Thursday, June 13, 2013

Creole, Mestizo, or Miskito? by Tina Romenesko

Creole, Mestizo, or Miskito? by Tina Romenesko

Carol opened our PINCC group meeting by exclaiming " This is the dampest PINCC first days we have ever experienced!"  The rain here comes and goes - one minute the sun is shining and the next the sky has opened up and it is raining gatos y perros.  We were without electricity for a full clinic day and for parts of the other three days which means no fans, no air conditioning, no lights, no computer back up.  You don't realize how much you depend on electricity until you don't have it!  

"Because this is a first visit - we all walked in completely cold," Carol reminded us.  We didn't have any idea what conditions would be, how the rooms would be set up, or even how much support the clinic could offer us.  The consensus is that it has been a very good couple of first days.  The trainees are beginning at ground zero as VIAA is a completely new technique to this area - so they are brand new to the idea, as are the patients.  PINCC's main mission is to train these doctors and nurses to replace the need for return visits, which usually takes a few years and lots of training and patience from the U.S. clinicians.  The day starts and ends with classroom time - combining study (lecture, slides, etc)  and hands-on experience.  VIAA, or Visual Inspection with Acetic Acid (or vinegar)  and immediate removal of lesions with cryo (freezing) or LEEP (electrical current) allows women to be evaluated and treated in the same day, a big advantage when patients travel long distances to be seen.  On day three, women traveled from the neighboring communities of Orinoco and Tasbapounie, spending one to two hours by panga (boat) through driving rain, to get treatment.  Most spoke predominantly Creole, a few spoke only Spanish, and we BOTH had a hard time understanding each other in interviews!!  

The support team spends a lot of time educating women in hallways and private rooms to help them understand the procedure they will be receiving, what we can evaluate, and what we cannnot do.

This part of Nicaragua was never conquered by the Spanish and therefore is unique in its ethnic and racial composition.  The population is mostly Creole, but also includes the indigenous ethnic group Miskito (nothing to do with the Spanish word "mosquito" which comes from "mosca") as well as the ubiquitous Mestizos that are a combination of many races, colors, and creeds and speak predominantly Spanish.  This diversity makes communication challenging here on many levels.  

I begin each intake asking the patient her name, figuring out how to say it correctly, and then holding her hand as I share my name and a smile.  I emphasize that clear communication is key and that it is important for us to be sure the answers are accurate.  Smiles and gestures are always helpful, like the one that seems to be universal for vaginal births - a sweeping energy with the back of the hand, down and out of the pelvic bowl!  I continue to do orientations with women that have a history of abuse and am keeping a running journal of the case histories, including only their age, ethnicity, and story.  No names.  Confidentiality is a big deal here.  Carol wants me to keep a data sheet so the director of the clinic can make a case for the need for support groups and psychological counseling for women that have been victims of rape, physical abuse, and sexual abuse.  I stress how important it is for women to support women.  "Find a good girlfriend,"  I counseled a young 20 year old mother who was feeling alone and disempowered.  "Changing your life alone is really difficult - but with the support of friends, it's always more hopeful."  This young woman found me as she was leaving - her VIAA was clear, and she and her one year old son gave me big hugs before they left.  " Girlfriends," I whispered in her ear.  She kissed me on the cheek and said she'd try.  

A troubling percentage of women admitted to being victims of domestic violence, sexual assault, or rape.  One admitted that she will not get into another relationship because she has 4 daughters and doesn't trust men, and based on her experience; she wants to protect their safety.

Each clinic day is dedicated to a different area, plus overflow from Pearl Lagoon and Haulover, the main pueblos in the area.  Day four included women from Kukra Hill, of which many were Spanish speakers, or Mestizos.  They seemed very relieved when we offered them the option of English or Spanish.  When the bus showed up - it was a sea of women that seemed overwhelming until we realized that half of them were here for ultrasounds and the other half for VIAA.  Whew.  

Tomorrow is dedicated to the Miskito women from Raitipura which is only about 10 minutes from Pearl Lagoon and will offer its own challenges in language and culture.  It will also be the day to see any local women that we were unable to see during the week and employees of the clinic.

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