Honduras Initiative Trip ’09: Post 10 (6/10)

One of our main goals for this trip was to get a picture of how the community perceives its health needs. Seeing as our purpose is to work with Guachi residents to improve their health, it is vital that we address issues they have prioritized. The topics that Guachi residents brought up in our conversations and surveys confirmed what doctors and previous volunteers thought to be the town’s most pressing health concerns: nutrition, headaches, and the common cold. It is good to know that we are already on the same page and can now move on to planning action.

            In terms of nutrition, both quantity and variety of food is lacking. Thinking about how best to approach this universally acknowledged problem brings up a whole slew of other issues. If we wanted to help with the cultivation of family gardens, we would first have to address the importance of vegetables in a health diet, a concept we found varying opinions on. Then we have to consider with whom we could initiate the project; the Madre Guias are interested and are our main connection to the community, but it is unclear whether or not they have the time and motivation. If we would therefore prefer to initially open the project to any other interested community members, we have to take into account how this decision would affect the Madre Guias empowerment and ownership of the project.

            In the rainy season, there is plenty of water to grow a family garden, but to address the seasonal malnutrition that occurs in the dry season we have to address the larger issue of water scarcity. Solutions range from fundraising to improve the pipe system and bring larger quantities of water to Guachi to teaching simple filtration techniques to reuse dishwater for plants.

            Better nutrition would hopefully lower the rates of colds, headaches and fevers, but education on how to prevent and treat these illnesses could also be beneficial. Currently, the Madre Guias are our best resource for disseminating this information, but they still reach a very small population of women. We therefore needs to either find a way to strengthen and broaden their reach, or develop another forum for education and community outreach. In the coming year, we need to think hard about these issues and be in frequent contact with the Madre Guias and other community members to determine which of these options they would like to work on together.

Honduras Initiative Trip ’09: Post 9 (6/3)

On the last day in Guachipilin, we held our second and final Madre Guias meeting. The format was drastically different from the first meeting’s, and much more successful.  For example, only women were in attendance (no Don Felipe), and four people led the charlas as opposed to all eight of us (a less intimidating gringa to Madre Guia ratio). The charlas lasted twenty minutes as opposed to and hour, and we broke up the teaching with group activities and a snack. All of these factors, as well as the fact that we had visited all the women beforehand to personally invite them, contributed to a very open atmosphere. Although only five women and their daughters attended, they all were glad to share their personal stories of what it is to be a woman, a mother, and a Madre Guia in Guachi.  In the course of these stories, the women told us that many mothers still follow the traditional month-long postpartum diet of cheese and tortillas.  At the last meeting, Don Felipe had assured us that this tradition was unhealthy and was a thing of the past.  None of the women at that meeting contradicted him, but we saw today that their silence was not assent.  It took a higher level of comfort for them to share the truth with us, and will take even stronger relationships for us to be able discuss the merits and drawbacks of different food choices with them.

After a bracelet-making activity, the charla and a snack we had a great discussion about the future of Guachi’s Madre Guia group. They would like to continue meeting once a month, but recognize that it will be difficult to convince women to attend. Without a North American volunteer or at least a certified health promoter to lead the meeting, the groups loses a lot of credibility in other women’s eyes. Although they were excited to teach each other any charlas we could send them in written form by way of Dr. Harrison, who is bringing a brigade in July, they acknowledged that other women in the community would probably not be interested. The limitations they cited in their work as Madre Guias included the fact that many women simply don’t listen to they health advice they give; they have their own opinions and choose to follow cultural traditions (such as the 22-day post-natal cheese diet). Additionally, as volunteers, they simply do not have time to talk in depth about health issues with every woman they distribute to or to start big projects. Their responsibilities as mothers and wives have to take precedence. Although they expressed that they have too little time and authority to start their own projects, they were enthusiastic about planting family vegetable gardens with support from our group.  They would like to do the project as individual gardens, but start by all working together on a demonstration garden at one of their houses. They gave us one of their cell phone numbers, so that we can be in touch about the project throughout the next year.

A major conclusion we can draw from this meeting is that Guachi’s clinic will be integral to the continuation of the Madre Guia group.  Successful chapters in other communities have health promoters that organize meetings and reinforce the nutritional and health advice that the Madre Guias seek to promote throughout the community.  In this manner, the Madre Guias gain a stable source of advice and organization for themselves and the credibility of an established health organization for the community.

