What Keeps You Awake At Night?

“Come inside, I’ll show you,” says the woman, beckoning us into her yard. She takes my arm and pulls me past the two pigs snuffling slops, past the old woman and young girl sorting through trash and over to the kitchen: a wood stove made out of a wheel rim and a fan cage under a partial roof of rusty metal sheeting. Next to the stove she points to her outhouse. 

“This is our latrine. Ten of us use it, and it’s full. There’s nowhere to dig another one,” she gestures to the tiny yard between the rooms of the house and the outside wall of their squatter’s shack on the edge of Nueva Vida.” I ask if I can take pictures, she says sure, as long as I don’t mind the smell. I pull back the plastic door and snap a few shots, but it’s impossible to get perspective on just how close the outhouse is to the kitchen where food is prepared, impossible to convey the stench through the lens.

We ask her the next question on our form, “Would your community be safer with street lighting?”

“Of course,” she answers, turning and showing me her front gate. “Look, we’ve had to reinforce our gate with steel so that my family doesn’t get hit by stray bullets when the gangs fight in the street. We need to make our community safer.” 


I was out with our Clinic’s health promoters and public health graduate students from East Tennessee State University taking survey on the quality of life in Nueva Vida. In past years, our work with ETSU has been surveying the community on topics such as birth control, diabetes and mosquito-borne illnesses. 

This year, we broadened the topic beyond strictly medical issues because we felt a need to look at the community’s health in a broader sense. At the Clinic, we’ve seen that it’s possible to improve people’s health to a point, but then patients reach a plateau that is impossible to move beyond using only medical solutions. The poverty in which our patients live means that other factors contribute to their poor health – safety, well-being and larger community factors. Therefore, we chose to ask them collectively: “What keeps you awake at night? What is your biggest worry for you and your family?”

To facilitate those conversations, our network of lay health promoters organized block meetings in their homes where small groups discussed the issues most affecting their families. Students then ranked the topics residents were most passionate or most concerned about and created a survey which we took door-to-door in the course of a week.

Nineteen years ago we held a similar series of community meetings in the newly-formed barrio of Nueva Vida shortly after Hurricane Mitch, and in those meetings, access to basic health care and jobs were at the top of the list of concerns.

In the meetings we just held, those two topics didn’t even make the list of top five concerns. Instead, the topics closest to people’s hearts were gray water (used wash water that runs through the dirt streets), lack of a sewage system, unpaved roads, and street lights.

Nueva Vida 1999

As I sat listening in those meetings, I was surprised at the marked change. I wasn’t there in those first meetings, but I was in Nueva Vida around that time, and the desperation there was palpable. This time around, the conversation was fundamentally different.

In 19 years, not only has Nueva Vida changed, but Nicaragua has changed fundamentally: poverty levels are now under 25%, down from 42% in 2009 and formal employment grew by 10.8% just last year.

Why is health care no longer a top concern? Not only do the people of Nueva Vida count on the basic and specialized services of our Health Clinic, but they have a government health post in the barrio, an actual hospital in nearby in Ciudad Sandino, and on a national scale, the Nicaraguan people can count on a series of new and expanded hospitals around the country. 

Walking around the barrio, I see so many changes that my heart soars with hope: people have houses, the trees we planted so long ago have been growing for nearly twenty years. And yet…

“I’ll be honest with you,” says one woman, standing outside her house where garbage trucks race through gray water mud puddles, headed to the dump around the corner. “There are 15 of us in my house, and we don’t have an outhouse. We just go across the road to the empty lot and go in the bushes. There’s too many of us, we don’t have space to dig a latrine. We need a toilet, we need a sewage connection to get rid of this gray water. We need this road paved for all the garbage trucks throwing up dust and mud.”

The results of the survey were that gray water and sewage were top priority at 62%, lighting/safety came in next at 26% and housing at 11%. Outhouses are most common in Nueva Vida, 59% of houses have one and 5 people use it on average.


If we are dedicated to the holistic health of a community in Nueva Vida, then it looks like we have our work cut out for us. - Becca 

Die With Your Boots On

Mike, with his boots on, working hard at the sesame plant.

