As I write this post, I am currently on a plane headed back to Houston, TX.

My heart feels like it is being wrenched in a million different directions right now as I reflect on the rich experiences and wonderful connections I developed with the people of Masaya, Nicaragua over the past nine weeks and think about all of the things about Nicaragua that I will terribly miss. I have been having difficulty controlling my water works since last night, after giving a last hug to my host grandmother, Doña Amparo, before my early morning departure today.

The last few days have been filled with despedidas (good-bye parties), excessive amounts of smoothies and nacatamals, and too many farewell hugs. I am terrible at saying good-byes, but farewell get-togethers are important to me because I desire a sense of conclusion.

On Wednesday, I treated two of the pregnant adolescent patients who had the best attendance at my workshops at the Roberto Clemente health post to smoothies at my favorite place in the Parque Central. Nory (in the center) is expecting her baby in the next month while Jessica (on the right) is expecting hers in December (a Christmas present)!

On Thursday, I planned to lead my very, very last Chicas Poderosas session on myths about sex and use of contraceptives, but since school got dismissed early that day, around half of the girls already had unfortunately already left by the time I arrived. However, as always, the same group of girls lingered around after school, waiting for me, so I still decided to run the session. In addition to these girls, a few of their male friends (who participated in the environmental health presentation for the primary students) also joined. It turned out to be an absolutely wonderful, eye-opening session – for both the students and me- and it deserves its own blog post in the future. At the end of the meeting, after exchanging email, Whatsapp and Facebook information, the students begged me to come back the next day for a more proper good-bye with everyone. Thus, on Friday, I returned another time!

On Friday, the room was packed with more girls than chairs. Since the club’s inception six weeks ago, some new additions were made because of friends asking friends to come along, and the club expanded. In addition to reviewing the information that I had discussed with the smaller group the day before (I had the girls who were there on Thursday to help me present.), I gave them final evaluation forms to fill out so they could reflect on their individual experiences participating in the club as well as provide feedback with ideas about how to improve the club. I stayed at the school long after the Friday session ended to help out a fellow intern with conducting parent interviews for her health research on contraceptive knowledge. I spent a great deal of time posing for pictures photos with them on our cell phones and chatting with several of them one-on-one and in small groups. They all told me that I had to come back during a future vacation and to never ever forget them.

Brenda, Sara, Rebeca, Morelia, and Miguel stayed behind to chat longer, and I got the opportunity to introduce them to some of my fellow interns who showed up to help out with the parent interviews. Listening to them rant on and on about all they have learned and done over the past six weeks to my friends made me very proud. They told them that they would not get boyfriends or have sexual relations until they are old and mature enough to handle the responsibility. They told me they did not want to end up like Ana and Pablo (a fictional teenage pair that had an accidental, unwanted pregnancy in a scenario that I had them act out in an early session). Not wanting to say goodbye to them just yet, I invited them to spend the following afternoon in the Parque Central for a small despedida with their friend group. They excitedly agreed and made plans amongst their group.

On Saturday, five of them showed up (three couldn’t go because their parents would not let them). Since they all live in different locations throughout Monimbo, the southern district of Masaya, they had left their houses at 1 PM to walk/take the bus to meet each other and then come meet me. All in all, it was a two-hour trip for them to come out to the park to meet me! I had no idea it would take them that long, and their act of doing so was a gift I will never forget. It was the first time I had seen them out of their school uniforms, and they all looked gorgeous wearing beautiful, colorful clothing and fancy bags. I treated them to Oreos and smoothies and we laughed and joked about experiences we shared together in Chicas Poderosas. They told me how sad they would be to have me gone with a nurse leader in my place – it just wouldn’t be the same. We walked around the park and then watched a cultural show, which was a sort of pageant competition for young girls that involved traditional dance and speech about cultural traditions. Held in the large Instituto Central, it was a very exciting event, packed full with a lively audience. We took an excessive amount of pictures to capture our last get-together (well, not hopefully not last… they made me promise to come back which I fully intend to one day once I can afford it).

In addition to my despedidas with my students, I also had the opportunity to go see the Masaya Volcano (a surreal, unforgettable experience) and enjoy a farewell dinner with karaoke with my fellow FSD interns. My host family also prepared me traditional, heavy dishes of baho and nacatamals.