            Even if the presence of the clinic gives the Madre Guias credibility in the eyes of the community, we need to consider the Madre Guias’ perceptions of themselves.  Currently, they see themselves as learners and distributors of folic acid but not as teachers or communicators.  We would like to empower them so that they feel inspired to share health information with other women and to present their own ideas and opinions within the group.

Honduras Initiative Trip ’09: Post 6 (5/27)

  The Madre Guia program that was initiated in Guachi last year has 17 female volunteers, 11 of which distribute folic acid supplements to women of reproductive age. Since last November, the Madre Guias have met about once a month to receive folic acid and charlas on a variety of common health issues. Before this Tuesday, they had not met since this March, when the last Brown students left Guachi.

      We were excited to bring back the program and looked forward to meeting a group of women dedicated to community health, but our meeting on Tuesday was disappointing. Don Felipe had announced the date and time at church services to invite the Madre Guias to come, but only five of the 17 attended. The low turnout was frustrating not only because we had meticulously planned a lesson on nutrition, but also because it was impossible to hand out folic acid for the entire town with only three distributors.

      Among the five women attending the two non-distributing women did not consider themselves madre guias, even though they were on our attendance list.  We were happy that they came to learn, but felt like this lack of identification with the madre guia program reflected that they do not take leadership roles in the health of the community.  The madre guia program was designed to empower female community health workers to spread knowledge in addition to distributing folic acid, but it seems that only the latter goal was fulfilled thus far. 

      Another aspect of the meeting that surprised us was the unresponsiveness of the madre guias.  The women hardly answered our questions or participated in discussions.  This might have been because they did not know us, but could also be attributed to the gender dynamics we have noticed.  In the presence of men, women are consistently hesitant to speak up, answer our questions, or otherwise distinguish themselves.  In the kindergarten classroom, only boys participated verbally.  When we visit houses, women talk readily with us if they are alone.  If their husbands are home, they tend to stay very quiet.  Don Felipe was at the meeting in place of his wife, which may have affected the women’s participation.

      For our next meeting on Wednesday, we would like to find a way to empower the women and make them feel comfortable talking with us and sharing their ideas.  Before the meeting, we hope to visit each madre guia in her home, to introduce ourselves and talk with them in a more comfortable setting.   

      The meeting raised questions about the duration of our stay in Guachipilincito. With only two weeks, we cannot both gain the trust of the madre guias and use that trust to create change within the program.  At the community level, the short stay limits our ability to gain an accurate perspective on the community dynamics that determine how we will be able to work with them.

Honduras Initiative Trip ’09: Post 5 (5/26)

We are currently sleeping in one of the classrooms in Guachi’s elementary school, an arrangement that has proved more difficult than we immediately anticipated. Although we arrived in Guachi with suitcases of school supplies to leave for the teachers, the self-imposed feeling of obligation brought about by using the schools resources for our daily needs has led to a more intimate connection with the school than we planned. We hoped in our spare time to coordinate after-school art activities, but no more than that because our primary focus was community health issues. However, after an invitation to teach kindergarten and after the director assumed that our interest in after-school activities translated into a desire to substitute teach, we realized had to reassess our scheduling priorities. Nearly every person we ask suggestions for needs we can fulfill in Guachi, and these needs span all facets of life. We are drawn to projects proposed by the community, so at first were excited to teach classes. But we also realize that community has just as great of needs and desires in the field of community health and our physical proximity to the school should not have determined our priorities as much as it did.

      Our pseudo-identity crisis also stemmed for the fact that most Guachi residents do not know why we, student, not doctors, are here. We have had three women visit the school compound seeking medical consultations that we simply cannot offer, and even the director of the school has no idea when we were coming or what we were coming to do. These occurrences forced a much-needed reevaluation of whether and how the Honduras Initiative can best serve Guachi. We decided to minimize our time in the school, but still teach a couple classes because it was an immediate way to fulfill a need. We also decided to focus our community health related activities on a conversational survey, which we hope will provide a basis for future projects. We have not finished talking, and still need to reassess the format and composition of future trips.   

