July 2006
Santa Ester Martinez almost died in my pickup last week. One more young mother who almost was added to the statistics of those who died in childbirth. Where does that story begin? Or end?
For me it began about 6:00 one morning, as I was enjoying a cup of coffee in a home about a mile up the road—if it can be called a road—above the community of Maleconcito. I looked up to see two men carrying a long pole with a hammock strung between them. They were accompanied by several other men who were ready to take someone’s place if those carrying got tired. They were bringing Santa Ester to the Ministry of Health (MINSA) post in Maleconcito.
For the young men who were carrying, it began about an hour and a half earlier when a local midwife awoke the chair of the CEPAD-trained Community Development Committee asking for help to carry Santa Ester down the mountain to the health post. By the time he and the men he gathered passed the house where I was staying, they had already carried her for more than an hour, slipping and sliding over wet rocks, through several rain-swollen streams, and in deep mud. Their open rubber (flip-flop) sandals were coated with mud, along with their feet, ankles and the lower part of their pants. But they kept on walking.
I quickly brought out the pickup. Santa Ester's husband helped her inside and sat with her, while all of the neighboring men jumped into the back of the pickup in case they were needed again. We arrived at the health post well before the normal opening time of 8:00 a.m., but one of the local people knew where the staff lives, and we went there. The “doctor” (more like a nurse-practitioner) came back to the health post with us, where he examined Santa Ester and started an IV. He came out and said that she needed to go to the nearest hospital in Wiwili. This is only eight kilometers, but well over a half-hour ride on such a terrible rained-out road.
For Santa Ester, it began about 9:00 p.m. the night before, when she went into labor at seven and one-half months. She was already worried because she had not felt the baby move much in the past week. After losing a lot of blood, the midwife began waking up the neighbors and organizing the men to carry her to the doctor.
For me it ended when I got back to Maleconcito and cleaned up the blood on the seat of the pickup. For the men who had carried her, it ended when they got back up the hill to their homes. But for Santa Ester it didn’t end that easily.
The hospital in Wiwili declared that she was not able to deliver the baby and needed a Caesarian Section. This required surgical skills and equipment that no one in a tiny hospital like Wiwili has. So she went for another bone-jarring ride for four hours to Jinotega, where the surgery was performed and she was left in very serious condition.
Thanks be to God, to the midwife who called for help, and to the men of this organized community who carried her for so long. It finally ended for Santa Ester—and the longer task of raising her first child began—when she brought her baby home three weeks later, after a difficult operation and a long struggle.
But for Nicaragua the story is an old one, and it doesn’t end here. Serious lack of trained medical personnel in rural areas combines with terrible roads and lack of transportation to produce thousands of young women like Santa Ester each year. Doctors in the MINSA public health system recently settled a strike that raised their $150 per month salaries to $175 per month. Because of such a low salary, doctors want to work in urban areas where they can work part-time for MINSA, and part-time in their private practice. Therefore, rural health posts like Maleconcito are staffed by nurses who function as doctors, and small town hospitals like Wiwili have a few doctors, but no one capable of doing this kind of surgery.
All of these figures add up to an alarming rate of infant mortality. In Nicaragua, 32 babies out of 1,000 die before reaching their first birthday. This compares with 9 per 1,000 in neighboring Costa Rica and 7 per 1,000 in the United States. Also 250 out of every 100,000 mothers die in childbirth each year (compared with 12 per 100,000 in the United States.) Without the help of organized neighbors and an experienced midwife, Santa Ester would have been one of the 250, and her child one of the 32.
So where does it end? It can only end with a more just and equitable society. All of the short-term mission groups with which I work, and all of the thousands of other groups which come to Nicaragua will never be able to end it with week-long medical clinics. The difference between 32 babies per 1,000 in Nicaragua and 9 babies per 1,000 in Costa Rica is a difference of many years of political choices. For centuries, forces from outside of Nicaragua, including from the United States, and forces from within Nicaragua, including many of the wealthiest families, have made shortsighted political decisions that have enriched a few and impoverished many. Santa Ester is one of the many. How many of us will work long-term to build the more just and equitable society in which men won't have to carry pregnant women for miles in a hammock to save their lives?
As I prepare to leave Nicaragua to return to the United States for several months of speaking in churches, I will carry the memory of Santa Ester and of the men who carried her with me. I will also carry with me the joy at being permitted the opportunity to play a small part in the story.
I will return to Nicaragua in January 2007. At present, because of the shortage of mission funds, I have been reappointed for only 18 months instead of the full 3-year term for which I had hoped. Please pray and give so that the mission budget of the PC(USA) may be strengthened, and the needed mission co-workers can continue their service.
Doug
The 2006 Mission Yearbook for Prayer & Study, p. 57 |
