El Fin, Farewell AMOS y Nicaragua

Mule knows best

I’ve realized that life is an aggressive, forceful Rottweiler that will indefinitely drag you in its direction of choice, unless you proactively pull back on the leash, take life by the collar, and command him in the direction you want to go. Life just takes you. Life will just happen. And if you want to live life for you, you have got to take command.

There isn’t a good English equivalent to the Spanish verb “aprovechar.” It best translates to “take advantage of” or “make the most of” … an opportunity, a time frame, a person. This is how I think of the word: opportunity is a tropical red juicy fruit, and you “aprovecharing” it is you squeezing it in your fist, extracting every last nourishing drop of juice.

Every moment has the seeds of opportunity to change you. And for the past nine weeks while working for AMOS in Nicaragua, I’ve tried extremely hard to “aprovechar” every single moment, because I know that every moment can teach me something new, and that there is always so much more that can be done.

Last week I visited my last community, El Bambu. It was awesome. The people were warm and friendly, over 150 children came to the health stations, there was a very low prevalence of malnutrition and anemia, and we each had to ride a horse for four hours to reach the community. Yep, throw four American girls up on horses, show them how to make popping noises with their lips to make the horses trot quicker, tell them to hold on tight, and they shall prevail through the thickest of mud. To reach this community, we had to trek through miles of mud amidst beautiful pastures and steep cliffs, but the mud was crazy. It reached the bellies of the horses. They gave me a mule the second day, and we turned out to be really similar. Smaller than the others. Adamant on taking our route avoiding pits of mud and capitalizing on rocks. Slightly competitive by staying at the head of the pack. Neighing and singing to pass the time. My mula (“mule” in the Spanish) was the best. Mules are also 4X stronger than horses, and he was WAY more confident in his foot placement than the horses were.

            We made quite an impression. Four foreign girls, mounted on horses, wearing big smiles, carrying weighing scales and iron vitamins, having come from far away without a man or without families. Just by being women volunteers, I think we affect notions of gender roles and of what women are thought to be capable of. In the campo (rural communities), it’s obvious that American female volunteers fall into their own third gender, not male obviously, but not traditional female status either. Normally at dinnertime, women set the table for the men, the men sit and eat, and the women watch. After the men have finished, the women eat while standing up around the table. We, as female volunteers, ate sitting down, before the males did. More so, we don’t get approached the same way females in the community do. Men are more thoughtful in their words, more polite. But men will be men, and still make passes, but less hissing and cat-calling and more questions like “when will you be back so we can get married?” Lastly, typically when in conversation with the men in the community, local women don’t enter discussions where there are lots of men. They really only talk to their husband or one man at a time. But as foreign females, we were invited to take part in these big, male, sausage-fest discussions about a variety of topics, not just those pertaining to health. It’s quite interesting this dynamic that plays out when we go to the campo. This “third gender” idea. I wondered what type of effect the image of “four foreign women on horses resolute in running health stations” might have in the minds of men, women, and children in the community. Though it’s subtle, I think it’s positively changing notions of women, what they can do, and what opportunities exist for them.

Enough of my musings, so what about nutrition?

At the World Food Summit in 1996, the Food and Agriculture Organization of the UN estimated that world food production that year was enough to provide at least 2,700 calories per person per day. The problem isn’t calorie scarcity but the equitable distribution of these calories worldwide. In this case, I’m hopeful. All we have to figure out is how to share.

  The communities AMOS works with face different challenges concerning their children’s nutrition. Some communities produced a lot of food, but the food was all in the hands of a few farm owners, and enough of it didn’t make it onto the tables of the workers. Some communities were in drier regions where access to water for farming was difficult. Some communities just didn’t know enough about proper nutrition and iron-rich foods. Some communities were very poor and had high rates of unemployment because there weren’t enough jobs available. Because these communities face different challenges, the solutions to improve nutrition in their individual contexts are different.

  And this is where the AMOS model shines. AMOS helps communities figure out what is wrong—which vulnerable groups are most in need, where health in the community most needs improvement—and then asks the community to come up with the solution. I’ve seen it with my own eyes. Groups of five to eight men and women discussing the data from the health stations concerning malnutrition and anemia, and figuring out plans for improvement. I’ve seen some passionate and inventive plans. One committee whose community had alarmingly high rates of malnutrition for kids under 2 years and widespread anemia decided that they were going to make house visits to all the mothers whose children were anemic or malnourished to personally invite them to a forum. And at this forum a mom who got her child out of anemia was going to speak. She would speak about how she changed her child’s diet and how the modification affected her child’s overall health and success in school. Without the community’s support, any intervention is destined to fall into the deep recesses of a latrine’s crap hole. But if the intervention is developed and executed by the community, the likelihood of seeing results is dramatically increased.

  I’ve learned a lot this summer. I’ve gotten so much valuable experience seeing public health as it plays out in the field. I’ve seen the application of what I learn in school, and I have a new found appreciation for my public health major. I’ve developed surveys, interviews, written reports, practiced a lot of Spanish. I’ve realized how happy I make myself, and how driven I become when I feel as though I can make a change. Surprisingly, I think I’ve gotten closer to my family being 2224 miles away. We’ve been able to talk about rural medicine, rural life, Nicaragua’s political history, and being away, always reminds me how much I love my family. I’ve come up with some creative ways to make beans and rice more interesting than beans and rice. Squeeze the juice from a sour orange into beans and rice. Mix well. Deliciosa! I’ve made some great friends, and learned about what drives other people to work in public health. To dedicate your life to helping those you don’t know and don’t have anything to do with. I’ve learned a lot. 

  I hope I don’t let everything I’ve seen and done this summer just wash over me. I’m going to have to work hard to remember everything—how access to healthcare is really limited when you have to take a four hour horse ride to leave the community, how beautiful it is that moms just whip out their boobies and breastfeed in public, how regional diets can not easily be modified—and let that knowledge affect my decisions, my educational plans, my future goals. Let it change me.

  And with that, I want to say thank you to AMOS, to friends here and abroad, to my family, and to you. For reading. Thank you. I’m honored you took the time to read my words. Tell me you’re reading this. I’ll think you’re really cool.

Mucho paz y amor,