The news was distressing and the timing unfortunate. I learned in a call from home that my father was critically ill and in the intensive care unit. Much of my time, when I was not engaged fully with the work in Cuje, was spent on the phone doing anything possible to help with the unfolding medical crisis. I am happy to report that, as of today, the crisis has passed. I offer this brief account as a partial explanation of the interruption of the “blog from the field.”
I regret that I was not able to chronicle the work day-by-day because it was extraordinary. The clinic was organized and operated with skill and dedication. At times, we were able to offer in-clinic medical consultations by three different doctors (Dr. Roger, Dr. John, and Dr. Francisco). At other times, Dr. Francisco was in the field with a MANOS student, making house calls to pregnant women identified by the Totagalpa clinic physician, Dr. Janet. Tellez. And, Dr. John spent time in the field with the research team and as a roving doc, accompanied by one or more MANOS students/linguists and visiting families that had been identified as being particularly at risk for serious and chronic illnesses. One call involved a young boy who had suffered a severe burn when he was younger and whose arm has scarred to his side as a result of inadequate medical care. It was heart-rending to see the fear and uncertainty of the mother as John explained that a very simple surgical procedure, involving almost no discomfort, could resolve the matter and give the boy full use of his arm. The boy had suffered terribly from the burn, and he and his mother could not quite bring themselves to believe that this would not be another agonizing experience.
Work in the field proceeded apace, with experienced field researchers (especially Molly Copeland and Gabi Arias) providing exceptional leadership and guidance, and new team members learning quickly and well the subtleties and nuances of ethnographic interviewing. All of the new team members, Yardley Albarracin, Lester Chavez, Jessica Yon, Jackie Goldschmidt, and Chrissy Sherman showed great potential for field research, and Jackie made a wonderful start with an in-clinic interview study. We missed field team stalwart Julie Sangimino, who this year is studying in Italy. Jackie (“Big Jackie”) Ramirez was engaged deeply in a study of women’s health care and building further our relationship with the Totagalpa Free Clinic and Dr. Tellez.
The field work was focused on a planned community meeting. We wanted to make sure that representatives of all the households in Chaguite understood that we value them and their participation in our work in the community. More specifically, we wanted all households to be represented at the planned meeting. Our data reveal that all but three households (of a total of 43) were represented at the meeting, and most families brought several adult members and a fair number of children. We had met in advance with the “CPCs” (community representatives of the mayor’s office) to discuss the community meeting, to present information from our research, and to develop agreements about the planned meeting. We asked them to help us to encourage residents to attend and they acknowledged that, while they work hard to get households represented at meetings, that sometimes is a problem. We offered to go door-to-door to invite residents, to discuss the purpose of the meeting, and to advise people that we would provide a shuttle service along the main road to the school where the meeting was held.
The offer of transportation understandably was well received. Recall that there are no cars in Chaguite, and only a few families have horses or burros for transportation over long distances of mountainous terrain. Driving our 15 passenger van (note: no 4-wheel drive), I drove up and down the main road gathering meeting attendees, sometimes packing a few more than the maximum load. There were no complaints from the passengers, but I had serious concerns about making the grade — literally, scaling the very steep incline with too much weight and too little horsepower.
Preparation for the meeting included intensive discussions of the core materials and the interactive (focus group-like) process for eliciting shared understandings about the key health concerns and ways to address those through “small-step,” collaborative efforts. Our research over the last two years has focused on collecting information from individual respondents about these matters, but we are moving now to find points of intersection and places to begin to encourage community-wide strategies. It is critical that all team members understand our methods and concepts — and that we find the right way to translate these into Spanish — and not just Spanish, but Nicaraguan Spanish — and, even more, Cuje Spanish. The challenges are extraordinary, and it would be surprising if we did not come up short at times — even with about half a dozen native Spanish speakers.
We worry about that — a lot. Still, as important as linguistic sophistication is, much of what we do for now can be based in more modest comprehension. We heard very clearly, for example, that some members of the community believe that re-forestation is essential to any and all efforts to improve life in Cuje. With mastery of the best local dialect, we might have appreciated more finely the beauty of the arguments that were advanced on that matter. But the essential issue and the depth of sentiment concerning it were clear. And, it was clear that others have strong sentiments about other issues that impact their lives and their health.
The next entry will describe the community meeting and the activities of the unfolding work in Cuje and Chaguite.