and Mayagna throughout the North Atlantic Coast! Knowledge is power, and if we can reach the women out in the communities hopefully they will in turn be able to reach us!

Well I have ventured down my own long, winding road and have arrived once again in the US. I am on the brink of beginning my official studies to become a midwife and am ecstatic for the opportunity to learn more and become more skilled. I hope that all of my beloved readers have enjoyed this leg of the journey...stay tuned for more!