Honduras Initiative Trip ’09: Post 4 (5/24)

On Sunday morning, we all attended mass at the church in Guachipilincito.  About one hundred people were there; mothers and daughters sat in the few rows of pews, while most of the men and boys stayed back towards the door of the church.

      There was no priest, but Don Felipe led a sermon that incorporated our presence in the community.  He used doctors and North Americans both as examples of how to be a good Christian and as evidence of the universality of Christianity.  For example, he reminded everyone of how the North American health brigades brought bibles and discussed passages with Don Felipe.   He told the congregation how a surgeon he had seen in Concepción asked him to pray for a cousin having surgery.  The connection between health and religion was reinforced throughout the sermon, and served to buttress and clarify the biblical messages he preached.  We were surprised by how successfully he combined pragmatic, health-related advice – eating enough calories – with more abstract ideas of piety – taking strength from God.  Reflecting on this, we realized that Don Felipe is the primary proponent of both the physical and spiritual health of the community.  He takes it upon himself to monitor underweight children and pregnant women, but also teaches a catechism class and works actively to buy bibles for community youth.  We wonder how such an intimate connection between health and religion impacts the healthcare decisions made here, and whether everyone in the community shares his views.

Honduras Initiative Trip ’09: Post 3 (5/23)

Here is our tentative schedule for the rest of stay in Guachi:

Sunday 5/24: Attend the local church and visit surrounding neighbors to introduce ourselves to the community

Monday 5/25: 8am-10am Meet the kindergarten teacher, María Dolores Hernandez and help her teach class.  12pm-1pm Teach all levels of the elementary school about the human body.

Tuesday 5/26: 12pm Meet the school director, Geovony Hernandez. 2pm First Madre Guías meeting, including a charla on nutrition

Wednesday 5/27: 8am-10am: Teach in kindergarten and teach English in elementary school. Send two people to test run conversational surveys. Afternoon: Health survey in Guachi through conversational interviews

Thursday 5/28: Morning: Shadow Madre Guías in groups of one or two. Afternoon: Continue health survey

Friday 5/29: Morning: Teach in kindergarten and teach English in elementary school. Afternoon: Pregnant mother charla on prenatal health

Saturday 5/30: Morning: Walk to market in Concepcíon.  Afternoon: Continue health survey.

Sunday 5/31: Attend church services and celebration for Día de la Virgen in Calusica, a nearby neighborhood. Afternoon: Health survey

Monday 6/1: Hike to surrounding casarías, small groupings of houses outside of Guachi, to conduct the government census for Shoulder to Shoulder.

Tuesday 6/2: Meet with families of underweight children to discuss nutrition and weigh and measure the children.  Continue health survey

Wednesday 6/3: Second Madre Guías meeting to discuss breastfeeding and dental hygiene. Continue health survey

Thursday 6/4: Leave for Santa Lucia, where we will be spending the last week of our trip. 

Honduras Initiative Trip ’09: Post 2 (5/23)

  We have spent these first few days in Guachí meeting various community members and trying to figure out how we can incorporate our work smoothly into daily life. On the six-hour bus trip from San Pedro Sula to Guachí we met Alex, an American Shoulder to Shoulder nurse who has been volunteering in Santa Lucía since Novermber.  He gave us his personal take on the most significant health challenges in rural Intibucá: diarrheal disease and malnutrition are widespread problems, as is herbicide toxicity during the planting season.  This was what we had gathered from previous reports from the area, so it was good to know we had planned appropriately.

      Our first day in town, Friday, we met with Don Felipe and Efraím, two key members of the community committee, to work out a schedule for our stay that was based on both our own plans and requests from Don Felipe. Don Felipe is a leader in Guachí; he is Shoulder to Shoulder’s health representative for the town, runs church services, and is overall highly respected.  He gave us a cultural perspective on planning our schedule: Monday is an important workday since it follows two days of rest, so any classes we wish to hold should be planned for other weekdays. He also requested that we visit all the pregnant mothers to discuss pre- and perinatal nutrition, as well as five underweight children that the village has been monitoring. We will also be meeting the kindergarten teacher and the school director upon request because no previous volunteers have done so.