On Saturday night, after hugging Doña Amparo and starting to cry, I went to bed with my emotions all knotted up and out of my control. As I looked around my room, which was all packed up and ready to be moved out of, my mind instantly flitted back to nine weeks ago, when I first arrived. I remembered that first sense of panic I felt nine weeks ago when I first brought my luggage in and got a chance to sit down on my bed. I remember questioning myself about what I got myself into… doubting whether I could actually survive the next nine weeks on my own… whether I would be lonely out of my mind, whether I would be able to communicate, whether my project would have any success or whether I would enjoy myself at all… All of these feelings felt so foreign and distant that it seemed like years ago when I first arrived, even though it was just back in May.

I couldn’t sleep at all last night. My emotions were in haywire while my mind overflowed with replays of various unforgettable experiences that I had… I couldn’t stop thinking about every single thing I would miss… everything from the vivid colors of the streets that I have gotten myself accustomed to, the laughter and singing of my host family that I would wake up to every morning, and my students screaming my name when they saw me at the entrance of the school to the pure feeling of excitement of living in the center of the city would bring every time I set foot outside of my door. I had gotten so accustomed to living my daily routine in Nicaragua – from eating traditional food every meal and saluting familiar faces and local friends that I have made throughout the streets to simply all of the smells and sounds in the bustling streets that I had grown to love.

I departed the quiet house at 4:30 AM this morning to reach my flight on time. Doña Ritana woke up at 4 AM to see me off. We both couldn’t stop crying after hugging each other. I still can’t think about seeing Doña Ritana break out into tears without crying. Throughout the whole car ride to Managua/ throughout this plane ride, tears have been uncontrollably falling.

These nine weeks have flown by way too fast, but I am incredibly thankful for all of the  experiences and relationships I have been privileged to develop. They will stay with me forever.

My Nicaraguan Loewenstern summer experience will always hold a very special place in my heart.

A couple of weeks ago, my supervisor, Maria, a trained forensic psychologist in Nicaragua, told me a chilling story of a case she had in the past.

Maria saw two young children of a homicide victim who were scarred from an incident they could never erase from their minds: the first-hand murder of their mother by their father. Their father had seen their mother giving a glass of water to a visiting male stranger, and without caring to know the context, proceeded to brutally slaughter their mother by wrapping her in barbed wire. The children were present while the whole event took place in front of their eyes.

Maria told me this story to help me better understand Nicaragua’s domestic violence problem, which is severe. One out of three Nicaraguan women have reported domestic abuse, making Nicaragua have the second highest rate of domestic violence in Latin America (after Guatemala).

Though in 1996, MINSA declared domestic violence a public health problem, it has done little to address the issue, which remains unfunded and often undiscussed. The problem has not gotten any better since then. Unfortunately widespread poverty and lack of hope continue to feed into this endless cycle of domestic abuse.

Yesterday’s Chicas Poderosa’s session was focused on violence within romantic partnerships and within families. To start off the session we discussed different types of domestic violence – physical, emotional, economical, and sexual- and how to recognize alert signals and identify violent and manipulative partners. We then discussed how to prevent and confront violence in their own romantic relationships. When Maria arrived at the end of the session, she helped me by leading them in an activity (pictured below) that demonstrated the unhealthy power dynamic that exists in violent relationships and then subsequently presenting on what they could do to change this culture of intrafamiliar violence that exists within their communities.

This was an especially difficult lesson for me to teach. I try to make all of my sessions interactive, by asking girls questions and having them raise their hands and participate, but the girls were particularly resistant to answering questions I presented to them about domestic violence. When I asked them if they thought domestic violence was a problem here, it took them a while for them to respond. After a couple of brave girls admitted that they have seen cases of domestic violence here, the rest of the class got the courage to speak up and agree that they thought it was a problem in their community, and that it was important to make changes in this area.

I realize that this is a very a sensitive topic, and I am very proud of the girls for participating in the charla. After the last few sessions that I have, girls are coming up to me afterwards to let me know that they think that the themes of my charlas are “bonita” and are grateful that I am bringing attention to issues that are recognized as important but often pushed under the rug. I hope that these sessions will start conversations amongst the girls and their social networks to ignite some change or some re-evaluation of their perception of how they can address the domestic violence problem in their community.