“So you’re going to die with your boots on, then?” 

We were talking to a delegation of volunteers in the dorm, many of whom were long-time friends of Mike and Kathleen and Sarah’s, and they’d asked a question that was concerning them: when and how are you going to retire?

Mike had answered, saying that he expected to work until he fell over dead, because “there’s still work to be done, whether or not we’re tired.”

As the one of token young people on our team (just barely 40, thank you very much!), people often ask me about the future of the CDCA – of the work, of our intentional community. Generally, I’ve been content to let things work themselves out as they will, but after Kathleen very nearly did fall over dead two years ago, we got a glimpse of what the work was like without Mike or Kathleen while Sarah, Pat, Kathy and I scrambled to keep things going. Suddenly, I felt the need for a better plan. So late last year I did a thing that everyone in our community dreads: I called a meeting.

Although most of us detest meetings, once we get to the nub of a problem, we are actually very good at opening ourselves up to unconventional solutions. We asked ourselves, “What’s most important to you about the work we are doing?” “What are the hardest things to do?” “Where do you want to be in five years?”

Sometimes our spaces get really, really crowded with volunteers!

When we began to talk about our volunteer program – both long term individual volunteers and short term delegations – we agreed this work is important: it allows us to educate folks from the global north (mostly U.S.) about realities here in Nicaragua, to help them to see their home country in a different light, and potentially sends them back with eyes wide open, ready to make change in their home countries. The potential for transformation of volunteers is exciting, and we believe this work is worth doing. 


The problem is this: working with short-term delegations requires an immense amount of energy and is something that all of us and our staff do ON TOP OF other work. We are not as young as we once were, and we are tired, so we don’t have the energy to do the program justice. We get impatient and grouchy, which is not fair on our volunteers. 

We can put up with LOTS of people constantly in our house...

It seems like volunteers have always been an integral part of our lives and work: from the time the JHC ran shelters in the U.S., to the earliest days of camping out along our house hallway Nicaragua, sharing our bathroom, eating meals on our porch, and throwing down on the work together, we have sometimes eaten, slept and breathed volunteers. Volunteers have built the first, second, and now third clinic buildings, the women’s sewing cooperative, and the spinning plant. They’ve made concrete blocks and slabs, poured floors, and dug countless latrines and miles of trenches to bring water up to El Porvenir. They’ve treated patients, visited them in their homes, pulled teeth, sewn people back together and saved lives.

...But after 40 years of it we start to go crazy! 

Every one of the crazy, wonderful volunteers who has come into our lives over the years deserves our attention, our compassion, our encouragement. 

But increasingly, we find ourselves without the high energy required to work with a volunteer delegation. Speaking just for me, I am pulled in many different directions with work, community and family, and too often where I cut corners, shorten sentences, and am left with little patience, is for volunteers.

Because of this, we’ve decided to make some changes which we hope will be positive for all of us, volunteers and staff alike.

Firstly, Daniel is working with us this year. He is working with our volunteer coordinator to take care of all things related to volunteers, to improve our program – not just the volunteer experience, but tapping into the potential for transformation within our volunteers. Daniel is also doing all the paperwork required for volunteer doctors and donated medicines to come in to the country, meaning that our VC Autumn is free to concentrate her energies on the groups.

The CEPS space is nice...

Secondly, we have found a local organization in Ciudad Sandino with a great physical space – private rooms with en suite baths and real beds! – and we are beginning to host our groups there. This organization, CEPS, is located right between the market and the park, near the police station, which means it’s safe and groups can more easily interact with the local community than they can from our Center.

...REALLY nice!

Groups are staying at CEPS, doing talks there, and eating breakfast and dinner there with Autumn. Lunch is still with us back in our dorm, so we get to see folks, chat and catch up, and answer questions. The physical distance isn’t much, but the difference for us is great: after 23 years, it’s finally possible to have a quiet night off, even if there is a group in-country. 

This week, we’re starting the 3rd step: we’re moving our office into the International Training Facility, aka the Building Formerly Known As The Dorm. While we continue to host long term volunteers upstairs, the bunk room is being turned into an office. The front room will be a meeting area and will continue to be where groups eat lunches. 

