11/24/2000
Health programs seek to empower communities
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Jon Reddy
By Jon Reddy
Of the Sentinel
MANAGUA, Nicaragua ñ On the outskirts of this city lies the landfill, the unbearable stench of hot garbage and humidity putrefying the air, while vultures fly overhead in swarms, hungrily eyeing each truckload of new waste.
Hundreds of people live on this landfill. They are the poorest of the poor, who wait each day for new shipments of trash to arrive in order to sift through it for food. Many of these people were formerly farmers. What remains of their livestock herds pace through the garbage as well, hoping to get enough food to survive another day.
Life-threatening disease and death is a common reality here. Clean food, water, electricity and plumbing are hard to come by for the majority of citizens.
Catholic Relief Services has been working for four years with rural communities, implementing public health programs and bringing them together to fight the simplest of health problems.
Dr. José Mendieta is the director of the health program at CRS. He holds a master's in public health, and has worked previously with squatters and rural communities in the northern part of the country.
Because of limited resources and money, he and his assistant, Dr. Anne Lifflander, have concentrated their efforts on the prevention of simple diseases, the health of children under five and pregnant women.
In the health program, they work with communities that are far from the city because of the structuralized poverty there.
Many of these rural communities are too far from roads to catch buses to the city. Many are too poor to afford transport to see doctors.
The ministry of health in Nicaragua has done studies on where health care is most needed. CRS uses these studies to position its assets.
'We are able to provide a part of the services,' says Dr. Mendieta. 'We do what we can, realizing completely that we are only a piece of the pie.'
That piece of the pie includes work to protect against diarrhea, malaria, and respiratory problems. Most people here live in homes with dirt floors, causing major lung problems for toddlers by age four.
The health education and prevention efforts here were set back by Hurricane Mitch in 1998, which exacerbated an already deteriorating health situation.
'In the last 10 years, there hasn't been much of a focus on public health in Nicaragua,' says Dr. Mendieta. 'With each government the focus changes.
The program has had to make many adjustments in spending in order to fit with the changes in the regime.
Because of the great pressure on Nicaragua to fit into the structural policy of international lenders, local officials have lost a great deal of their emphasis on public health. The majority of funds are used to reduce the spending gap and to pay down the debt.
This is a major problem where health is concerned, says Dr. Mendieta.
'You can't just tell these people to wash their hands,' he says. 'The construction of roads is vital. Transportation is vital. Clean water is vital. Electricity is vital. The health problems of Nicaraguans are all part of a much larger picture.'
Both of these doctors speak in the rural communities about health issues, but they also help organize community committees that make proposals (to get latrines, for example), and to empower them to be advocates for their own needs.
'In reality, you just can't wait to improve roads; to end these disasters, there has to be social investment,' says Dr. Lifflander, who has worked in clinical medicine and who is now part of a collective of doctors that have a clinic in a poor part of Nicaragua.
Hurricane Mitch has affected the economy drastically, causing many people to flee their own communities in search of jobs.
'The economy makes people transient, and transient people are more susceptible to health problems,' says Dr. Lifflander.
There are positive things going on. Education about these problems has increased tremendously and people in the communities are increasing their volunteerism. People are learning to stand up for their basic health rights.
CRS and its ability to work directly with other aid organizations enables it to work with contacts in the community, rather than starting over.
'CRS' interests and main goal is to train the community to carry out the work themselves,' says Dr. Mendieta. CRS will coordinate with the ministry of health instead of simply working with them. CRS is more community based.
'We'd like to be able to do more, but unfortunately we need more money to do that,' he adds. 'The limitation of working with these projects is that we'd like to give the people all the tools they need to have healthier communities; but that will not happen for years in Nicaragua. Not without a focus on that need.'
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