It’s 8 PM here in my cute and quiet mint green bedroom, which I have settled into quite nicely. I can hear the long awaited rain pattering quietly on the roof and the the hearty laughter of great-grandmother, Doña Amparo who is exchanging a joke with a neighbor on her rocking chair in the living room. I can still taste the flavorful homemade cerda con verduras y tortilla and fresco that I just finished off for dinner.

Though I’ve only been here for three days, I have already fallen in love with the city of Masaya and my lovely host family.

Since arriving on Sunday afternoon, I have been participating in an orientation week held by the Foundation for Sustainable Development, the third-party organization that is facilitating my internship with the community health center in Monimbo, Nicaragua (a nearby city in the Dept. of Masaya). Through this orientations I have been able to get a taste of life in Masaya and some of the surrounding cities. I absolutely love my family’s location in Masaya, which is right next to the Parque Central, the heart of the bustling, colorful city. People are always out and about… walking or in cars, bicycles, horses, or buggy-like taxi’s. Flamboyant processions for weddings and funerals constantly fill the streets and huge busses blasting music pr community announcements pass by house frequently. There are several schools in the area, and there are children of all ages livening up the park at almost every time of the day… at the same time there are working people, tourists, and all sorts of people visiting the park to get smoothies, enjoy some popcorn, relax, or even go to the large church.

Along with getting an introduction to the local scene and a little orientation of how to navigate myself around to main areas like cafes with wifi, supermarkets, the health center, etc. I have also been able to go on excursions to other beautiful places around the outskirts of the city/ in neighboring cities. I have been able to visit Coyotepe, Las Flores, Malacón, and Catalina… all of which marvelously showed off the natural beauty of Nicaragua. See pictures below of volcanoes, farms, lagoons, and marketplaces…

Along with all of the excursions, we have been having discussion-intensive days, preparing the other two interns and me for our development work here this summer. I got a chance to see the bigger picture of Foundation for Sustainable Development (FSD)’s work and where my work will fit in. I learned much about Nicaragua’s history, economy, and the lifestyle of citizens of Masaya and some of the surrounding cities and I received invaluable advice. I hope to make the most out of my time here by truly taking the time to connect with the community members and learn more about their strengths and challenges.

Because I need to get ready for an early day tomorrow, I will have to cut this blog post short.. but already I am extremely excited for all that is to come. I have several ideas running through my mind for my project and other sorts of activities I hope to pursue while here. I have been able to talk with Doña Ritana (the abuela en mi casa) about many of the challenges that the Centro de Salud Monimbo faces, and I am excited to meet their doctors, who do so much with so little time every day, and learn and be inspired from them. I hope that I will learn as much as I can this summer and help contribute the sustainable progression of the community.. in what ever small way I can.

 

Coyotepe

Catalina

Farm in Las Flores (part of a previous intern’s project with an organization called Alternativa that empowers women start their own businesses)

More pictures are to come… my internet is just too slow right now.

Thanks for reading!

“Keep your feet on the ground, your heart in the wind, and your head in the sky”

– Dr. Romero, May 2016

There is much I am looking forward to during this summer abroad in Masaya, Nicaragua. After a trying year of classwork and constant worrying about pre-professional preparation, I know I will treasure this time away from the student life to which I have come accustomed. I am excited for the opportunity to truly push myself beyond my comfort zone and challenge myself in ways I have never done before. The only other past experience I can think of that can only slightly measure up to this international project work is leaving for college. However, I recognize that this opportunity will be different in numerous challenging and rewarding ways.

I have never missed a summer away from my comfortable, sunny home in Southern California before. I have never lived with a family of strangers by myself, let alone for nine weeks. I have never independently navigated a country that spoke a different language without a translator or a large group of English-speaking classmates. I have never worked in a place where absolutely no one spoke English. I have honestly never encountered many challenges that I will be facing this summer.

However, with every “have never” comes an invaluable learning opportunity. I have never been this excited yet nervous.

Though nine weeks seems like a long time, I recognize that international development work is a long, long process, and my goals for this summer are not to implement a revolutionary, game-changing project because I know that the chances of this happening in a meaningful, sustainable way is close to mute. Rather, my goals are to learn as much as I can from the people I hope to surround myself around… my host family, other community members, staff at the Centro de Salud Monimbo (the health center I am working at), the program coordinators and my fellow interns, and the other FSD organization partners in Masaya and surrounding cities. I hope to gain a better sense of the true challenges of international sustainable development work. This nine-week experience will be different than the one or two-week service trips I have previously participated in and will allow me to get a better view of the bigger picture and taste of the whole process of project implementation. These nine weeks will involve conducting needs assessments, forging lasting connections and community relationships to gain the social capital and knowledge necessary to truly create something impactful and sustainable, writing a grant/securing funds for my project, getting frustrated and feeling powerless and ineffective a million times over, failing at my original goals, but ultimately accomplishing invaluable things for myself and the community that I might not have been able to predict or even appreciate before the entire experience itself.

I decided to begin this journal entry with a short quote from one of the Honduran doctors, Dr. Romero, who served with our Rice Global Medical Brigades Chapter on our free medical brigade last week. I shadowed her in our gynecology station one afternoon and saw how she relentlessly saw and advised woman after woman, administrating Pap smear after Pap smear, never sitting down to take even a lunch break. If you didn’t talk to her, you might have thought that she hated the station, but that couldn’t have been further from the truth. In fact, she volunteers her time to work with Global Brigades for a low cost in order to serve people in her country that need it the most because she loves her job. To her, administering a million Pap smears after Pap smears is worth it if she can spot cervical cancer early in one out of the millions of women.