The ITF...soon to be transformed!

As we make this change, we’re also planting a living border, a dense row of plants along the backyard between the house and the ITF. The entrance to our new office where all our business will now take place, will be the Industrial Park gate next door. This means that there will now be, we hope, an attractive little crowbar of space to delineate work from home, a little bit of room for us to catch our breath.

We hope these changes will make it possible to transform many, many more lives before we die. Some of us might even slip off our boots occasionally… -- Becca 

A Great Man is Gone - a tribute to Padre Miguel D'Escoto

Padre Miguel D'Escoto Brockmann, a priest of the Maryknoll Missionary Society, died on the 8th of June.  With his death, Nicaragua and the world lost a great man.  Let me tell you just a tiny bit about him.

In January of 1973 and as a response to the displacement of thousands from the massive earthquake that hit Nicaragua the previous December, Padre Miguel formed the Nicaraguan Foundation for Integral Community Development (FUNDECI), a nongovernmental agency, which continues working til this day. 

He and this foundation asked us to come work in the Ciudad Sandino area and surrounding rural communities in 1993.  His staff was wonderful for us in our early years getting us established and pointing us in the right directions.  This giant of a man graciously agreed to serve on our Advisory Board in order for us to "use and abuse" his name for funding sources to do our work and help us with Nicaraguan government bureaucracy.

That is how we got to know Padre Miguel personally, while the world knew him as the leader that he was.  After becoming a priest in the Maryknoll Missionary Society, he practiced the principles of Liberation Theology.  Though born a son to a diplomat of the dictator, Anatasio Somoza, he became a non-violent participant in the revolution to overthrow that dictator and he helped set up a new government to serve the poor.

He was the foreign minister of Nicaragua from 1979-1990 in that newly formed government.  In 1983, he was one of five priests that Pope John Paul II chastised in front of international cameras when the pope visited Nicaragua, because they all worked in the government.  John Paul II then suspended them in 1985. 

Not to be able to celebrate mass deeply wounded Padre Miguel. In August 2014, Pope Francis rescinded that order.  Soon thereafter Padre Miguel joyfully celebrated mass once again.

During his time as foreign minister, the United States supported the contra fighters in the Contra War.  Padre Miguel was a voice for human rights and for sovereignty of the government that replaced the dictatorship of the Somoza family.  He was also a strong voice within government encouraging them to live up to their own goals of the revolution. 

As a strong believer in non-violence.  In 1985, he went on a month long fast  marking the 40th Anniversary of the Hiroshima bombing  to call for the U.S. to stop financing and supporting the terrorist activities of the contras ... many around the world fasted with him.  Soon after in February he led a peace march of 300 km into the war zones, many joined him in the 15 day march with bloodied, blistered feet.

In 1986, Padre Miguel was the brainchild behind Nicaragua successfully winning a case against the United States for their illegal mining of one of Nicaragua's harbors in the World Court...the only time anyone has ever won a case against the U.S.

In 2006 after the Sandinista party won again the majority giving them the presidency and the majority in the Assembly, Padre Miguel was appointed as Nicaragua's ambassador to the United Nations and was elected the UN General Assembly President in Sept 2008 - Sept. 2009. 

He said in a press conference:

     "They elected a priest. And I hope no one is offended if I say that love is what is most needed in this world. And that selfishness is what has gotten us into the terrible quagmire in which the world is sinking, almost irreversibly, unless something big happens. This may sound like a sermon. Well, OK..."

Although he was an international figure, he was an easy person to be around.

He was funny and kind.  He believed in what the Nicaraguan Revolution could have become - if it had been given a chance - and boy! could he tell stories.  

One story he told was revolved around a Danny... about what a good reporter Danny had been; about how Danny would come to his house and they would talk way into the night; about how he didn't know what happened to Danny after he became anchor...[Lightbulb!  He's talking about Dan Rather!]...but his reporting just went downhill after that.

