Newton-San Juan del Sur Sister City Project

Cebadilla Kids with Cameras

by Jessica Chermayeff

I arrived in San Juan del Sur in early May 2005 and began teaching my six-week photography course at a brand new one-room schoolhouse in rural Cebadilla, built by the Sister City Project. The children’s homes do not have running water and few have electricity. I had enough Polaroid cameras and supplies for seven students and amazingly exactly seven hands shot up.

The next day I started meeting with Lievis, Guadalupe, Nieve Maria, Fatima, Erika, Yader and Norlan twice a week for the six weeks. The oldest was twelve. I soon realized that my ideas and high expectations needed to be altered. The children exploded with enthusiasm and curiosity but when directly asked for their input, “Do you like this image better or worse than this?” they responded with lost looks of embarrassment masked in nervous giggles. They were capable of imaginative thought and numerical estimates, but they lacked the confidence to give their opinions or execute the guidelines about lighting, composition, etc. My goals for the class were redirected to simply giving them more self-confidence. I can say with pride that I think we achieved that goal even if momentarily.

The assignments began with photographing inanimate objects. For several assignments I forbade their photographing people in an effort to prevent them from taking repetitive snapshots. They could include people but only without their faces.

For me (and I think for the students) the best class was the day of our field trip to San Juan. They were now ready for taking portraits. I told them they needed at least two photos of strangers. While they were very excited they became increasingly nervous. To ease the tension I explained our intentions to the market vendors and asked if Guadalupe, the youngest (seven years old), could take a portrait. Guadalupe nervously but skillfully produced a simple headshot of the woman selling limes. The vendor gasped and began to show all the other women “the beautiful picture this girl made of me.” From that moment, my students began to approach other eager volunteers who all realized with disbelief that “those kids could make pictures.”

We also spent time writing. While they often complained bitterly about this, throughout the weeks the level of opinion required for each assignment increased. They worked up towards writing about what they liked and did not like about their communities, and what they wanted to be when they grew up (two wrote they wanted to be photographers). For our final project each student wrote a short story based on their dreams and then illustrated the story with photographs. We mounted the series on poster boards and the Youth Center in San Juan displayed their work.
For all the things I taught them they taught me just as much. While I learned techniques for teaching I learned to be a better student; and while teaching, I learned how to take better photos–to let go of the technicalities and to focus on ideas and emotions. I am very grateful for the opportunity to work with this wonderful group of kids and also for a chance to explore some of the multitude of ways I might be able to use photography to benefit other people.

Jessica’s students at a 2010 exhibit of their photographs in San Juan. To see a slideshow of the opening of the exhibit click here.

Jessica Chermayeff works as an assistant curator in an art museum in L.A.

Work at Community Medical Services in San Juan

by Rachel Ross

My time at the San Juan clinic of Community Medical Services was the single largest contributing factor to my decision to work in public health.

My friends Rachel and Leah and I arrived in San Juan del Sur for the first time just as the sun was setting. As we watched it dip dramatically beneath the horizon, none of us had any idea at that moment that San Juan and the people who lived there would change the course of our lives both professionally and personally.

At Community Medical Services, where we had volunteered for the duration of our stay in San Juan, director Rosa Elena Bello sat us down on our first day and in very rapid Spanish announced that because there were two Rachels, one of us would be called Raquelita Chiquita, and the other would be known from there on out as Raquelita Grande. Six years later, I am still “little Rachel little” and the other Rachel remains “little Rachel big”.

The next three months were filled with long days at the clinic where we helped in the pharmacy, taught (only somewhat successfully) sex education classes to community teenagers and (somewhat more successfully) English to community members of all ages.

We also spent hours on Rosa Elena’s home computer formatting a workbook that had been developed for the second-year students in the adult literacy program. And we helped a group of optometrists who had come to give free eye exams to the San Juan community.

Rosa Elena and her assistants–Teresita, Patricia, and Maria Eugenia–and as well as their families were our constant companions and teachers. They explained Nicaraguan history and culture to us (often multiple times as our ears slowly acclimated to the Nica accents and colloquialisms) as well as the many health and educational challenges facing the poor, primarily rural, population they were serving.

By the time we boarded a bus that would take us to Costa Rica and the next chapter of our adventure, our Spanish had improved ten-fold, we were deeply tanned, and we had an entirely new understanding of the way that medical care, education, and housing conditions affected people’s health. The people who had taught us those things were among the kindest, most generous, determined and intelligent we had ever met, and we were sadder than we expected to say goodbye to them. I have returned several times over the subsequent years to continue to work at the clinic, and to do research on the Nicaraguan health care system.