To her, keeping her feet in the ground, her heart in the wind, and her head in the clouds involve maintaining humility, striving to be compassionate and serve others, and constantly maintaining an open mind to a lifetime of learning about the world and how she can contribute to making it a better place. Her level of self-realization and dedication to giving back to her community are admirable. Over this summer, I hope to apply this mentality to my service and aspire to reflect long and deeply on my personal and professional goals to re-evaluate my directions in life from a valuable new perspective.

Michelle Alyssa Tran, Rice University

I. Background:

Nicaragua

Nicaragua is the largest but most sparsely populated country in Central America,  flanked by the Caribbean Sea and the Pacific Ocean and bordered by Honduras and Costa Rica. The country has a diverse geographic makeup with its volcanic and fertile Pacific coast contrasting its swampy Caribbean coast. Nicaragua is also home to several mountainous regions and two large lakes, Nicaragua and Managua. It is divided into 15 departments, 2 autonomous regions, and 153 municipalities, and its capital city if Managua. The majority of the population lives in the western Pacific lowland region between the Pacific coast and Lake Managua.

Nicaragua is the second poorest country in the Western Hemisphere after Haiti, with 48% of the population living below the national poverty line. As of 2010, 57.2% of the population was reported to live in urban areas with 45.5% of this urban population living in the slums. Nicaragua is still largely an agricultural country, but its nontraditional exports (tobacco, gold, textiles) have increased over the past few years. Most of the population is Mestizo and Spanish-speaking. The Catholic Church plays a dominant role in society and is the religion of the majority of the population.

Nicaragua has had a conflicted and anti-democratic history, but currently has a constitutional democratic system presided over by Daniel Ortega, who has retained his position since 2006. Nicaragua was first settled by the Spanish in the early 16^th century and was under Spanish rule until it achieved independence in 1838. For the next century, political unrest, civil war, natural disaster, corruption, and economic instability plagued the country, several issues of which remain present today.

During this time, the United States made a controversial appearance on the Nicaraguan political stage, which was dominated by competition between the Liberals in León and the Conservatives from Granada, which were backed by the U.S. government. The socialist Sandinista party was in power for the majority of the 1900s, and in 1981, U.S. President Reagan authorized covert support to the Contras, the anti-Sandinista forces. In 1982 the Contra, trained by the U.S. CIA, began assassinating high-level Nicaraguan government members. The interventions of the U.S. government resulted Nicaragua pursuing a case against the U.S. in the International Court of Justice, which ultimately ruled against the U.S. and further strained U.S.- Nicaraguan relations.

U.S.- Nicaraguan relations have improved since then, and today the two countries cooperate on counter-narcotics, trade, and security matters. The United States provides significant foreign assistance to Nicaragua, helping out extensively with humanitarian relief efforts after Hurricane Mitch in 1998 and providing the country $50.2 million in aid in fiscal year 2006. However, it will still be important for me to cognizant and sensitive of the strained historic relationship between the U.S. and Nicaragua so I do not overstep my boundaries as a U.S. visitor to the country.

Adolescent Sexual Health in Nicaragua

Nicaragua has the highest rate of teenage pregnancy in Latin America with 28% of women giving birth before the age of 18. Maternal mortality continues to persist as a significant issue in Nicaragua, with adolescents accounting for one third of all maternal deaths. Out of these deaths related to pregnancy, childbirth and the postpartum period, around half occurred in public hospitals and other treatment facilities with the remaining having occurred at home or other public places. In respect to sexual activity amongst Nicaraguan adolescents (15-19 years), 39% of have had sex, and of these, 13% had started before age 15. Of adolescents with sexual partners, 46% already had at least one child, and only 30.7% had ever used a contraceptive method.

These concerning trends are considered to be resultant of several sociocultural forces. Since the Catholic Church remains a powerful force in the nation, abortion is completely illegal, without any exceptions granted on behalf of mothers’ health. There also exists some religious prohibition of contraception. Furthermore the machismo mindset continues to cultivate the traditional view that Nicaraguan men should prove their virility by fathering numerous children without any societal expectations to marry their mothers or support their newly created families fiscally or otherwise. Sexual violence against girls is a contributing factor to this high pregnancy rate. Out of over 6,000 cases of sexual violence in 2014, 88% of these cases involved young teenagers.

While the Nicaraguan National Health Plan acknowledges that adolescent pregnancy is a problem, it has failed to offer any solutions. Current existing efforts are small, inconsistently funded, and not supported well by the government. There continues to be no formal sex education in schools, and pregnant girls can be summarily expelled from schools. Additionally, limited access to health care and education for families and adolescents, especially amongst the indigenous and in rural areas, are key issues that prevent women from receiving regular or emergency medical reproductive general services and screening; in rural Nicaragua, the majority of women in rural areas (65%) are illiterate and with most (55%) giving birth at home instead of at public medical centers. In these poorest and most isolated regions, infant mortality remains high. For the indigenous Nicaraguan population there is a 25% illiteracy rate with pressing health issues of poor housing conditions, overcrowding, and lack of electrical service.

While working on a sexual and reproductive health adolescent education program at an urban health center in Masaya, Nicaragua, I should be cognizant of the limiting social and cultural forces that I must work around. Cultural sensitivity will be integral to my project’s success, and I must take the time to gauge the local attitude towards women’s responsibility to use contraceptives and receive regular well-women exams before jumping into my work. Especially for my outreach projects for surrounding rural communities, I should be aware of infrastructural issues that perpetuate the communities’ lack of access to regular medical services and develop curriculum accordingly.

