By Natalie Walter
AMOS Photographer and Field Reporter
Far up into the highlands of Matagalpa, Nicaragua, the disperse homes of communities like Apantillo dot the hillsides, picturesquely placed at the end of winding trails or in lines along long dirt roads. The scenery is idyllic, but not everything about the peaceful, removed existence of life in a rural community in Nicaragua is so ideal.
In remote communities like Apantillo, there is no doctor’s office for pregnant women to visit. It takes hours to get to the nearest government health center – if you have a car. It’s even longer by horseback or on foot, the way most people in the communities travel. And in a community where there is a lack of steady jobs and people live on what they make daily, paying a bus fare can mean going without any food for a day or more. This is the first barrier to seeking prenatal care, or giving birth while attended by a medical professional.
The second barrier is that seeking medical care during pregnancy is not always something women or their husbands feel comfortable doing. Stories of health centers being understaffed and doctors and nurses rushing to see too many patients under pressure lead women to worry about the care they will receive. Many women express that they would prefer to stay home for their birth, surrounded by their family members. A persistent machista (male chauvinist) culture is another barrier. The idea is often enforced in rural Nicaragua that women should not leave the home. And maternal healthcare, according to a machista mindset, would only be acceptable when provided by a woman, because the only man that should see a woman’s body is her husband. Fears of things happening otherwise mean that many women don’t go as often as they should to see a doctor during pregnancy, and may stay at home to give birth.
All these factors together make it very difficult for pregnant women in Nicaragua to get the medical attention they need. This is why Ada Luz does what she does.
Ada Luz is the Health Promoter of her community. She counsels her neighbors when they come to the community clinic in Apantillo when they are sick, and she also visits them in their own homes to provide counseling and follow-up there. This is especially important for her pregnant neighbors, like Ubencia, who Ada Luz recently visited and checked in on. Ada Luz herself was recovering from surgery on a tumor at the time – her motivation to serve her community is so great that as soon as it was safe for her to do so, she started visiting her neighbors once again to counsel them on their health.
Ubencia is 35 years old, and is expecting her 9th child. Her husband is a local pastor in Apantillo. She’s 8 months along, and Ada Luz has been visiting her throughout her pregnancy.
One day this month, Ada Luz stopped by along with a member of the health committee in Apantillo, and a few visiting AMOS staff. Ubencia has given birth eight times already, and each time, she did so in her house. “Will you go to the health center for this one?” Ada Luz and the other visitors ask her. Ubencia laughs shyly in reply.
Ada Luz brought a scale with her in order to weigh Ubencia – and it turned out Ubencia had lost a little bit of weight, though not enough to be alarmed over.
So, it was the perfect time for them to chat again about Ubencia’s nutrition. Ada Luz reminded Ubencia of all the vegetables she can add more of to her diet – “they’re good to eat, and they have the vitamins you need,” she reminded her.
Ada Luz also checked in to make sure Ubencia is taking her prenatal vitamins in addition to adding more vegetables to her diet.
The last thing for them to go over, then, was the signs of danger that a pregnant woman should be aware of. Ada Luz made sure that Ubencia hadn’t experienced anything like bleeding or strong headaches, and that she knew to come to Ada Luz if she did.
“All that’s left, then,” Ada Luz said to Ubencia as the group prepared to leave, “is for you to go to the health center when it’s time for the baby to be born. Not all births are exactly the same. Some can have complications. So, we have to think about what’s best for your child.”
Ada Luz reminded Ubencia that the whole community was praying for her and her baby, so she had nothing to worry about. “We put everything in God’s hands – in him we can do anything,” Ada Luz reminded her neighbor as encouragement.
Ada Luz does this work out of a desire to serve her community. She has spent years developing the skills to match her desire to serve others, and the whole community benefits from her coordination with the health committee. Having a trained health promoter in Apantillo means that the community has someone they trust to turn to when they need help.
After all, it can be difficult to do something we’ve never done before. Ada Luz is there to walk alongside Ubencia in encouraging her to go to the doctor to make sure her child is safe and healthy. “We just have to visit them, frequently,” Ada Luz later says when asked how to make sure a pregnant woman doesn’t give birth at home, away from medical attention. “And if that doesn’t work, we can call the Ministry of Health to ask for support from their health workers to come to them.” However it’s done, Ada Luz is determined to help her neighbors.