Juntos Adelante
Musawas Midwives Project - 2006
Background
In March 2006, after five years working with Mama Licha to make a new model of midwifery-owned and operated reproductive health facility, ICAS/Juntos Adelante co-founders, Bethany Golden and Angela Rogers, visited the remote Bosawas Reserve, where they met a group of courageous midwives. The mission of ICAS/Juntos Adelante, a project of the Institute for Central American Studies, remains the same: to promote the just distribution of health, financial, intellectual, and artistic resources abundant in the developed world to women-owned and operated organizations and businesses in developing nations. The goal is to encourage self-sustainability of women-initiated projects dedicated to health and human rights in their communities. All projects are identified by the communities or women of the developing world.
Musawas is nestled into the Bosawas
Biosphere Reserve in North Central Nicaragua, which is predominately rainforest
and makes up 15% of Nicaragua. The reserve is protected by the Nature Conservancy,
an international non-governmental organization, which helps the indigenous
people establish legal claim to their lands, protect the boundaries and natural
resources of the Reserve, and determine appropriate land uses. The Reserve
houses three indigenous groups, Miskito, Rama, and Sumo/Mayanga. Musawas is
the home of Mayanga people located in a remote area of the Reserve which is
inaccessible by motor vehicles. Only 8,000 Mayanga exist in the world. This is
a land of dugout canoes, thatched roofs, and barefoot children. There is no
electricity, no running water, and no phones. But in Musawas you will find a
proud, unified, indigenous community that has largely been ignored by their own
government. They have sustained their indigenous language and culture. Women
of this ethnic minority have no or extremely limited contact with the rest of
Spanish-speaking Nicaragua or other outside groups. With low rates of literacy,
high rates of poverty, and linguistical isolation, women live the majority of
their lives within the Reserve.
Project Origins
The co-founders of ICAS/Juntos Adelante were able to visit the Bosawas reserve with the help of The Nature Conservancy and the guidance of Thelma, the president of the local indigenous women’s organization. On the four-hour hike to the village through the rainforest (in knee deep mud) they learned the basics about the community, politics, economics, gender, and health issues. They were told that no one had ever visited the community with an interest in women’s health or midwifery. This was clearly an incredible opportunity to meet and hear from the midwives of the community. The morning after arriving, with the help of Thelma and the community leaders, the meeting room filled up with midwives. They talked to the midwives about the current status of women health services, pregnancy, labor management, birth practices and traditions, and birth outcomes. During this meeting they learned that mothers and children bear the greatest health burden which results from a lack of access to health services. Women often labor and deliver their babies in isolation, far from hospitals and clinics. Last year in this community of 3,000 people, 4 women died during childbirth – an extremely high rate of maternal mortality.
Midwives are often
the only health providers attending births in the area. Because of their
dedication, they will walk barefoot at night, in the rain for hours with no
poncho, shoes or flashlight to show up at a woman’s house to deliver a baby.
They use bamboo to cut the cord because they have no scissors. They rely on
traditional medicine, but also desire to have access to much needed western
medication. At the end of this four-hour meeting, the midwives presented both
an oral and written proposal for midwifery trainings, educational materials,
medical equipment and supplies. The proposal requested assistance for all fifty
women who are midwives or women who are training through birth observation to
be future midwives.
From March through August 2006, ICAS/Juntos Adelante started sharing the story of the Musawas midwives, and eventually acquired the requested supplies through financial contributions and in-kind donations. ICAS/Juntos Adelante enlisted a great team to make the project a reality: Maraya Kennedy-Friedman (a certified nurse-midwifery student at Yale University, who helped with fundraising, transporting supplies to the Musawas midwives, and helping to coordinate the trainings), Ramona Alfaro “Monchita” (the Head of Nursing and Midwifery for the Ministry of Health in Esteli who conducted the trainings in August), Dalit Gulak (nurse-midwifery student at Georgetown University who assisted Maraya and Monchita with logistics and coordination of transportation and trainings), and Dana Rogers who helped secure numerous in-kind donations of needed supplies.
Objective of the Musawas Midwifery Project:
Equip, train and empower the Musawas community of midwives to recognize complications and refer for additional medical assistance when needed.
Goals to meet the objective:
1) Deliver the requested medical equipment to the fifty midwives and midwifery students, as per request. A backpack filled with these items:
a. One headlamp with 6 extra batteries, a thermometer, a stethoscope, a blood pressure cuff, a pair of rubber boots, a sweater, 2 large gauze packets, 12 packets of alcohol swabs, 6 packets of antibiotic cream, 10 condoms, a notebook, a pen, a poncho, a packet of string, a metal placenta bowl, a pair of scissors, a bulb syringe.
b. A guide/manual to midwifery, put together by our team, primarily made of pictures. A large percentage of the women do not read or write.
c. One emergency portable stretcher for the community.
2) Complete two days of trainings (capacitaciones) for the midwives, led by Ramona Alfaro (“Monchita”) in Spanish, with Mayanga interpreters.
3) Documentation of the project through audio recording, photography and written notes.
The Journey back to Musawas:
Friday, August 25th: Maraya, with the five hundred pounds of supplies, arrives in Bonanza after an eight hour drive over rough terrain. She meets up with Dalit and Monchita who arrived in Bonanza via plane on the same day. They are joined by Roberto and Valeriano, two local representatives who assist with the trip.
Saturday, August 26th: Monchita, Maraya, Dalit, Valeriano,
Roberto and five others met at the river outside of Bonanza to load the
supplies and head to Musawas. They stopped seven hours later, a little over
half way of the voyage, to spend the night in a local house on the river. The
people of this house welcomed them in as stranded travelers, fed the group and
gave them a space to lay their heads.
Sunday, August 27th: The
canoe and all its passengers arrive in Musawas. During the boat ride, Valeriano
made announcements to women on the shore to inform all midwives to come to
Musawas for a training seminar—a common form of public communication for the
tribe. Shortly after arriving in Musawas, forty midwives came streaming in,
filled a local schoolroom, and expressed their desire to learn. The first
day’s lectures were on basic anatomy and progress of labor, stages of labor and
nutrition during pregnancy. Many visual aids were used because most of the
women do not read or write Spanish.
Monday, August 28th: The second day of training took place in the local church, with fifty midwives and three bilingual nurses from the community. Topics included the menstrual cycle, nutrition, pregnancy, childbirth, and preventing infection. The midwives then received their backpack with their essential equipment and supplies and the trainers went through the kit item by item, teaching each midwife to ensure she understood its use.
The midwives learned how to take blood pressures and temperatures among other things. The group showed passion and initiative to continue learning and practicing skills. They planned to use their manuals as a guide, and conduct review sessions to strengthen their skills
Maraya, one of the trainers, states, “The midwives thanked us in unison by saying “Ten Kay” and repeating it three times in unison with a specific hand, arm and body movement. The sound of Mayanga resounded in this space of learning, and they honored us with their cultural form of thanks, sharing the feeling of deep-rooted joy for the educational opportunity and supplies.” The trainers also expressed their deepest gratitude for the tribe’s invitation and hospitality, and shared how much they learned from the midwives during the trainings.
The objective of the project was to execute the trainings in a culturally specific manner and empower through education for the midwives so that they could support healthy mothers, newborns, and strengthen the community from within. Members of the midwifery community expressed the uniqueness of this project. They told us this was the first time that a project focusing on women actually made it to Musawas, ended up in the hands of the right people, and included education and empowerment.