 

II, Breaking News:

Nicaragua accumulates 70 positive cases of Zika

El Neuvo Diario, February 17, 2016

 The Zika virus is making headlines and arousing fear amongst communities worldwide. Because of its rapid spread throughout Central America, the Zika virus is dominating the Nicaraguan news. It is of utmost importance that I keep updated on Zika developments and WHO and CDC recommendations before working at the Masaya health post this summer. Zika will likely be a pressing concern for community members, male and female alike. Furthermore, due to recently proposed links between microcephaly birth defects from mothers who had Zika-like symptoms during their pregnancies, there may be more young mothers-to-be, mothers, and other females who will likely be worried about safe contraceptives or about how this virus may affect their sexual and reproductive health.

This particular recent article (published February 17^th, 2016) discusses how seventy cases have been reported in Nicaragua so far, with four new cases having arisen within the previous 24 hours alone. The Ministry of Health is currently playing an active role in responding to this public health crisis by pursuing a comprehensive campaign to eliminate mosquito-breeding sites. This campaign specifically involves spraying in areas where dengue or chikengunya Zika virus have been reported. Health Ministries of Central America are currently collaborating and discussing on how to best work together to best respond to Zika to keep citizens healthy.

As community members may seek to gain more information and facts about Zika from a local family health clinic, it is integral for me to be aware of this situation and be up-to-date about ways to prevent Zika before leaving to Nicaragua. I may also consider addressing this virus as part of my female health curriculum. I must be wary of this health situation and knowledgeable about recommended preventative precautions, so that I may protect myself against infection while there for the summer.

 

“The Ministry of Health trains 500 health graduates and 700 midwives”

El Nuevo Diario, January 6, 2016

The Nicaragua Ministry of Health recently announced their new initiative to train and certify 500 health graduates and 700 midwives to address emergency situations throughout Nicaragua, especially in rural communities. This program involves selecting students from rural schools that will be committed to working in Nicaragua after graduating through special work contracts. The Ministry of Health’s plan involves training these students on first aid so that they can respond to a range of types of emergencies, including small house incidents to larger-scale disaster situations. Beyond identifying new students from schools, they also hope to certify already existing community health leaders including medical volunteers, traditional healers, brigaders, and others who collaborate with the Ministry of Health.

This article sheds valuable insight onto the community-based health priorities of the Nicaraguan Ministry of Health. The Health Ministry seems to be attempting to build-up community medical support systems and encouraging their workers to stay and practice within their places of birth rather than leaving to other more developed regions or countries. Through identification and medical training of community members, this national program appears to be focused on building community trust from within, an important aspect of their national medical care that I hope to learn more about firsthand this summer. This new training program may or may not affect the Masaya health centers or partner centers in surrounding areas, but it is still useful to be aware of this program so that I may engage in meaningful discussion with doctors and other community leaders while there. This article was also another reminder that I must always keep in mind the importance of implementing sustainable programs that are community-based and community-driven. Cultivating trust through friendship will be important for my project’s success, especially when focusing on such a sensitive topic as healthy sexual and reproductive hygienic practices.

 

 

“Nicaragua’s Construction Sector Expected to Improve Through 2016 and Beyond”

LatinOne, February 15, 2016

Nicaragua’s construction industry grew 18% in 2015 and is expected to grow another 17% this year, a positive trend that has been attributed to the presidency of Daniel Ortega. This article mentions that this boom is evidence that the country has been steadily recovering from poverty after a history setbacks due to interventions led by the U.S. and multinational corporations. Beyond an increase in private construction projects, Nicaragua has several major national construction projects scheduled for 2016 and beyond. One of the more advertised projects is a 170-mile long inter-oceanic canal, a $50 billion canal hydroelectric project that is backed by China. The goals of this project is to attract larger vessels that do not fit through the Panama Canal to help lift Nicaragua’s current $12 billion economy. At the conclusion of the article, the article reports that there have been protests against the building of this canal, with 34% of Nicaraguans believing that this project is “pure propaganda” and purely a self-advertising method for Ortega to regain presidential election this November. However, article mentions that the government published a separate contradictory statistic that indicated that 81% of Nicaraguans supported the building of this canal.

The president’s recent updates about his commitment to pursuing the canal project have several implications for my internship experience in Nicaragua. First and foremost, it is for me to be aware of the political unrest that has resulted from the announcement of President Ortega’s commitment to the building of the Nicaragua Canal. My partial Chinese descent could perhaps result in misdirected animosity towards me. The lack of transparency about the financial feasibility of the project has seemed to raise distrust amongst Nicaraguans directed towards their government and its partnership with the Chinese. This has likely raised suspicions that this is more of a commercial security project for China than an economic project for Nicaragua. Either way, it is important that I am at least familiar with this project so that I could participate in basic discussions about the project with others during my stay there and protect myself. Furthermore, the building of this canal would have significant impact on the environment and therefore the health of Nicaraguans. From what I have previously learned, the building of this canal will require the dredging of one of the nation’s most critical water source, Lake Nicaragua. This reduction in access to clean water could have dire health consequences for the nation’s population. With all things considered, I should keep updated on this controversy that is currently playing out between the Nicaraguan government and citizens from both health and political standpoints.