His humility and frankness was refreshing in this world.  His love for this world and his desire that the world become healthy and how we needed to love.  He was a huge voice to stop climate change and end poverty.  We, humanity, could use many, many more Padre Miguels and we will surely miss him.

During the Revolution when a hero fell, his or her name was called and everyone repeated three times Presente! (Present [with us])
                   
                        Padre Miguel D'Escoto Brockmann
                         Presente!  Presente!  Presente!

-Kathleen

Begging for Health Care

It is sad to see fathers and mothers begging for money for their children's medication.   Ten years ago here in Nicaragua, it was almost a daily occurrence; now, rarely.  

What changed? 

The Sandinista government takes the constitutional guarantee of health care for all much more seriously than the previous Nicaraguan governments.   

Today when I sat down to check email, this is what Mike had sent me from Nate Silver's FiveThirtyEight:

Here’s a disturbing stat about the state of medical care access in the United States: A study of GoFundMe crowd sourced fundraising campaigns found that $930 million of $2 billion analyzed was for medical campaigns, or people who had to beg on the internet to pay for medical procedures. [Bloomberg via Ross Baird]

Instead of begging in parking lots, people in the United States are begging on-line. 

Many people who voted for Pres. Trump and the current congressional members did not

know that the Affordable Care Act (ACA) was the same as Obama Care and are losing their coverage.

Even our own son, Joseph, is losing his college's health insurance because of the repeal of the ACA.  The small college used the ACA to insure their students who were not covered elsewhere for a fee.  

When the Supreme Court upheld the Affordable Care Act, The Atlantic published an article about how the U.S. still stood entirely alone in wealthy countries who do not provide universal health care for its citizens.  

Though not on The Atlantic's map, Nicaragua does provide universal health care... such as it is.  Nicaragua provides an insurance plan for people, who are formally employed, and universal care for those who are not enrolled and are by-and-large the most vulnerable...in other words, it has both single payer and universal health care plans.  

photo by Bart Cleary

Unfortunately the wealthy Nicaraguans have access to much higher quality private care that allows them to not bother or invest in the public care which lowers the quality of care the rest of the country.

Good or not-so-good, the reality in Nicaragua is: if a kid is sick in the middle of the night...a parent can then go to the hospital, have a doctor exam the child, either admit the child or send the child home with medicines without ever paying a bill or being harassed later to pay the bill.  

We have had first hand experiences with this: Sarah - and later Joseph - had an allergic reaction with their throats starting to tingle, they received care without paying a dime. 

No one should ever have to beg for health care.  No one.

-Kathleen

Un-American

Sometimes one has these days…you know the type…when you feel exhausted and just plain weary and then when walking from one place to another, God’s own bird drops its waste in your hair and on your clean shirt.  Sigh.

Most of my weariness today comes from once again being called anti-American, which I just don't get.  Here are some questions for you, the reader, to ponder…

1. If citizens from Belgium, France, Norway, Italy, et al, call themselves Europeans…AND if citizens of India, China, Japan, et al, call themselves Asian…AND if citizens of Uganda, Egypt, South Africa, et al, call themselves Africans…THEN why is it that most citizens of the United States of America think that they - and only they - are Americans?  
2. To put it another way, how can I be “Anti-American” when I point out to college students that the country where I am a citizen (the U.S. of A.) has supported regimes and a terrorist war in the past and is now plotting to block international loans for social programs in the country where I now live (Nicaragua)…WHEN both countries are part of the continent of North America?  I have been accused of being anti-American since the 1980s when I learned about the history of Nicaragua and came to Nicaragua while the country was being terrorized by U.S.-funded rebels.  Accused publicly in newspapers!
   
3. WHEN did criticisms of one’s own national agendas become unpatriotic?  Occasionally, I have  happened upon a clip of Fox News blasting Pres. Obama ad nauseum, but I personally never heard the network called unpatriotic.
4. And lastly…why are these things considered  unpatriotic by many?...

a.       having a global awareness,

b.       having an awareness of the suffering of others (including homeless vets),

c.      understanding how empires and international corporations use people of color, and

d.       having an awareness that most places of power protect the people in power, not those living in poverty.