      We discussed with Efraím and Don Felipe the possibility of starting a home gardens project with the Madre Guías. They said that most women have agriculture skills, but simply lack appropriate seeds and the money to buy them. We are still unsure about this project because it seems as though we will have no more than two or three days to devote to it. We plan to discuss health problems and possible long-term projects with the Madre Guías, so their input will decide whether or not we proceed. If nutrition and access to vegetable seems to be a major concern, we may be able to buy the seeds for them from a market in La Esperanza. However, since we are only here for another ten days, the success of the gardens would be entirely contingent on their own initiative. We are wary of starting a project and not being able to support it the whole way through, but if the Madre Guías are excited enough to carry it through themselves, it could be feasible.

      On Saturday we took a ninety-minute hike to Concepción, the closest market town. Most people make the trek every Saturday to buy or sell at the open-air market. Although Guachí residents grow their own corn and raise their own livestock, produce is mostly bought at the market. We noticed that junk food, churros y confites, was much less expensive than produce. Accordingly, kids in Guachí eat chips and candies they can find in local pulperías throughout the day.  In our health education charlas, we would like to encourage mothers to replace junk food snacks with fruits and vegetables, but we need to take into account how this would affect their budgets. We’ll incorporate this issue into our discussions with the Madre Guías.   

Honduras Initiative Trip ’09: Post 1

“Honduras is the third poorest country in the western Hemisphere . . . The poverty rate, defined as households living on less than $2 per day, is 40%, while the childhood malnutrition rate is 17%. However, poverty and malnutrition rates are thought to be as high as twice the national average in the rural remote areas of western Honduras.”
(http://www.shouldertoshoulder.org/Articles/Jeffrey644.pdf)

Tomorrow we, eight members of the Honduras Initiative, leave for rural Intibucá in western Honduras to volunteer for the NGO Shoulder to Shoulder. We have been meeting once a week since the beginning of second semester to plan the logistics of our trip, to fundraise, and to design a nutrition curriculum to teach to female volunteer community health workers (Madre Guías).  However, in our preparations for this trip, we have never explicitly or extensively discussed the bigger picture, the role our group and our trip should be playing as part of Shoulder to Shoulder’s quest to channel volunteerism into sustainable health care change. Shoulder to Shoulder’s mission is “to develop educational, nutritional, and health programs that help poor communities in resource-poor countries achieve sustainable development and improve the overall health and well-being of their residents” model. What strikes us as most essential about Shoulder to Shoulder’s model is the insistence that volunteer efforts be long-term and collaborative in nature; working with the community rather than simply for it.  This probably seems obvious, but it has significantly impacted the direction of our efforts.  For the Honduras Initiative, partnering with the community to support sustainability will mean that the purpose of this summer’s trip is by and large to build relationships with community members and engage them in a discussion of what health or nutrition projects we can help them start or support in the future, rather than start new projects. We will mostly be listeners as opposed to actors.

We’d like to outline our trip, looking specifically at how our plans fit into Shoulder to Shoulder’s model.  We will be spending the first two weeks in Guachipilincito, also known as Guachí, a small town in rural Intibucá. While residing in Guachí, we plan to conduct health surveys and interviews with members of the community to assess what residents view as the most pressing health needs, and what the best way to confront those needs would be.  We will also shadow and train the Madre Guías, a group of about 20 female volunteers who are responsible for distributing folic acid supplements to women in their community.  Our training includes several charlas, lessons, on nutrition, breastfeeding, and dental care. Aside from providing a venue to teach the information that we have, we hope that the charlas will create a space for the women to share their own knowledge and to discuss common health problems amongst themselves.

The last week of our trip will be spent in Santa Lucía, where the Hombro a Hombro (Shoulder to Shoulder) clinic is located.   We will shadow doctors in the clinic and on home visits, which will allow us to learn about health issues in the area from a physician’s perspective and to understand what health care is available to local residents. We will gain experience interacting with patients by assisting with simple procedures like dental varnishing.  Perhaps most importantly, though, we hope that our week in the Shoulder to Shoulder clinic will help us understand the organization, form relationships with the staff, and discover how our group’s work can best coordinate with that of Shoulder to Shoulder.

Our ultimate goal on this trip is to lay the groundwork for a long-term relationship with the town of Guachipilincito and determine how we can best support sustainable community-based development. Check back on this web site for regular updates on our project! We would love to hear any feedback.