 

“Hyatt businessman shows interest in continuing to invest in Nicaragua”

El Economista, January 29, 2016

The construction of a new Hyatt Hotel, the first Hyatt Hotel in Nicaragua and the second Hyatt Hotel ever built in Central America was just completed in Managua. This project was prompted by a desire to make the city an international meeting point for corporations and construction. The article discussed how the LATAM Latin American Hotel Corporation that partnered with the Hyatt recently expressed their interests in increasing their investments in Nicaragua. The reasons for their interest in Nicaragua stem from the nation’s high economic growth, especially relative to its other Central American nation counterparts. Over the past three years, the Nicaraguan economy grew at a 4.7% rate, exceeding the Central American average rate of a 3.7% growth. The president of the corporation reported that Nicaragua’s high security, wealth of appealing hotels on the coast, and the varied natural beauty contribute to its value as a prime tourist destination worth investing in.

Though I will be living and working in Masaya, Nicaragua summer, it would be beneficial to be aware of the changing dynamics of the nation’s capital city. Though the article touches upon the economic benefits that Hyatt’s expansion into Managua will have, it does not go into much detail about the opinions of the Nicaraguans on the increased commercialization of their country. The increase of tourism and international visitors in the city may or may not be something that the citizens of Managua or citizens of other areas in Nicaragua will welcome, and this is something that I should be wary of as an American traveler. Furthermore, it is valuable to know that capital is evolving more and more into an international hub; the city’s rapid economic growth as well as its citizens’ increase in exposure to international visitors and international cultures could affect the health of community members as well as change their lifestyle values. These changes might influence other regions of Nicaragua as well. These are all considerations that I should think about as an American traveler to the Nicaragua this summer.

 

III. Local Faculty Connection:

To gain some insight into working on women’s issues in Nicaragua, I spoke to Dr. Cymene Howe, an Associate Anthropology Professor at Rice. Starting from a brief undergraduate experience in 1990 and continuing after, she has spent over ten years researching and serving in Nicaragua with various organizations including Casa de la Mujer, a women’s health and rights organization that has a network of clinics throughout the nation. Based on her research there, she published Intimate Activism: The Struggle for Sexual Rights in Post-revolutionary Nicaragua, a book on how sexual rights activists have created new national models of sexual subjectivity and rights.

During our conversation, we discussed cultural differences that I should prepare myself for. Dr. Howe said that though Nicaragua is a machismo country with men having the license to do many things that are not egalitarian, as a foreigner I would generally be respected in a gender-neutral manner. That being said, she emphasized that I should always be vigilant and careful about not leaving my host family’s home late at night without a group of both men and women. She recommended that I bring a house-warming gift for the mother of my host family on my first day, as this act would be appreciated and looked upon fondly. In addition, she suggested that for my despedida, I should invite my family out to a restaurant for pizza and coke. She said that eating at restaurants is generally reserved only for special occasions for most Nicaraguan families, and that despedidas or good-bye parties are important to them. In regards to daily life, she said that I should be prepared for extended amounts of family time and relaxed attitudes about time and appointments. Though she mainly worked in Jinotepe and San Marcos, she visited Masaya and explained some its cultural traditions.

To prepare myself specifically for my public health project focused on female sexual and reproductive health, she highly recommended that be up-to-date about the Zika virus before and during my trip. She said that though it is a dangerous time to be traveling to Nicaragua, this would be a truly unique experience to see firsthand how Nicaragua is responding to this public health threat. She encouraged me to talk to people about this and ask people about what they believe to be solutions for this to be – mosquito spraying or eliminating standing water to rid of breeding grounds? – , and furthermore where they believe responsibility should lie – outside organizations, national/local government, individual families?

To conclude our interview, she gave me some general advice to attempt to develop community connections by making the effort to reach out to people and visiting other organizations to learn from them. She recommended that if I try to make myself of service to any organization, they would be willing to let me work with them. Dr. Howe also left me with a short list of news sources that I should read before and during my trip to be able to be conversant with community members about current national happenings. This list included La Prensa (national news source), Envío (academic Nicaraguan articles), and La Boletina (Nicaraguan feminist magazine). I ultimately found all of her personal reflection and specific suggestions to be very useful, and plan to follow her aforementioned advice and read articles on her recommended news sites to prepare myself a richer cultural immersion experience and a more meaningful health post internship.

 

IV. Community Connection:

The Baylor College of Medicine has a Teen Health Clinic that offers comprehensive reproductive health and family planning care at free or low-cost for both females and males ages 13-25 through a network of nine clinics throughout Houston. The clinics specifically serve neighborhoods that are well known for high infant mortality, sexually transmitted infections, and/or teen pregnancy. The clinic also pursues several community outreach programs and academic research on topics including adolescent high-risk sexual behaviors, young fathers and male development programs, ethnicity and reproductive health, social determinants of health, and HIV/AIDS risk reduction.

Specific medical services that the clinic provides includes immunizations, annual gynecological check-ups for girls who are sexually active, STD tests, and birth control methods and counseling. Beyond these services, staff members pursue several outreach programs including: school-based clinic interventions for first generation immigrants in select Texas high schools (primary care, early pregnancy detection, prenatal care referrals), mentorship programs for young mothers, a scholarship program for young fathers, education outreach to adolescents in lower teen pregnancy, infant mortality, and STDS in high risk areas of poverty in Houston.

I predict that many of the services offered by the Baylor Teen Health Clinic will be similar to the community health center I will be working at in Masaya, Nicaragua. There are pockets in Houston with incidence of disease that are similar to the socioeconomically disadvantaged population of Masaya, Nicaragua. However, there will be differences. From what I have head from previous Loewenstern fellows and my site coordinator from Nicaragua is that the local community health center in Masaya is busy and greatly strained for resources. The Baylor Teen Health Clinic is based in the largest medical center in the world and is connected to several advanced medical institutions. In terms of resources, I predict that there will be a significant gap. The Masaya medical center is also significantly understaffed, and these low doctor-to-patient ratios may translate to less time available to pursue meaningful outreach initiatives.