Are we so blinded by the stars and stripes that we cannot question and call for our own nation to be better than it is? 

“But look at all the good things the U.S. does,”  people say.  

Many U.S. citizens treat their government like a child…one that has to be protected at all costs even ignoring their own faith, let alone someone else’s faith; one that has to be coddled “France was mean to us so we are now going to call fried potatoes freedom fries;” one that has to be reassured constantly and never challenged....

The U.S. is over 200 years old…I know, I was there for its 200^th birthday watching blurry fireworks because of the tears in my eyes.  200 plus years would lead one to think that the U.S. is in its "adult stage."  

Demanding that we as a nation be more just, work for peace, strive to care for the most vulnerable and  be respectful of all its citizens as well as other sovereign nations of the world is not going to break a fragile persona, but it will make us better and stronger.

Maybe I'm stupid, but I just don’t get how feeling that way is "anti-American."

-Kathleen

What is Normal?

I watched Real Time with Bill Mahr last night and one of the comments was “how do you feel with two weeks of basically ‘normal’ news?”  Normal? 

In Afghanistan on April 13^th, the U.S. dropped the largest conventional bomb ever!  How can that be normal?  That is horrifying!

Afghani farmers seeing the blast thought it was a nuclear explosion and worried about radiation.

On April 12^th, Pres. Trump announced that he was sending an armada as a warning to North Korea (turns out the armada was going in the opposite direction).  Recently North Korea is threatening to sink the armada…

None of this is normal. 

It is frightening.  I have two sons still within the age of a draft.  I have children, grandchildren, mother, brother, nieces, nephews, and friends that I cherish dearly living in the States.  War…stupid, dangerous war... seems more immanent. 

The Doomsday Clock, set by the Society of Atomic Scientists, is set at its lowest since 1953…two and a half minutes to midnight.  It was moved the last 30 seconds when Pres. Trump took office, because of his comments on nuclear weapons.  This clock is the representation by atomic scientists of how close we as humans are to global destruction.  Add to the above…

Now the U.S. is saying that Nicaragua is basically getting into bed with the Russians…

therefore, the U.S. should block loans and threaten this country as the U.S. has done in the past.  Nicaragua is once again going to be a pawn in the game of chess that the U.S. and Russia (in the past U.S.S.R.) has been playing for decades. 

In 1983, a Canadian song-writer, Bruce Cockburn, wrote The Trouble is It Always Gets Worse.

Strikes across the frontier and strikes for higher wage
Planet lurches to the right as ideologies engage
Suddenly it's repression, moratorium on rights
What did they think the politics of panic would invite?
Person in the street shrugs -- "Security comes first"
But the trouble with normal is it always gets worse
But the trouble with normal is it always gets worse

Callous men in business costume speak computerese
Play pinball with the Third World trying to keep it on its knees
Their single crop starvation plans put sugar in your tea
And the local Third World's kept on reservations you don't see
"It'll all go back to normal if we put our nation first"
But the trouble with normal is it always gets worse
But the trouble with normal is it always gets worse

Time for the abnormal.

-Kathleen

Three Year Reprieve

In the late fall of 1999 I was living in a house of women who were seniors in college. One day a housemate came home and announced that we were now close enough to graduation that if any of us got pregnant, we would still be able to graduate college before the baby would be born. The relief in our household was palpable. Up to that point, I’m not sure I’d realized the extent to which I’d been holding my breath, determined to carry out my life plan, which did not involve having a baby before I’d finished school and gotten a start in life.

Maybe it’s that sharp feeling of reprieve that made the work I did last week so satisfying.

I was translating for a volunteer gynecologist as she taught our Clinic staff how to place birth control implants. The implants are tiny – they’re placed underneath the layer of skin and on top of the layer of fat inside the inner arm. They release a low dose of progesterone, preventing pregnancy…

…For three years.

Three years…long enough to get through high school, or maybe college. Long enough for a new mother to nurture her baby safely into toddlerhood. Long enough for a harried mom to concentrate on raising her kids. And maybe then get another implant.

