Rural Community Health
AMOS prioritizes the needs of vulnerable people in remote, rural areas of Nicaragua through a variety of programs using community-based methodologies.
“Before the work of AMOS, we didn’t even know our children had anemia or malnutrition. But with the new knowledge that our children had anemia, and with the education about how we can treat and prevent anemia, I was able to give my children the right kinds of foods, and avoid coffee and sugar, and now my children do not have anemia.” ~ Mom from Cumaica Norte
Anemia remains a major global health issue, affecting nearly two billion people worldwide. In Nicaragua, it is estimated that 20% of the general population and approximately one third of pregnant women have iron deficiency anemia [1,2]. The great danger of this condition is that it often remains hidden. Children grow up frail and small, often struggling in school; pregnant women become sick or easily exhausted, leading to an increased rate of stillbirth and low birthweight babies.
AMOS works closely with the health promoters to coordinate anemia and growth monitoring screenings regularly in their communities. HemoCue screening devices donated by HemoCue® allow rural health promoters to accurately diagnose and treat anemia. Parents receive health education talks from the health promoters on nutrition and specific dietary needs for children recovering from malnutrition and anemia. Several times throughout the year, health promoters review their census data with AMOS supervisors to determine what factors might be causing these cases and plan together how the community might address the issue. The series of activities of the Community Nutrition program has led to better nutrition education and improved care for new mothers & infants.
References: 1. WHO Report, Worldwide prevalence of anaemia, 1993–2005. Source: http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf 2. Mora, Jose. O. Integrated Anemia Control Strategy has significantly reduced anemia in women and children in Nicaragua, 2007. Source: http://www.micronutrient.org/CMFiles/MI%20Around%20the%20World/Americas/Nicaragua_Anemiacontrolprog_finalrpt.pdf
Contaminated water translates to a high prevalence of diarrheal disease which can lead to death among children in Nicaragua. In the rural communities where AMOS works, less than 20% of families have access to safe drinking water.
To date, AMOS has installed over 1,100 water filters in 19 communities in conjunction with community leaders, GlobeMed of Rhodes College, many short term mission teams, and Aqua Clara International,. Maintained by local community leaders, these filters have proven to be effective in removing over 90% of the pathogens related to waterborne illness. Using a portable laboratory, we analyze samples of the water sources, the individual filters and storage recipients to ensure that community members receive the cleanest water possible.
Drinking clean water, however, is more than just having access to clean water. It also means knowing the steps to keep the water free from further contamination. We work with the local leaders to continually educate their communities about the use of the filter, its maintenance, and personal hygiene and sanitation.
In Nicaragua, school-age children are affected by illnesses such as intestinal parasites and anemia, which left untreated, affects their growth, and thus their ability to learn in school. Knowing that healthy children are much more likely to go to school, AMOS supports a national Nicaraguan program called Healthy Schools to help give children a better chance at a quality education. By coordinating with the Nicaraguan Ministry of Education (MINED), school teachers, local health promoters, and the Ministry of Health (MINSA), AMOS works with communities to encourage school attendance, teach nutrition and health concepts to school children, and train teachers in first aid.
The Healthy Schools program is carried out in large part by AMOS health promoters who give educational talks to children in their classrooms about topics like washing their hands, brushing their teeth, and what kinds of foods will help them grow up healthy and strong. Also related to the Healthy Schools program, our deworming campaign occurs twice a year in which children ages 2 to 12 also receive a dose of albendazole deworming medication to prevent and treat intestinal parasite infections. Delegations who work with us help us to provide children with toothbrushes when they visit communities and also assist in coordinating anemia and growth monitoring screenings of children. Finally, health screenings are held at local schools and help us identify malnourished children who need extra care to get healthy again.
Occasionally a health condition is so serious that it cannot be treated by health promoters in the community. The geographical distance and challenging terrain in the rural areas of Nicaragua also makes transportation to the closest health facility very difficult and costly for families. In these instances, AMOS provides lodging and transportation for rural patients who need access to specialized care in Managua.
AMOS’ Patient Care program is made possible by purchases of T-shirts, coffee, and other AMOS Store merchandise and by donations from members of the delegations that partner with us each year.
PhotoVoice is a community empowerment tool which seeks to facilitate meaningful change through community dialogue. AMOS trains local leaders how to take quality photos to share images of both community strengths and community issues. We use the SHOWeD methodology from Roy Shaffer of AMREF as a tool to help communities to recognize their strengths, identify their needs, and develop action plans for improving their communities. The photos give a visual voice to the issues identified and help empower the photographers to believe they can speak for and serve their communities. Educational tools can also be made from the photos and stories for the elected projects.
In 2010, youth in the communities we serve asked us to support a dream:
“We face problems like excessive drinking, violence, and teenagers getting pregnant. But we can do something as youth if we participate and work together. We can learn to raise healthy families with no violence, to fill ourselves with values, and to have a better future — not just for our own communities, but for all of Nicaragua.” – Jeymi Jarquin, youth leader of las Macias
Young people are the future leaders in many rural communities. Since 2010, AMOS has been working in collaboration with a program called TeenSmart, which seeks to help young people cultivate their strengths, promote self-awareness, and develop a vision for their lives. Together we have formed a partnership to train and empower youth facilitators in rural communities so that they can form youth support groups to promote healthy behavior. As these youth leaders become educated, they can share their knowledge with their peers in hopes of preventing drug use, early pregnancy, and suicide.
JOSECHAS (“Youth planting seeds to harvest hope”), is the name given to the program by the youth facilitators themselves and is an integral part of community development. Our hope for these youth is that if we can help them achieve the positive outcomes for their future then they have the potential to change the course of their entire communities.
– A woman who accompanies and supports another woman through pregnancy, birth, and the postpartum period.
Volunteer Mother – A woman who voluntarily works to support other women in her own community.
In recent years, women in the communities that AMOS works with have expressed that if the health promoter in their community is a man, it is harder to talk to them about certain health issues or concerns that they have, such as discomforts during pregnancy or breastfeeding difficulties. In response to this concern, numerous women are being trained in multiple communities on how to teach, to partner with, and to support other women in their communities. For pregnant and breastfeeding women, it is extremely important to receive loving and knowledgeable support during these vulnerable times in their lives. After 25 years of replicating the community based doula program across the US, HealthConnect One’s experience shows that community-based doula programs “improve infant health, strengthen families, and establish supports to ensure ongoing family success, including”(1):
- Improved prenatal care
- Fewer pre-term births
- Increased breastfeeding rates
- Increased birth weight
- Fewer medical interventions
- Fewer c-section deliveries
- More positive birth experiences
- Increased mother-child interaction
- Improved parenting skills