Three years after that first visit, I sat down at my computer in Oakland, California and tried to articulate why I wanted a Masters in Public Health to the admissions committees of the best Schools of Public Health in the country. I explained that before going to Nicaragua, I’d thought that I wanted my contribution to the world to be as a teacher. Since living and working there, however I’d realized that working on issues pertaining to population health, and understanding the policies and infrastructure that were necessary to improving health among poor populations was what I wanted to do, My me at the San Juan clinic was the single largest contributing factor to my decision to work in public health. The choice seems such a clear one now that I can’t imagine what my life would be like had Rachel, Leah and I not shown up at Rosa Elena’s doorstep sweating through our tank tops, stumbling over that ever elusive Spanish “rr”, wanting desperately to contribute somehow to the work she and her staff were doing.

When I received my MPH in May 2005, I owed a debt of gratitude to many people. At the top of that list is Rosa Elena Bello, the women at CMS, and the whole San Juan community. I think the only way I can possibly reay them is to continue the work that began with them: to increase justice and equality through a commitment to health and education. And to do it with passion, dedication, and a full, open heart.

Rachel Ross works for Partners in Health in South America.

It All Started with Weighing Babies. . .

by Jason Schweitzer

In the winter after my high school graduation I went from Cambridge, Massachusetts to San Juan. Under the auspices of the Sister City Project I prearranged room, board, and a position teaching English at the local high school.

The tattered local economy was fairing slightly better than the national economy, as fishing and tourism boosted the regional income. The beach strip, lined with open-air restaurants and lodged between two rocky cliffs, provides a center for commercial activities. Luxurious houses line the strip of beach, nestled under the cliffs and behind stone walls. The paved streets run inland, slope upwards, and turn into dirt roads that lead to the neighborhoods and rural areas where the majority of people in the San Juan region live.

The sharp stratification of wealth is clear. The luxury of the beachfront houses rivals Miami Beach mansions, yet the economic condition of the town as a whole is astoundingly poor. I learned this firsthand when, after a strike in the Ministry of Education at the national level, I began working with the local health center to take part in rural and urban public-health programs. As a part of the rural team, I visited more than 30 villages in the San Juan region. While we never traveled further than ten miles, we often spent four or five hours walking, hiking and traversing muddy bodies of water to reach the villages in the dry forest.

Our work consisted of weighing babies, taking vaccination histories, vaccinating women and children, providing medical supplies, and offering an opportunity for rural people to consult with a doctor in their village (as opposed to having to travel a day to the Health Center). I had the privilege of meeting, talking, and working with people from each of the rural villages we visited. The experience was overwhelming. While learning Spanish, processing Nicaraguan sayings and speaking styles, and driving through an unbelievably beautiful and different countryside, I was part of a national effort to improve health outcomes of people who suffered dearly from basic problems arising from lack of public health: dirty water, lack of health education, poor sanitation, dependence on livestock.

My daily routine was so intense that I had little time to question what was happening to me and how I was growing. I was experiencing cultural immersion. Yet unlike the anthropologist who works to balance his or her thought between experience and analysis, I put little effort into considering my role as a foreigner in a town immersed in political strife and differing ideologies of activism. My social life further complicated the issue. I was caught up in learning new idioms, figuring out a new body language, and having fun.

It was only later that I assessed how I grew and how my experience affected my course in life. San Juan molded my college experience (Brandeis, ’99) by provoking me to consider the inner workings of culture, and by reminding me of a social context in which people work pragmatically to improve the welfare of people in need. My academic endeavors in anthropology, my current work in public health and service, and knowledge of the Spanish language and Latino culture find their roots in San Juan del Sur. Beyond that, I can say only that it was the most fun and exciting six months of my life.

Examining Parasitic Re-Infection Cycles in Rural Nicaraguan Villages

by Abraar Karan

Abraar Karan graduated from Yale University in 2011 and is applying to medical schools. You can contact him at abraar.karan@gmail.com and follow his blog at abraark.wordpress.com

I worked for Newton-San Juan del Sur in June-August of 2009 as a research fellow after my sophomore year. I initially contacted Vice President David Gullette with the interest of exploring parasitic re-infection cycles, a problem that I had encountered in the Dominican Republic and India previously. In Nicaragua, this problem was present in villages that had introduced BioSand water filters a few years earlier. My research aimed at understanding both the traditional Knowledge, Attitudes, and Practices (KAP) surrounding parasitic infections/hygiene as well as the particular cultural and developmental factors that may facilitate re-infection. The main parasites affecting the community included Giardia Lamblia, Entamoeba Histolytica, and Ascaris Lumbricoides.