Another differing aspect between the two is that the Baylor Teen Health Clinic pursues several male-oriented sexual health education and counseling services while I predict that the equivalent of these services in Nicaragua almost solely cater towards women. Because of the machismo attitude that Dr. Cymene Howe brought up during our conversation, I do not think that discussing contraceptives and hygienic and safe sexual practices with men is common.

When I return from the United States, it would be wonderful if I could volunteer at this teen health clinic or another local women’s health clinic to look at varying styles of approach and implementation in different cultural, social and political contexts to broaden my perspective on how to pursue sustainable solutions. 

 

V. Reflection:

Last May I traveled with Rice’s Global Medical Brigades Chapter to rural Jinotega, Nicaragua to help implement a mobile medical clinic and a public health hygiene station construction project in a small community. My experience during this trip was the primary motivation for me to apply for a Loewenstern program experience in Nicaragua for the summer of 2016. Through my interactions with the community members in Jinotega, I learned how their lack of access to healthcare and preventative care education due to their geographic isolation influenced their medical conditions. More specifically, I was exposed to an overwhelmingly high frequency of teenage pregnancies and conditions such as urinary tract infections, consistent vaginal bleeding, and renal infection amongst the young female patients I encountered during our mobile clinic. I saw the pressing need for sexual reproduction and proper hygiene education for female adolescents. This ultimately influenced me to apply for the fellowship to support an internship with Foundations for Sustainable Development at a public health center in an urban health center in Ciudad Sandino that pursues frequent health education outreach programs for the socioeconomically disadvantaged citizens of the community and surrounding rural areas.

As an intern there, I hope to explore these gender-specific issues prevalent in both rural and urban settings in Nicaragua more in depth. Additionally, I hope to learn more about the socialized healthcare system of Nicaragua, which I have heard has a huge focus on preventative care. Through pursuing my own project there, I hope to learn much about effective public health outreach from those around me. As a pre-medical student interested in women’s health and holistic care with a focus on prevention and continued care, I am interested in comparing my experiences working in a community health center in Nicaragua with my experiences interning and volunteering in centers here in the Texas Medical Center. Exposure to different types of contexts, focuses and implementations of health care will definitely change my perspective on delivery of effective medical care. This broadened perspective will hopefully allow me to approach and develop solutions for problems in healthcare delivery here in the U.S. in a unique manner in my future career.

I additionally am interested in pursuing this fellowship to gain experience connecting and immersing myself in a community different than the towns I have been raised in the United States. I predict the most valuable component of my trip will be my interactions with the community members I will meet. As a young student, I hope to challenge myself with the task of thriving in a completely different context than what I am used to. This experience will test my boundaries and will hopefully contribute to my personal development and overall understanding of my capabilities. As an aspiring healthcare provider, I desire to challenge myself with developing meaningful connections with an international community. I personally believe that the ability to empathize and understand different populations is important to be a physician as well as a worldly citizen in general. This trip will allow me to hone on this ability.

This fellowship will provide me the unique opportunity to immerse myself into a community much different than those I have grown up in and expand my worldview. I am excited and ready to confront the challenges that this fellowship entails and am certain I will learn much about the Nicaraguan people and myself from this experience.

 

VI. Appendix:

 References

 Capacitarán a 500 bachilleres en salud y a 700 parteras. (2016, January 6). El Nuevo Diario. Retrieved from http://www.elnuevodiario.com.ni/nacionales/381419-capacitaran-500-bachilleres-salud-700-parteras/

Child and Maternal Health Issues in Nicaragua. (n.d.). Foundations for Sustainable Development. Retrieved from http://www.fsdinternational.org/country/nicaragua/healthissues

Demographics of Nicaragua (n.d.) Retrieved from http://www.nicaragua.com/demographics/

Empresar de hotel Hyatt muestra interés en seguir invertiendo en Nicaragua. (2016, January 29). El Economista. Retrieved from http://www.eleconomista.net/2016/01/29/empresario-de-hotel-hyatt-muestra-interes-en-seguir-invirtiendo-en-nicaragua

Gordillo-Tobar, A., Beneitez, G., Ortega J., Waters W., Bravo, E. (n.d.) Adolescent Sexual and Reproductive Health and Rights in Nicaragua: An Analysis Using a Sexual and reproductive Health Framework and Human Rights. World Bank Group – Health, Nutrition and Population. Retrieved from http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2014/12/12/000333037_20141212013101/Rendered/PDF/930930BRI0Box300Rights0in0NICARAGUA.pdf

Lempiainen, M. (2013, March 15). Let’s talk about sex in Nicaragua. Pass Blue. Retrieved from http://passblue.com/2013/03/15/lets-talk-about-sex-in-nicaragua/

Lion, K., Prata, N., Stewart, C. (2009, June). Adolescent Childbearing in Nicaragua: A Quantitative Assessment of Associated Factors. International Perspectives on Sexual and Reproductive Health. Retrieved from https://www.guttmacher.org/pubs/journals/3509109.html

Ma, E. (2016, February 15). Nicaragua’s Construction Sector Expected to Improve Through 2016 and Beyond. Latin One. Retrieved from http://www.latinone.com/articles/32661/20160215/nicaragua-s-construction-sector-expected-improve-through-2016-beyond.htm

Nicaragua. (n.d.). Retrieved from http://www.infoplease.com/country/nicaragua.html?pageno=5

Nicaragua. (2013, April 11). Pan American Health Organization/ WHO. Retrieved from http://www.paho.org/saludenlasamericas/index.php?option=com_docman&task=doc_view&gid=140&Itemid

