By Natalie Walter
AMOS Health & Hope Field Reporter
As a new year is in progress, we at AMOS Health & Hope are taking some time to reflect on all that we’ve learned as an organization. And it’s a good time to do this, since 2017 is a very special year for AMOS: We’re celebrating our tenth year as an organization, and the fiftieth year since the one of our founders started his pioneering community health work in Nicaragua.
In 1967, in rural Nicaragua, a Nicaraguan medical doctor named Gustavo Parajón took action to address the deep inequities in health and access to healthcare he saw in his country. He began training community leaders in remote areas to provide community-based primary healthcare right where they lived, where there was no access to healthcare otherwise. Forty years later, he founded AMOS Health & Hope along with his son and his daughter-in-law, Drs. David and Laura Parajón. So 2017 is a big milestone for us and for Nicaragua!
To begin the commemoration of this special anniversary, here is a list of ten things we’ve learned over the past ten years!
1. You have different health outcomes depending on where you’re born and what family you are born into.
At AMOS, we pay a lot of attention to a concept called “social determinants of health.” What this means is basically that someone is more or less likely to be healthy depending on certain factors in their life, such as their education or income level, the safety of the community they live in, if they are employed, and how supportive their family is. These factors can influence a person’s health even more than their access to healthcare can.1
2. Everyone deserves access to healthcare.
Just because social determinants of health exist doesn’t make them right. AMOS recognizes that this is an injustice that we need to address. This is the basis of all of our work. We believe that everyone deserves great healthcare, even if they aren’t born into privileged living conditions. This is why we work in our home community in a semi-urban setting, but also in remote communities all over Nicaragua.
3. Health can often be better improved by prevention rather than later treatment.
It’s great when we’re able to heal someone from being sick. But it’s even better when we can make sure that they don’t get sick in the first place! It is important for our health promoters to know how to treat diarrhea when they encounter it. But it’s just as important that a health promoter knows how to explain to her community how to avoid contamination in food and water. This is why we equip communities with medicine, but also water filters and hygiene education, to prevent the medicine for diarrhea from ever being needed.
4. Health is about treating the whole person, and whole communities.
It’s not just enough to treat sickness when it comes up. We are aiming for so much more than just not letting people die. We want people to flourish!
This belief comes back to a role model of ours: Dr. Jack Geiger, a founder in the movement for community health who first advocated for not simply treating illness but also addressing the social determinants of health. Said Dr. Geiger once: “The last time I checked my textbooks the specific therapy for malnutrition was, in fact, food.”2 Rather than only turning to medicine to treat disease, we must ensure that people are well in a variety of ways.
5. Good work is based on data, and the community must have ownership of this data.
It’s important to listen to concrete numbers and data that tell us what the needs of a community are and how well we are responding to them. But no one can tell us what a community needs better than the community itself!
This is why one of AMOS’ key methodologies is called community-based participatory research. Traditionally, research is something that students and professors at universities produce, by gathering information from somewhere or from a group of people and then analyzing it themselves. The people who provided the information very often do not hear about the results of the research.
AMOS doesn’t do research on communities – we learn alongside them when we are invited to do so. The problems we address are the ones identified by the community, the community participates the collection of information on the problem, and all data is shared with the community. This helps us to constantly adapt methodologies of change to the local context.
6. Empowered communities are healthier communities.
Research has shown that when public health programs focus on empowering the people they work with, there are better health outcomes.3 Instead of merely treating sickness in patients, we train community leaders using methods from great thinkers such as Paulo Freire. AMOS works to teach people the skills they need to prevent and treat illnesses in their own communities, and also works on supplementary efforts such as our youth empowerment program, which helps young people learn how to choose healthier life styles, avoiding teen pregnancy and abuse of drugs and alcohol.
7. Community work is based on relationships.
It isn’t possible to achieve real, long-lasting change if strong relationships haven’t been built. A community health worker’s success relies on her relationship to her community, so that she can guide her neighbors to better health in trust and friendship. Our success as an organization is also based in our relationship with community health workers, so that we can listen to their assessment of how their communities are doing, and provide useful training in the necessary skills.
For AMOS, this work is also based in our relationship with the churches, universities, and individuals outside of Nicaragua who support us by donating their financial resources to support this work, as well as their time to participate directly when they come to work here.
And it’s of course based in relationships between individuals who belong to any of these groups – the love and caring between each member of the AMOS family keeps us passionate for the work we do, willing to serve with humility.
8. Better health takes hard work, but it is achievable.
There are a lot of health disparities in Nicaragua. People live in poverty, children die of preventable diseases, and people suffer of chronic illness – all unjustly so. After years of hard work, we know that these problems will not fix themselves.
But, we have also learned that with this hard work, it is possible to do something about these injustices. Since 2012, we have seen a 78% decrease in childhood mortality in the communities we work in! That’s a big difference, and means all the world to the families of the children whose lives are saved. We have also had no maternal deaths in the communities we work with for many years running now. It took tremendous effort to achieve these outcomes. But we’re making progress every day!
9. Health is a human right.
In fact, this human right to health is also guaranteed by the United Nations’ Universal Declaration of Human Rights in 1947. “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family,”4 states this fundamental international document.
One of our foundational guides as an organization is the Alma Ata Declaration, which was signed at the International Conference on Primary Health Care in 1978 and later adopted by all World Health Organization member states. It states that health – not merely the absence of disease but also “a state of complete physical, mental and social wellbeing” – is a human right, and that protecting this human right is the responsibility of all.5
It’s not just the role of health workers and it’s not just the job of those who health disparities affect most. Health inequality is a grave injustice and one that we can all do something about. And we do this work out of our deep love and responsibility to our neighbors – every one of us.
Which leads us to the tenth thing we’ve learned in these ten years as an organization…
10. Everyone has a role to play in health equity!
AMOS works with people from all different countries, of all different ages, with different skill sets and different worldviews. And just as we all have a responsibility towards one another as human beings, we all have something to contribute, as well!
We’re looking forward to the years to come and all we continue to learn and achieve alongside you!
1. Howard, T, and Norris, T. (2015, December). Can Hospitals Heal America’s Communities? Democracy Collaborative.↩
2. Bornstein, D. (2011, July 28). Treating the Cause, Not the Illness. The New York Times. Retrieved January 24, 2017, from https://opinionator.blogs.nytimes.com/2011/07/28/treating-the-cause-not-the-illness/↩
3. Wallerstein, N, and Bernstein, E. (1998). Empowerment Education: Freire’s Ideas Adapted to Health Education. Health Education Quarterly, Winter, 380. doi:10.1177/109019818801500402↩
4. The United Nations. (1948). Universal Declaration of Human Rights.↩
5. International Conference on Primary Health Care, Alma-Ata, USSR. (1978). Declaration of Alma-Ata.↩