My STEP Signature Project was a 17 day BUCK-I-SERV study abroad trip to the city of Managua and a rural community of Tapasle in Nicaragua. Our BUCK-I-SERV team stayed at a nonprofit organization called AMOS. During this experience, I was introduced to community-based primary health care which means that a nonprofit organization or institutions will identify and combine strengths of impoverished communities in an empowering way. The first week was to understand and comprehend the idea of a community-based primary health care in a rural low resource community. The second week was to travel to the rural community of Tapasle and work with the AMOS rural health team to gather information and use it to develop or support a community-driven action project that will benefit the community in the future. The third week was to gain a better understanding of the different factors that are involved with the decision making in rural health care.

What about your understanding of yourself, your assumptions, or your view of the world changed/transformed while completing your STEP Signature Project?

Throughout this experience, my understanding of myself changed. Before this trip, I was blind to the hardship and difficulties of communities who have low-access to resources. I created a screen of ignorance where I assumed that the world was alright and people were living their lives with enough resources to survive. When I signed up for this BUCK-I-SERV trip, I thought that I was only going to learn about the differences of the public health system from Nicaragua and the United States. However, that was not the case. When I arrived in Nicaragua, it was a different experience than what I assumed. For the first time, I experienced what it felt like to be an outsider. Our BUCK-I-SERV group was stared at since we looked different from Nicaraguans. It was also difficult to understand the natives since they only spoke Spanish.

While driving to the AMOS campus, I discovered their city was different from ours. They didn’t have skyscrapers and tall buildings. The buildings they had were rundown and the shops were small and family owned. In the rural community of Tapasle, the houses were made of clay and the floors of dirt. Not many people had cars so the roads were rock paths and most of their houses took a half hour to an hour to walk to. The Tapasle community had latrines as bathrooms and their water was unsanitary. This is where I discovered that I was privileged. I became grateful that I didn’t have to worry about my water being contaminated and where my next meal was coming from. I am now thankful that I can drive to a grocery store and have air conditioning. I realize I have plenty of resources to stay healthy and I have access to medical care and physicians when I am sick. The community of Tapasle may wait for days or weeks for the physician to come to their community. My assumptions of Nicaragua were semi accurate. While most of Nicaragua cities I visited were impoverished, there were cities that had many resources and access to these resources. These cities are the places where there is tourism. I then had the realization that these cities had historic beautiful cathedrals and buildings, with paved sidewalks.  While visiting different cities in Nicaragua, it opened my eyes to the hardships of people who do not have access to the same resources as me. Even though this was the case, these people where a lot happier than most. They were willing to help in any way that they could to improve their community. The people in the rural community were grateful that we were helping them through their hardship and were grateful that we were there to help achieve their goals.

Granada Cathedral

an outside kitchen in the rural community of Tapasle

Tapasle, Nicaragua

What events, interactions, relationships, or activities during your STEP Signature Project led to the change/transformation that you discussed in #2, and how did those affect you?

My view of the world changed when visiting Nicaragua. Since I was immersed in their culture, I viewed different traditions from people I was in contact with. This created an understanding of their way of life and how it is different from the United States. I learned about their values and traditions by reading and living the life of the native people in a rural setting. Even though I had little knowledge of speaking Spanish, I developed relationships with Nicaraguans and asked many questions about their lives. Throughout the trip, I submerged myself in their culture by eating native food to the country. They eat rice and beans for every meal. I discovered Nicaraguans like to salt their food and their ice cream is creamier than ours. Also, chicken and beef are the main meats that are available and homemade tortillas are way different than those bought at a store. Creating bonds with people and immersing myself in their food was one way to I learned about their culture.