Nicaragua acumula 70 casos positivos de Zika. (2016, February 17). El Nuevo Diario. Retrieved from http://www.elnuevodiario.com.ni/nacionales/385330-nicaragua-acumula-70-casos-positivos-zika/

Political History of Nicaragua (n.d.) Stanford University. Retrieved from http://web.stanford.edu/group/arts/nicaragua/discovery_eng/history/

Seelke, C. (2008, March 17). Nicaragua: Political Situation and U.S. Relations. CRS Report for Congress. Retrieved from https://www.fas.org/sgp/crs/row/RS22836.pdf

Photograph References

Preidt, R. (2016, January 27). CDC Broadens Zika Virus Travel Alert for Pregnant Women. Retrieved from http://www.usnews.com/dims4/USNEWS/eefadd1/2147483647/thumbnail/652×431%3E/quality/85/?url=%2Fcmsmedia%2F36%2Fbe97f9e5c51c429dd2f6d518bd7b52%2Fmedia%3A12cc993fff6242ffb273fcb77b04d111ZikaVirusUSWarning.JPEG

(n.d.) Retrieved from https://www.alexanderroberts.com/getmedia/7889d2cf-9c7c-48e8-ae38-fb299d1a1435/14-Nicaragua_MainPic.jpg.aspx?width=940

(n.d) Retrieved from http://cdn1.bostonmagazine.com/wp-content/uploads/2014/03/noambulance.jpg

(n.d.) Retrieved from http://www.ketzal.com.gt/images/proyectos/M1.jpg

(n.d.) Retrieved from http://www.mdgfund.org/sites/default/files/images/Nicaragua%20girls%20dancing.jpg

(n.d.) Retrieved from https://www.planusa.org/stuff/contentmgr/files/1/2dbff34dd445aa02f56d61333f7ff0d2/image/sexhealth-nicaragua-2-h.jpg

(n.d.) Retrieved from http://www.retirenicaragua.com/wp-content/uploads/2014/06/Mukul-2.jpg

(n.d.) Retrieved from http://www.scidev.net/filemanager/root/site_assets/maps/Nicaragua-canal.jpg

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Last week, Rice lecturer Dr. Yehuda Sharim led our class in meaningful discussion about ethical principles that should guide us to represent and share the stories of the international communities and individuals we will be serving this summer in a responsible manner. In particular, Dr. Sharim posed several questions that forced me to reflect on how my perceptions of the world and approach to interacting with others have been strongly influenced and shaped by my background and life experience.

Having been raised in an upper-middle class household in a very wealthy and predominately white Californian town, I have been exposed to a narrow realm of thinking that was strongly influenced by a  widespread sense of superiority and self-entitlement. Since there was very little presence of ethnic minority groups, I grew up surrounded by racial stereotypes and assumptions made solely on basis of socioeconomic status. I was exposed to my friends and friends’ parents misguided perceptions of people living in the “poorer parts” of the world, nation and even our town, and was even heavily indoctrinated with negative stereotypes of Texas from fellow students (and even teachers) when I announced that I would be attending Rice University. Though I am cognizant of several of these influences on my upbringing and know that many of these false judgements were deeply rooted in a lack of understanding, Dr. Sharim reminded me that many of these misguided stereotypes have unconsciously impacted the way that I perceive and interact with the world around me.

Dr. Sharim emphasized how it is essential to be aware of how our various upbringings – our heritage, hometowns, American primary/secondary education, etc. – will play a role in how we may desire to communicate our summer experiences abroad to others through social media or otherwise. Particularly, he stressed how we should strive to make concerted efforts to avoid blindly perpetuating stereotypes. 

After reflecting on his lecture and our class discussion, I have come up with my own few key guidelines that will be important to my ethical service this summer. I will strive to…

1. Take the time to forge meaningful connections and listen. 

While interacting with the members of the Masaya community or other surrounding more rural communities this summer, I must try to reach out to people and forge meaningful relationships. I hope to do so by interacting with the Nicaraguans around me in a genuine manner. I believe I can achieve this by always attempting to connect and understand the people that I will be working with in a manner that is devoid of other motivations or interests. Instead of approaching conversations with pre-determined mindsets and asking questions with hidden goals of searching for answers or responses that I want to hear, I will simply listen. Meeting and connecting with the community members I am traveling to will be one of the most valuable aspects of my summer work. However it is important to approach this in an ethical manner. Coming in with simple, untainted goals to make friends or simply to have enjoyable conversation will hopefully reduce the incidence of having my stereotypical judgements influence the value that my conversational partner and I will extract from our interaction.

2. Appreciate and share the whole story.

Dr. Sharim repeatedly emphasized that we must contextualize the stories of the communities when we share them with others, especially in photograph form. A photograph is only a snapshot of a moment, a single representation of a multidimensional truth. Because photographs are limited in the way they selectively capture reality, it is important to provide some contextualization for our posts whether that be through publishing complementary written descriptions or a photo album series instead of posting a single picture. If provided no context at all, people will rely on their own stereotypes and judgements to influence their interpretations of these photographs. As a Loewenstern International Service Fellow, one of my responsibilities will be to uproot stereotypes and encourage Rice peers to understand others. By contextualizing my social media posts, I can help humanize some of the subjects in the photo and help my social media audience see and reflect upon similarities between them and the people in my photos rather than immediately focus on differences. This will be important because stereotypes are driven by an unbalanced focus on differences followed by generalization and compartmentalization based on them. I ultimately strive to broaden my audience’s perspective on the world around them by showing them a side of my service that they would not expect. I definitely cannot achieve this without contextualizing my posts.

