Guest speakers at the fair discussed violence as a social problem and encouraged open discussion of violence related issues. The UCA theater group also got the audience involved in a game designed to provide information about the different types of violence.

A local musical group and two local dance groups performed and the UCA invited community members to sell their produce, coffee, and other products. Mixed in with these for-sale items was a wealth of information and resources related to violence.

The Teach for Health program assistants put together a poster with information about the community health promoter program to spread awareness. They also contacted the local Ministry of Health who agreed to donate a box of condoms for us to pass out during the fair, along with informational handouts we compiled from previous promoter workshops and from the resources of UCA – San Ramon.

A local news group covered the event and even interviewed the program assistants! We were able to watch the interviews and the report of the event that night on three local channels.

An amazing estimated 300 people attended the event. It was a wonderful opportunity to provide support and open up discussion of the many types of violence that can affect the lives of people here and around the world.

La Feria de la No Violencia Teach For Health - Health Education for Developing Communities Worldwide

M – Medible (Measurable): projects should have measurable outcomes that can be tracked to evaluate success

E- Especifico (Specific): Specific endpoint to guide efforts and evaluation of the relative endpoints

T – Tiempo (Time): Promoters are encouraged to set a specific timeframe to achieve their goals

A – Alcanzable (Achievable): Realistic and achievable goals are important to build momentum and be able to see success.

META goals Teach For Health - Health Education for Developing Communities Worldwide

The promoters again requested an injection training seminar, with greatest interest in being able to provide contraception (Depo-Provera) to isolated women of their community. TFH is coordinating with the Ministry of Health to arrange such a training, while again emphasizing the scope of practice for health promoters, and the need to not exceed their level of medical training with focus on primary prevention and community organizing.

Many promoters advised TFH that they would be unable to attend the December monthly meeting since this was the time for the coffee harvest, and they would be needed on their family farms. It was decided that the December meeting would be cancelled, with TFH program assistants instead traveling out to each participating village to give 1 on 1 support for projects.

View the Spanish report.

November 2011 Promoter Monthly Meeting Teach For Health - Health Education for Developing Communities Worldwide

Week one brought Teach for Health volunteers to the communities of El Naranjo. Early morning, day one, volunteers brought Teach for Health materials and food to feed a small army of promoters up the hill from San Ramon. The workshop was held in an unused classroom in El Naranjo, home of a (nonpoisonous) snake that hung out in the rafters.

La escuela in El Naranjo, site of the first regional workshop.

Health promoters in La Corona modeling the voting process.

During the three days, promoters practiced one form of community diagnosis, leading a mock community meeting focused on identifying “los problemas más sentidos” in the community. Participants then discussed which of the top problems would be most feasible to address and analyzed root causes and possible solutions. In addition to introducing the problem identification and analysis process, the workshop provided close coaching of promoters by program assistants and TFH volunteers, enhancing their presentation and meeting facilitation skills.

After El Naranjo, Teach for Health facilitators conducted the same workshop in three other communities: La Corona, El Plomo and Monte Grande. During our visits, we were excited to learn that many of the participants had already scheduled community meetings to introduce themselves as health promoters to their communities. Many promoters felt that the workshop material could fit well into subsequent community meetings. After each of the three days, promoters received certificates of completion and community first aid kits.

Health promoters in the Monte Grande regional workshop.

Workshop facilitators were excited to witness the collaboration between new and veteran promoters. As we move into fall of 2011, we look forward to supporting all health promoters as they engage their communities to bring about meaningful change.

Written by Anita Roberts, RN

Masters Student, Advanced Public Health Nursing

UCSF School of Nursing

Community Diagnosis & Action Planning Workshop Teach For Health - Health Education for Developing Communities Worldwide

El Trentino: Health promoters are currently coordinating with the NGO ODESAR on projects for low income families. Water faucets are being constructed along with latrines, water purification/chlorination projects, as well as teaching on hand washing, discussions with local teachers to aid teaching on family planning for their students plus supplemental teaching by health promoters to young adults in the community.

Community Mina Verde #1: Promoters have recently given talks about themes including reproductive health, gender roles, community cleanliness, sexual and reproductive rights.

San Pablo Central: No current projects, is looking to develop and implement programs with children, women and family planning. Meetings for one on one project assistance by Teach for Health are planned.

Samulai #2: Has been working to identify problems for programs in the future, specifically within children and adolescents.

El Plomo: Has arranged for a comprehensive community meeting where community members will meet with the health promoters to collectively identify projects that they would like to work on, with the health promoters returning to help solidify project goals with TFH staff and program assistants.

La Pita: Current talks at the local school about hygiene (particularly hand washing). Household visits are planning for the beginning of 2012.

Samulai #1: Did a health talk with children and adolescents in the community.