Another way my view of the world changed while visiting Nicaragua was reading about their politics and having all my professors coming from Nicaragua. I learned first-hand how they grew up and listened to all of the stories they had to share. I discovered their neoliberal policies and how the MDG is progressing in Nicaragua. I also learned about how the sustainable development goals created by the United Nations effect Nicaragua and how the United States influences the economics of their country. During these classes, I learned about the history of how Nicaragua came to be and how religion wars, and different countries affected their country. When I traveled to the rural community, I discovered that Nicaraguans pile into buses and cars for transportation. Some even sit on the roof of buses if there is not enough room. They burn their garbage and they do not put toilet paper in the toilet because their plumbing is not updated. While watching the news, I noticed that they do not sensor the images. They show the deaths of humans in gruesome ways. While in the rural community, most of the people had dirt floors and no plumbing what-so-ever. They took bucket showers and gathered water from a river. They also had one floor houses where animals roam freely. Their family size was usually seven or greater due to an abundance of children and grandparents living together. Most of the native people in the rural community were not educated and didn’t know how to read. I also discovered their school system was poor and children go in and out of the classrooms freely. While visiting Nicaragua I realized how much different my culture is to theirs. I can now appreciate everything that is provided for me and how the United States created a foundation full of opportunities and resources.

Throughout the trip to Nicaragua, I learned about the ideas and practices of public health. The first day of class, I was introduced to the idea of critical theory and power and privilege. I also learned about the socialization process and how single stories and stereotypes affect a person and a country as a whole. Throughout the rest of the week, I learned about the importance of community empowerment and how people feel powerless in different situations. I also discovered how to empower others and the community by using the SHOWeD method and I now understand the creation and formalization of community-based primary health care and the health care’s strengths and weaknesses. I learned about AMOS’s principles and activities to creating an empowerment environment to the communities that reach out them and the importance of community-based participatory research. Before traveling to the rural community, I learned about the numerous steps that AMOS uses to work with communities on nutrition and clean water intervention. While in Tapasle, I participated in research. I traveled house to house and talked to the people living in the rural community about the importance of clean water and Zika. I collected data about their latrines, the animals they had, and stagnant water, and how their house was set up. I emphasized the importance of water filtration and checked to see if their water was clean. One day during my stay in the rural community, we had women and children under 5 come into the clinic. We checked their height and weight, if they were anemic, and if they had enough vitamins. Towards the end of my stay in Tapasle, we gathered all the information and held a meeting where we explained how well their community is doing as a whole and what they can do to improve it.

During the last week of my stay, I reflected on my stay at the compo in the rural community and connect the themes we talked about the previous week including the idea of cultural humility, power and privilege, and the strengths and weaknesses of faith based organizations in the health care provision. I also learned about the power of Photovoice and how it is connected to the social ecological logic model of health. I discovered how the role of social determinants of health effects the empowerment of the community-based interventions and the interplay of governing global institutions. I also learned about how the global health policies influenced Nicaragua as well as the IMF, World Bank, and trade agreements. After this trip, I now understand community-focused methods and the differences between horizontal and vertical interventions in public health. I learned that AMOS’s goal is to use a diagonal intervention that incorporates both horizontal and vertical aspects. I used all of this knowledge throughout my stay and solved a real case study in community based primary health care. Throughout this trip, my understanding of myself, public health, and the world changed.

Why is this change/transformation significant or valuable for your life? 

            This transformation is significant to my life because I want to be a nurse when I grow up. I discovered how public health influences the health care and witnessed first-hand of those who do not have the proper resources or nutrients to live a healthy life. I learned that peoples eating habits affect their health and how people live with low resources survive. I discovered that people’s actions and decisions affect their well-being and health. This change is valuable to my life because it opened my eyes. It confirmed that I want to help people live healthy lives while providing them with the proper care they need. This trip helped me learn to work with others who come from different backgrounds even with a limited amount of English. I developed relationships with people by using other ways to communicate besides talking. I truly realized that happiness isn’t about how much you have it’s about appreciating and learning to live with what you have. These people were so appreciative and happy. I learned a great deal about myself in this process and discovered my true self.

Tapasle Nicaragua

AMOS Headquarters