3. Consider audiences to avoid perpetuating stereotypes when sharing stories.

I love posting photographs and sharing written posts with my Facebook friends, but I must exercise caution when sharing posts over the summer. While I might be motivated to post a photograph of my young host brother playing barefoot street soccer with another volunteer to share positive memories of my experience, I must also consider what my Facebook audience might think of the photograph. Would this photograph be communicating something that I did not intend for it to communicate? Maybe my audience would look at the photograph and only notice the poverty of the child. They might fabricate their own ideas about how the smiling child in the photo was only happy because of the American volunteer, while perhaps the child in the photo was playing with his friends in the street as he did everyday with the volunteer just joining that single afternoon. As seen in this example, the message of my photograph I hoped to convey was misconstrued due to the stereotypes and judgments of my post’s audience. I must always keep my audience in mind when publishing posts this summer. This could entail choosing to keep some photographs for myself and not publishing some or simply providing context (as I elaborated in #2).

Overall, when interacting with others over the summer and recounting these interactions afterwards, I must always be cognizant of stereotypes and judgements that cloud how my social media audience and myself view others.

Journal prompt: What responsibilities do you have as a participant in international development? Will these responsibilities change after your immersion experience? If so, how?

For class this week, I read Bill and Melinda Gates’s “3 Myths that Block Progress for The Poor” and Michael Hobbes’s “The Problem with International Development-And How We Plan to Fix It”. These two articles provided refreshing views on popular myths about international development, effectively rejecting widespread notions that development work is ineffectual and a waste of resources. Though Hobbes and Gates admit that this type of work is complex, both emphasize that there have been many success stories so far, and that international development projects can genuinely be of significant benefit to communities.

I found several of the arguments they made about the importance of changing these popular mindsets and perspectives to be very applicable to my upcoming summer project. One point that has deeply resonated with me was their argument against the myths that “the poor are doomed to stay poor” and “foreign aid is a waste”, which was that the concept that international development work is slow. Gates claims that on a global scale, countries are getting richer and health is improving, but “it’s hard to capture that on video” and that “there’s no press conference for children who did not die of malaria”. Almost always, only extreme poverty, debilitating disease, and horrible human rights crimes make it into the limelight. We almost never see the positive stories, the tales of success of good organizations’ initiatives in the media. This negative focus perpetuates a state of constant frustration and pessimistic stagnancy. We are led to believe that nothing is going right with current humanitarian aid. This is the wrong mindset to have. We must realize that…

“Development, no matter how it happens, is a slow process” – Hobbes.

To put this idea in the context of my upcoming service project, I realize that reconciling personal expectations for my project achievements with the actual realities of what little I can do over a short time span will be a difficult challenge for me. As a university student used to the fast-paced, enriching environment that Rice cultivates, I know I will naturally want to accomplish as many tangible achievements as possible over the summer. Instead of seeing seeing the larger picture of where my project fits in with my organization’s work, I predict that I will tend to only see my own small project’s limited accomplishments and failures. I will have a hard time accepting the fact that “development, no matter how it happens, is a slow process”.

In order to avoid this, I must essentially change my mindset and understand that my project’s immediate results and effects on communities might not be significant or seen at all. Putting my project into perspective is important. Lack of immediate results is not failure, and I should be motivated by and not discouraged by setbacks.

Now to get to the meat of this week’s question about what my responsibilities I will have as a participant in international development..

Knowing that my project will only be a small parter of a greater initiative spearheaded by my community partner, I need to ensure that my work be as sustainable as possible. To do this I must properly document my work and communicate with other workers at the health center to share my progress so that they may build upon what I create when I leave. I must not work in an isolated manner but rather always be in constant communication and collaboration with the in-country staff members who will be working on my project long after I fly home at the end of summer. I must always keep the long-term context of my project in mind and should not be set on short-term goals but rather always strive to work towards long-term progress.

My responsibilities after I return from Nicaragua also require that I maintain a similar outlook. My goal after coming back will to challenge the my peers’ stereotypes about Central American poverty, Nicaragua, international service and more. I hope to do so by sharing what I learn from my community and from my project with others as well as remembering to communicate this idea that international development is not a futile process but rather a complex and challenging one. Perhaps I can influence other students to participate in a similar international immersive experience so they can understand these important ideas to a greater depth. Ultimately, I hope to inspire and enlighten my peers to take action to learn more about the world and international problems rather than help perpetuate a pessimistic outlook and encourage them to stand idly by.

For my international service class, I recently read an article discussing the S.M.A.R.T. project goal-setting technique. This method dictates that goals should be Specific, Measurable, Achievable, Relevant and Timely in order achieve goals in a more effective manner. I found this simple approach attractive and relevant for my international summer fellowship.

While I hope to spearhead new projects and see them to completion, I know from previous short-term projects and other summer internships that achievements made during these short time spans should be measured on an adjusted scale. Especially from my experience with summer lab research, I know that my goals will evolve and be influenced by a diverse set of circumstances, so it is better for me to set out to accomplish specific tasks and see where these tasks will take my project and my personal development goals. It will be beneficial to have a starting point from where I can pursue an evolved set of goals in the future.

Community immersion is important for me this summer. I am interested in interacting with community members in Ciudad Sandino and adopting their way of life so I can develop more empathy and understanding for a population of people very different than the people I have grown up surrounded by. Furthermore, community immersion will aid my project (which is focused on youth education on sexual and reproductive health) and allow me to be able to communicate  important health topics more effectively and meaningfully with the locals visitors to the community health center.