I’ve got no idea if boys and men feel the same anxiety about unwanted pregnancy, but I know that women are rarely out from the shadow of it. In fact, I’d be willing to bet that most of us start getting anxious about being pregnant before we’re even sexually active.

Maybe that’s why I’m so excited about these implants. Or maybe it’s working with teenage girls, knowing that no matter how accessible birth control is for adult women, for a teenager it can feel like there is a long, wide river of mortification between you and condoms or pills or monthly injections.  Just getting what you need can feel insurmountable when embarrassment looms large.

So what if you could place a tiny tube in your arm that no one would ever have to see? What if it meant you knew you couldn’t get pregnant for three years? What if you could concentrate on finishing high school without having to wait anxiously for your period each month?

So last week gynecologist Emily Parent, a Bucknell University alumnus who first became interested in medicine when she came to

Nicaragua on their Brigade, brought an implant placement training kit and I translated while she taught nurse Isamar and doctors Jorge and Elizabeth to place them. All week, patients kept walking into the exam room and saying, “I want the implant.” 

“Have you heard about what it does and how it works?” Emily would ask.

“I’ve heard it goes in your arm and lasts for three years and I want it.”

In two days, they placed the 20 implants we’d raised money for – each one takes about 5 minutes total. They put them in for young women with no kids yet, a teenager with a newborn, a nineteen year old with four kids, a mom of seven. 

Now word has gotten out about the implants and our health promoter Jessenia says she can’t go out into the community without being accosted by women asking for the implant – she’s now got a waiting list as long as her arm. Thanks to those giving online and the continued fundraising of Emily and others, we have 10 more implants ready to be placed, and hope to have 15 more before the week is out, but we’re far from done yet. 

Currently we are sourcing them from an organization that is selling them to us for $45 each. To help cover the cost of local anesthetic and lab tests (routine pregnancy, HIV and STI screening), we are asking folks to donate $50 to place one implant. Three years…long enough for a young woman to get her high school diploma…and you can help make it possible. 

To donate, Click here and mark your donation for Health care “birth control implant.”

Thank you! – Becca 

Reflections Before Going Under the Knife

Today I'm having surgery...to repair my hernias that developed from the splenectomy I had in 2015. Although I will be under general anesthesia and cannot have laparoscopic surgery, everyone assures me it will be easy peasy..no worries.

But I am worried.  It is not logical, but the fear resides in my gut and I know that fear comes from the last time I was in the hospital... when I almost died; when I was in ICU for nine days; when I lost so much brain function.  And THEN..even though I know in my head that the following events of my dad's and brother's deaths and my mother surviving 3 very damaging strokes were not a result of my hospital stay, I am afraid.


When I get afraid or depressed, let me tell you I can wallow in it with the best of 'em.  I can lay awake at night and imagine the worst, but when I can look around me it is my fear and sadness that help me begin to touch the pain and horrors of those who walk through our clinic doors.

From my 2015  trauma and now resulting fear, I can just begin to understand how people live in dread of their own future.    

• Parents afraid to die because who would feed their children? 
• The constant waiting for the other shoe to drop.  
• The guilt and shame of feeling stuck and not able to move and do what needs to be done.
• The feeling of hopelessness.
• The stress...the constant stress of not being able to provide for one's family.
• The physical aches and pains that come from grief, trauma, and poverty.

We, who have what we need, cannot understand what it is like to not have what one needs to prevent suffering.  And because we cannot understand,  we minimize the pain and suffering of others.

There is another way though...we could end the suffering over which we have control.  

There need not be any person on this earth who lives in poverty.  Our world has plenty, we just have to share. 

There need not be any person on this earth who lives with war.  We as humans can learn to negotiate and put our resources to peace not weapons.

There need not be any person on this earth who lives the results of others  raping this planet. We as humans are brilliant and can work for different solutions to the crisis of climate change.

In today's time, many of us think that we as the human race are racing backwards in time, but we must not resign ourselves to that fate of destruction, hate, and death.

I will not choose that fate, instead  I choose to end suffering; I choose life; I choose love.

What will you choose?

-Kathleen

photo by Greg Ewart