 

Every Nicaraguan here who I have talked to about my service has been encouraging. With girls dropping out of school and leaving the labor force and with more mouths to feed, they recognize that teenage pregnancy results in many serious economic and emotional strains on families. Many who I have talked to have also recognized the more nation-wide problems that teenage pregnancy presents in terms of its limitation of the growth of the nation’s economy. Most can talk on and on about how teenage pregnancy is a definite problem in Nicaragua. They can bring up their friend’s daughter that got pregnant at fifteen or their neighbor’s son who impregnated a sixteen year old and talk for hours about how this affected the lives of their families. But when it comes to offering solutions to the problem, it’s not always clear what should be done.

The issue of high rates of teenage pregnancies in Nicaragua is definitely multifactorial. Nicaraguan machismo, lack of contraceptive knowledge, and religious beliefs contribute to 28% of Nicaraguan women giving birth before the age of 18 years. Because there are so many sociocultural forces at play, it truly is difficult to approach this issue with any one clear-cut answer. However, what I have learned over my time here, is that sexual health education here is extremely lacking.

Two of my fellow interns at Foundation for Sustainable Development are currently conducting research at the Centro de Salud Monimbo, the same health center I am serving at. They are interviewing pregnant teenager patients (12-19 years old) to better gauge their understanding of pregnancy and contraceptive methods. Unfortunately, they have been finding that knowledge in this area is extremely lacking and that false community myths are all too common in these girls who are coming. Patients come in believing that taking the day-after pill one time will cause them to be sterile for the rest of their lives. Some think that they can’t get period during their period and depend solely on the unreliable calendar method for birth control.

Last week during my workshop on birth control, I found this widespread lack of knowledge to be true amongst my club of secondary school girls (13-16 years old). Though the girls were naturally embarrassed about this topic, they were intently paying attention throughout the entire duration of my presentation. Out of the thirty girls there, only two had attended any educational session on contraception in the past. I tried to make the session as interactive as possible to make sure the girls absorbed the information. I passed out condoms to the girls, and demonstrated how to properly open the packet and use a condom, using a glue bottle as my model. I kept the session full of back-and-forth Q&A. I observed that when I presented them questions such as if it is better to wear one or two condoms during sexual intercourse, the girls did not know the answers. (The answer is that a single condom is better; two or more can cause friction that can increase the likelihood that they will break and fail at their original purpose.) This experience strengthened my feelings that education about sexual health here is definitely lacking and is likely a strong contributor to why the rate of teenage pregnancy is so high in Nicaragua.

Unfortunately there are many barriers impeding widespread advances in contraceptive education in Nicaragua. Because of adamant religious beliefs, there is no push to teach sexual health in schools. This leaves public health centers and women’s health organizations left to find their own funding to send representatives out to teach students. The initiatives that these organizations spearhead are often very admirable, but sadly are unable to reach many students due to irregularity because of a lack of established widespread model and accountability structure.

I have seen the incredible success of Nicaragua’s community and family health model (Modelo de Salud Familiar y Comunitario – MOSFAC) at work while shadowing doctors at the various rural and urban posts throughout the neighborhoods. These doctors go knocking door-to-door to make sure that no chronically ill patient is left undiagnosed and untreated. This is credited to the dedication of the doctors at the Centro de Salud and MINSA, Nicaragua’s health ministry.

In my personal opinion, a nation-wide model integrating sexual health education into secondary school curriculum would have great success and perhaps make a dent in lowering the national rates of teenage pregnancy. However, implementing a program this wide-spread on a topic that is controversial and touchy for people of certain beliefs would be an extreme challenge.

On Tuesday’s, I work with adolescents aged 13 – 18 years old in a secondary school. Before and after our sessions, the girls are always laughing with friends, flirting with boys, playfully teasing me, and just generally enjoying their teenage years.

On Wednesday’s, I work with girls that are their same age, who are living in a whole other world. They are pregnant with either their first or second children. Most are out of school and do not receive the support that school social networks offer. They walk to my sessions alone, or sometimes with a young baby on one shoulder.