I worked with Fidel Pavon, the on-site coordinator for Newton-San Juan and together, we rode on his two-seater motorcycle through dirt roads encompassed by the foliage of tropical jungle to reach small communities nestled away in the hills surrounding San Juan del Sur. Most rides were unbelievably serene and bucolic—untouched and preserved stretches of land provided the background as we zoomed from village to village. At first, I conducted open-ended key informant interviews with several mothers of school age children to understand the hygiene habits of the youth as well as the general community perception of parasites.  From these and from the extensive literature on parasitic transmission cycles, I developed a 47 item questionnaire that assessed the traditional KAP as well as aspects of culture and development. The research study questionnaire was administered in 10 different communities with the help of students who carried out several interviews in their communities. In total, 213 interviews were conducted. The results showed many interesting relationships between KAP, culture, and development. The manuscript of the study is under review for publication (link to be updated soon).

In addition, I organized several health education workshops using Spanish-translated materials I acquired from the WHO. I conducted informational sessions with groups of community health workers (over 40 in total by the end) and taught workshops on how to improve hygiene in communities, particularly aimed at reducing risk of reinfection. Moreover, I taught this workshop in over 10 elementary schools in the communities surrounding San Juan del Sur. Lastly, I held a workshop for several traditional healers to comment on ways to improve treatment of parasites in conjunction with clinical medicine. Many of the remedies used by curanderos (traditional healers) shared the chemical properties of anthelmintic drugs.

Lastly, I found extra time to volunteer at the San Juan del Sur Biblioteca (library) to teach elementary English to a group of young children.

ABRAAR KARAN (R) WITH MEMBERS OF THE BIOSAND FILTER/ANTI-PARASITE TEAM

My experience working with Newton-San Juan del Sur was particularly meaningful because of the changes that my research effected. Some of these include a new initiative to procure shoes for the many barefoot children who are susceptible to hookworm infections. Additionally, the dirt floors are going to be replaced with Compressed Earthen Blocks to alleviate the uncleanly interior of most houses. The lack of developed water systems is also being addressed through work with the Mayor’s Office, namely in installing new wells and piston pumps to transport the water. Oversight of proper filter usage is also being addressed, as well as improved collaboration with the brigadistas (community health workers). The contamination of wells by the pit latrines through cross-water flow, one suspected source of infection that my study identified, is being addressed via the introduction of new Composting Toilets. Additionally, educational materials are not only being introduced but some of the more gruesome images revealing possible outcomes of parasitic infections are also being displayed to attract attention.

My experience working in San Juan del Sur Sister was remarkable for it changed my perspective on the ability of a single project and idea to have such a large impact on institutional changes within the functional systems of NGOs and other groups involved in global health work. The villages are in a stark dichotomy with the budding tourist town of San Juan and the people are truly amazing to work with. They would appreciate you to become a part of their community as I was able to do during my time. I hope to return and continue working on issues of medicine in public health with the community in the future.

 Teaching and Latin-American soap operas

by Lukas Pattis

Lukas Pattis came from Vienna, Austria to teach computer skills in the Computer Lab with Darling Mercado in the spring of 2010.  The Lab is open from 9 A.M. to noon and from 2 to 7 PM. Computer courses are mandatory for those in Accounting and Tourism.  He taught English as well.

“I did a lot of work  over the semester.  Darling does a great job. We did the preparation and the classes together as there were really many students in those mandatory classes. When there was no mandatory class, students were free to come whenever they had time to practice and do their homework. I tried to help with the homework and there was always time for a chat with the students. In addition, Darling organized voluntary classes for whoever was interested. These classes were usually small (2-6 students) and it was really great to teach in a more interactive way which only works in small groups.

Lukas in the classroom

There were a few problems (apart form me having to get used to Nicaraguan culture / sense of punctuality). Some were technical (different operating sistems / versions of software etc.). As far as possible I tried to fix that by reinstalling some of the computers. We also connected the computers to a network in order to make it easy to exchange data for practising. In my opinion students spent way to much time on copying (manually) the stuff they needed to practice.

As far as learning computers are concerned, the problem of most students is that they have little to no access to computers outside the FHS’s pc lab. There are many interested in the voluntary courses – especially the computer classes. Unfortunaltely motivations drops when the topics get harder and more practicing is needed. Especially in the voluntary English classes (I took over those classes since no native speaker was available at the moment), motivation seems to be quite low. So the job was sometimes 50% teacher, 50% motivational coach. Apart from that we only experienced some infrastractural problems –water dripping through the roof when it started to rain heavily.

It was an awesome experience. I learned a lot and I also think I was able to pass a lot of my knowledge on to the people here. Life was great there. For my last weeks I lived with a family in order to improve my Spanish and my knowledge of Latin-American soap operas. I must say I really enjoyed it.

Liz Goggin

English as a Second Language

Liz Goggin, Brady Francisco-Fitzmaurice, and Margaret Gullette: Liz and Brady taught ESL in 2010.