AS ALWAYS, WHEN I come back to Nicaragua I am acutely aware of the contrasts: breathtakingly beautiful landscapes in a crumbling country, the wealth of her natural resources and the poverty of her people. I keep coming back to visit Nicaraguan friends and family and work with a woman’s health project that I have been involved with for eight years.
This past February I spent five weeks in Matagalpa, Nicaragua. I brought $5,000 for hurricane relief aid collected from generous friends, and delivered it to the project, the Casa Materna. The money will help pay for clothes, bedding, roofing, food and medicine that they are providing to several small communities damaged by Hurricane Mitch.
I spent several days in the capital, Managua, with a family I met in 1992. We spent time visiting and catching up on family news and playing with their grandchild, four-year old Sofia. My last visit to Nicaragua was in 1995, and as I walked through Managua, I saw that although the city had not been affected by the hurricane, the gap between rich and poor has grown ever wider.
There are new luxury hotels and restaurants, more cars, new shopping malls, McDonalds and Domino’s Pizza, all catering to foreign investors and the small middle/upper class who live in houses protected by high walls and armed security guards. But in Maria Elena’s neighborhood, only fifteen minutes away, there are no phones; no indoor plumbing and most people still cook with wood.
On the trip north to Matagalpa, our bus had to bypass road damage where hurricane flooding had pulled away parts of the highway and destroyed bridges. Even after three months, in some places the water had not yet receded, and it was a sad sight to see only the tops of trees and roofs of submerged houses.
The city of Matagalpa is in the mountains with a delicious, cooler climate. December through March the ripe coffee beans are harvested and the beneficios, or processing plants, were busy. Outside in the sun, workers were raking and drying the beans, after which they will be bagged and sold to exporters.
February is a beautiful month in Nicaragua: trees and bushes in flower and hosts of butterflies. Outside the window of the Casa office is an enormous hibiscus bush, and the red, trumpet-shaped flowers were a favorite of the hummingbirds. It felt good to be back home where I had lived and worked for nine months in 1992.
The Casa Materna is a house for women with high-risk pregnancies who live in rural mountain communities and must deliver their babies in a hospital. Women can safely wait out their last weeks of pregnancy at the Casa, knowing that when they go into labor, it is only a few minutes drive to the regional hospital.
The Casa has a Nicaraguan staff that includes a coordinator, two nurses, a part-time doctor, a midwife, a program director and an office administrator. It is funded entirely by foreign donations from countries that include Spain, the United States, Japan, the United Kingdom and Holland. Since its opening in 1991, the Casa has served more than 5,000 women. There are always twenty-five to thirty women staying at the house, which has five large bedrooms built around a central courtyard, a large kitchen, dining room, living room, clinic and office.
The women pay nothing, but most families bring food to share: a bag of dried corn or beans, cheese wrapped in banana leaves, oranges, a stack of homemade tortillas, and sometimes a couple of live chickens. There is a pleasant, informal atmosphere with the staff and the women sharing the housework and cooking.
An important part of the Casa’s work is ongoing workshops about maternal and infant health care and family planning. An increasing number of women ask for contraceptive devices and those who have had more than four children can have their tubes tied at a local clinic.
The maternal mortality rate in Nicaragua is extremely high. Between 250–300 women die per 100,000 births, a striking comparison to the figure of 6–30 women in countries where a hospital or clinic are nearby. In the countryside, seventy percent of births take place at home attended by a midwife, but even the best-trained midwife is incapable of dealing with a sudden emergency. With access to a close, adequate health system, the majority of these deaths are preventable, but in many outlying areas, roads fit for vehicles are non-existent and people must walk or ride a mule for hours to reach someone with health training — a dangerously long trip in an emergency.
The Casa is literally a lifesaver for the women who stay there. After delivering at the hospital, the mothers and babies come back to the Casa for a few more days before going home, as untreated post-partum infection and hemorrhage are two major causes of maternal mortality.
The Casa is a safe haven for mothers and babies, but soon they return to a life typical of the majority of Nicaraguans. The families are very poor and they grow barely enough maize and beans to feed themselves. They live in houses without electricity, running water or indoor toilets, cooking on wood stoves and carrying water from long distances away. Most of the women have at best a third grade education and many are illiterate.
For several weeks after the hurricane, in addition to their busy schedule, the Casa also housed and fed a number of refugee families. They have taken responsibility for helping several communities who suffered extensive damage. I was fortunate to go along on several of these monthly visits and was able to visit with some of the families. In addition to delivering bags of beans, rice, sugar, soap, and cereal, one of the Casa’s nurses was available to see people and give out medicine.
Hurricane Mitch brought heavy rain for four days, which resulted in rivers overflowing, sweeping away bridges, roads and topsoil. Decades of land abuse and environmental neglect increased the death toll as well as the damage to the already shaky Nicaraguan infrastructure. In some places the water rose so rapidly that the geography has been permanently changed. Where people had planted crops there is now only mud, sand and enormous rocks. Huge uprooted trees still lie along the riverbanks and the side of the roads. Masses of plastic bags and debris hanging high up in other trees show how far the flooding waters rose.
Questions have arisen concerning the Nicaraguan government’s response to the crisis. The government did not establish an emergency plan of action as the hurricane threatened the country. President Aleman tried to minimize the seriousness of the disaster even after it was clear what was happening. Decisions about where to distribute international aid were often made on where it would most benefit his supporters. In response to the lack of governmental cooperation, Nicaraguan churches, universities and civil organizations like the Casa Materna have put together a plan to bring immediate assistance and reconstruction.
The tragedy of Hurricane Mitch has clearly shown the failure of the structural adjustment programs imposed on Nicaragua by both U.S. and international lending agencies like the World Bank and the International Monetary Fund. In order to receive these loans, Nicaragua had to agree to austerity programs that negatively impact its economy and the natural environment.
The Nicaraguan government has cut health, education and human services to the bare minimum, and spending on health care dropped from $58 per person in 1989 to $14 in 1997. Nicaragua owes $6 BILLION in foreign debts. Last year it made payments of $349 million, nearly $1 million a day and which represented well over half of the Nicaraguan government’s yearly earnings. $106 million of this debt is owed to Washington.
In the aftermath of Hurricane Mitch, the only just course of action for the United States is to cancel all of Nicaragua’s debt and aid reconstruction that is not subject to any structural adjustment programs.
The Casa Materna should be an addition to an existing health system, not a substitute. The Nicaraguan people deserve a well-functioning and accessible health system. It is a vital part of any country’s infrastructure.
To make a tax-exempt donation to the Casa Materna — or to hurricane relief in Nicaragua — make checks out to Nicaragua Network/AGJ, 1247 “E” Street SE, Washington, DC 20003. Indicate on your check which project you are giving to: The Casa Materna or the AGJ Hurricane Relief Project. (The relief project is providing hundreds of families with home reconstruction kits, which include all materials for rebuilding a house as well as the technical training to do so.)
ATC 81, July–August 1999