Since I am working with both groups at the same time, the contrast between the groups is not something I can ignore.

I am older than many of the pregnant patients in my group, but they carry heavy, real responsibilities that I have never experienced, responsibilities I cannot even begin comprehend.

Take Jessica for example. She’s fifteen years old, and seven months pregnant with her first child – a boy. She’s attended all three of my workshops and has been on time each time, maintaining a perfect attendance record that beats the rest of the club’s participants. Each time she brings her notebook and pen that I gave out on the first day and attempts to take copious notes. She no longer attends school, and from the written evaluations she has turned in, this is obvious.

Since we both live close by, after our last session, we walked part of the way home together. Under the strong sun, my heavy backpack and long pants were suffocating me, and I was sweating up a storm. But I did not dare complain while Jessica walked beside me in her skinny jeans with her bulging belly.

During our conversation, I learned that she has already moved out of her home and is living with her partner’s family. She’s only one year than my younger sister. Yet, she no longer lives with her parents, and is already independent, ready to raise her own family on her own.

We talked a bit about what we were up to that afternoon. I told her that I was going to a meeting with the director of the health center that afternoon, and then to dinner and a volcano excursion with the other interns in my program at night. She told me she was about to take a long nap. Her petite body was tired after the long walk to the center, and she almost wasn’t able to make it out that morning. After her nap, she would clean her house a bit, prepare dinner for her household, rest, and then start the day over again.

I have less than 10 days left here in Masaya, and I can’t seem to wrap my head around the little time left I have.

Before leaving for my trip, I was given envelopes with essay prompts to open up at different times all throughout my internship. Now with only one week left, I have a small stack of prompts that I have not directly addressed in my blog posts. At some point over the past 8 weeks, life here just caught up to me and I was overwhelmed by the feeling of too many things to write about.

However, before I leave the country, I hope to document some of the feelings and experiences I have had here while they are fresh in my mind. Be on the look-out for future posts.

After a wonderful week’s stay in Nicaragua, my family departed last night back to Los Angeles. I thoroughly enjoyed the quality time I was able to spend with my family and was happy that I could show them around the area. I had not seen my sister or father for seven months, which was longest period I have spent away from them in my life. During that time, my sister actually outgrew me!

While my family was here, I enjoyed a brief vacation away from my host family, staying with them in peaceful eco-lodge in Catarina, Masaya that overlooked the Laguna de Apoyo. My family spoiled me with the opportunity to enjoy hot showers, a brief reprieve from mosquito attacks, and the ability to avoid walking the dusty streets by cruising in an air-conditioned, new rental car. Seeing the area from a tourists’ lens was honestly quite strange after six weeks immersed under much different conditions and watching my family’s reactions to what they saw around them gave me some new perspective into my experiences over the past six weeks.

While they were here, I introduced them to my host family. They brought a whole duffel bag of assorted gifts for them, and in return my family treated them to a Nicaraguan-flavored “chow mein” dinner. Unfortunately my family knows little Spanish, so conversation was limited; however, my father, extroverted and unabashed as always, pulled out his Google translator app on his Nexus phone and was somehow able to engage them in conversation the whole time (with a bit of my translating help). My family was overall impressed with how much my Spanish language abilities had improved and admitted to me that they had thought that my pre-trip Spanish accent was no bueno.

I also had the opportunity to show my family what I have been up to over the past seven weeks. They accompanied me to my Monday health workshop for the pregnant teenagers at the Roberto Clemente health post. I was lucky to have my mom there to help me prepare because the theme was “Caring for your Infant: Breastfeeding, Bathing, and More”, and I did not have much prior first-hand experience with this.

Afterwards, I got to show them around Malecón Park, downtown Masaya, and the main healthcare clinic.

They also helped out with my Thursday Chicas Poderosas meeting with the secondary school girls. The day’s theme was birth control methods, and I was forever grateful my parents were there because the girls were infinitely much better behaved. The girls were naturally embarrassed at the topics I covered, so my sister led the girls in an arts and crafts project afterwards. They embellished hair ties with bows and flowers.

I am so happy I could share a slice of my experiences with them and wish they could have stayed for longer!