In terms of setting specific and achievable goals, my objectives include, in no particular order, (1) meeting at least 5 neighbors (2) befriending my health center co-workers (3) attending at least 5 non-work related community events throughout the summer. These are all three measurable and achievable goals, and will help me develop community relationships that will aid my personal and project development as well as hopefully enrich the lives of the people I meet/befriend.

Another priority of mine for the upcoming summer includes learning more about the health challenges facing the community. Working at a community health center and pursuing outreach-oriented projects allows me to have the perfect opportunity to learn more about this topic. However I want to make a point this summer to maintain a consistent focus on learning and continually seeking out opportunities to learn from the people around me. Specifically I hope to (1) discuss community health and opinions on Nicaraguan healthcare with my host family and at least 3 other people (2) ask my health center co-workers about their previous experience interacting with the community/ their perspectives on problems they have seen at least 3 times for the first 5 weeks.

After asking various people about their perspectives on the health challenges facing the community, I intent on reflecting on these responses, and generating my own opinions on the subject, incorporating my own insights from my experiences. Therefore, in my free time outside of working on my personal project, I hope to ask if I can (1) volunteer/shadow other co-workers during their outreach initiatives at least 3 times if possible (2) visit a nearby public hospital or other health center to develop my own comparisons in terms of delivery of care/ demographics of patients seen.

In order to keep my self accountable for these actions. I plan to keep a blog and update it at least 3 times a week. I want to record all meaningful interactions/ experiences that I have in this journal so I can have a tangible record to measure my depth of reflection and incorporation of my activities into my own development of new perspectives and insights. Maintaining a publicly read blog will also hold me accountable to reflect on the events in my life for my personal growth.

Hello from the depths of the third week into spring semester! Just wanted to check in and share some of my thoughts from all the ideas and material I have encountered through discussions and readings in my pre-Loewenstern Fellowship international service course. Though the class has just begun, I have already exposed to a range of new enlightening perspectives on what the role of an international volunteer should be. These unique perspectives have made me re-evaluate many of my preconceived notions of international service and led me to start developing my own thoughts and opinions towards this topic.

International development work is a complex field. International developers will always have to face pros and cons of the consequences of their actions.There will always be unintended effects of any implemented change, whether they be tangible or not. Because international volunteers come in as strange foreigners to the community, they will inherently lack insiders’ knowledge into the dynamics of the people living there and the problems they face. They thus are more likely to create trouble as they do not know how to best work within the already existing infrastructure of a community or predict how community members will respond or react to their actions.

Furthermore, one of the most dangerous part of international development is coming in with a mindset that you know a community better than its actual residents. The end goal of international service projects is to help improve the lives of the people in the community. However, there is a perilous trend of disconnect between international volunteers and community members perpetuated by a variety of factors including but not limited to cultural misunderstanding or lack of transparency about one’s goals. With the increasing popularity of “voluntourism trips” and widely socially accepted notion that international volunteers should be praised for all work, there is a frightening shift from focusing on the people they are trying to help to focusing on how volunteers can make themselves look better. I have seen cases where volunteers go abroad to see how much they can accomplish. They measure their success by short-term tangibles such as building classrooms or bringing advanced medical technology to hospitals. International development is not a quick or easy fix.  They also mistaken in that they think that by trying to implement changes to make communities more like those in the United States is inherently good. Situations in communities abroad are often very different those at home; the people, societal systems, and overall infrastructure are not going to be the same for any two communities. There is a strong need for shifting away from a selfish volunteer-focused mindset or Westernized mindset to a more community-driven approach towards international development work.

In my opinion, international development work should be centered around community understanding. Service volunteers should be more focused on immersing themselves amongst community members to better understand how their society functions and what the community itself feels needs to be improved. I believe that it is of utmost importance to know and be familiar with a community’s people instead of attempting to devise a completely revolutionary idea to end poverty without even visiting the community for which you hope to implement the project.

Up to this point I have not brought up anything distinctly good that I can stem from international development work; however, these above thoughts are only incomplete parts of my feelings and opinions towards international service work. There are several positives to international service work that are not often discussed by analytical scholars. One of such positives is that international development workers have unique perspectives on problems facing community members as well as valuable ideas for how community resources can be moved around and used in new ways. International development workers bring a fresh set of eyes and ideas. They are generally less deterred by power hierarchies to voice for change. The type of refreshing and innovative thinking sometimes might be the catalyst needed for stagnant communities to start improving.

I would like to conclude by reiterating that there are many considerations and precautions volunteers must take in terms of preparing appropriate mindsets towards international work, but also highlighting the value of spreading ideas and innovation through this method of global interconnection.

Hello all!

My name is Michelle, and I am an undergraduate student at Rice University in Houston, Texas. I am studying biochemistry and cell biology and minoring in poverty, justice and human capabilities.

I was recently awarded a prestigious Loewenstern Fellowship to pursue a service internship in Nicaragua over the summer of 2016. I will be working with Foundations for Sustainable Development at the Davila Bolaños Health Center in Masaya, Nicaragua on a sexual and reproductive health education program.

My interest in this fellowship arose from my previous Rice Global Medical Brigades trip to Nicaragua. During my trip I saw the pressing need for sexual reproduction and proper hygiene education for female adolescents. Through the Loewenstern Fellowship, I will have the opportunity to explore these gender-specific issues prevalent in rural areas in Nicaragua more in depth and help develop a sustainable outreach project to educate young girls on basics of reproductive biology, instill safer sex and hygiene practices, and increase their overall self-confidence.

I will be sharing updates from my pre-trip preparation, in-country experiences, and post-trip reflections in this blog. Please feel free to check in here to follow me on my journey!

Best,

Michelle Alyssa Tran