Guadalupe: Health promoters from this community have decided to focus on the elderly and will be working with their community to open a senior center.

Cerro Grande: Is currently working with MINSA (Ministry of Health) to provide chlorine purified water to the community.

La Pacayona: Promoters are giving talks at the school and are looking for ideas that will help them gain community support with community cleanup projects.

Las Delicias: Is regularly using the first aid kit, and wants to open an infant nutrition center.

Monte Grande (La Reyna): Currently doing regular trash cleanups on the village streets and is giving school talks about various health topics to the students.

Promoters expressed a desire to get more presentation supplies (markers, white paper, tape) for community presentations. Finalizing photos and information about health promoters for the promoter profiles was also introduced as a topic for coming meetings. The meeting concluded with a discussion about the significance of self esteem (individual and in relationships), how to improve it, and causes of low self esteem. Planning a text messaging system that would reach the majority of the promoters to give notices about future meetings for better communication and attendance was introduced, with the concern that not all villages have cellular coverage.

The Spanish meeting summary is HERE.

September Health Promoter Project Summary Teach For Health - Health Education for Developing Communities Worldwide

Each day of the NI workshop brought a new surprise to the TFH crew (not uncommon
here in Nicaragua, as the team learned). Challenges included: arriving in town to find the
planned workshop location unavailable; the whole town without power, making copies of
handouts not possible. But it was valuable lesson in rolling with the punches, improvising, and throwing in games to keep everyone laughing in the meantime. We managed to pack A LOT into the
curriculum, and the NI crew was pretty exhausted at the end of each day.

Over the two weeks of training, promoters covered health topics in a framework that
examined issues at individual, community, and system levels. For example, participants
brainstormed barriers to stopping disease transmission, from individual habits to lack to
infrastructure such as trash collection. As a group we discussed reasons why people don’t wash
their hands: no access to soap and water, no concept of the need to clean hands,
inconvenience. Spreading glitter among their hands to represent germs, and singing a song
about hand-washing, the group practiced effective hand hygiene, scrubbing down with buckets
of water and soap in the courtyard. For the topic of diarrhea and dehydration, facilitators acted
out a skit to show symptoms of dehydration in a baby. Promoters looked up the topic in their
books, and topped off the lesson by making their own bottle of suero, oral rehydration solution,
out of salt, sugar, and banana for potassium. Hands-on activities like this are always popular.
We had several guest presenters as well. Everyone loved the impassioned sociodrama
on community organizing, full of Nica slang and funny antics. In light of the strong tradition of
herbal medicine in Nicaragua and especially in the campo, a presenter led a session on
medicinal plants. Then, another one of our TFH volunteers gave a presentation on diabetes,
going over the basics of the condition, which was new information for the majority of the
group. Two days were dedicated to First Aid, taught by the San Ramon firefighters.

Participants also explored the role of the promotora, a community health worker who
evaluates the needs of their community, shares information, provides basic treatment, and
works with the community to make healthy changes. After reviewing the obligations and
expectations of the promoter and TFH, each participant signed a memorandum of agreement
acknowledging their scope of practice. Promoters also practiced adapting their style of
communication to fit different individuals in the community, using techniques of therapeutic
communication, e.g. using open-ended vs. closed questions, validating feelings, sharing
observations of the other person. Finally, we spent ample time refining presentation skills to
encourage promoters to become comfortable giving charlas to groups. After drills on speaking
in a loud voice, using helpful body language and position, and making illustrated health
messages, the week culminated with each community group presenting a charla in either a
sociodrama, song, game, or poster presentation. Some groups were very creative, especially
hilarious was the drama of an elderly couple on health of ancianos. The final day was full of
team-building games with the promoters from last year’s group and a certificate ceremony.
But the highlight may have been the piñata that sent the group into squeals of delight and a
frenzy of scrambling on the floor for candy—who knew that would be such a hit?

New Intake Workshop 2011 Teach For Health - Health Education for Developing Communities Worldwide

Smoking Cessation Song Teach For Health - Health Education for Developing Communities Worldwide

Recruitment for the new intake workshop is going well so far. It is A LOT of talking, networking and a lot of very long, bumpy, muddy rides in the truck, but we’ve had some truly inspiring visits to date! The promoter recruitment team has done an amazing job gathering info on the new communities and setting up appointments. Special thanks here to Dinora, Yara, Carolina, Damaris, Xiomara, Adalila and Nilda for all their hard work setting up appointments and collecting demographic info in these communities without the use of the truck! We are visiting the most vulnerable communities (identified by MINSA) and also those communities where we currently have inactive promoters. The steps towards locating new promoters in a given community are as follows:

1. Talk to people to find out where the community is and how to get there (if the recruitment team members are not already familiar with it)

2. Locate the elected community leader/s (representantes del poder ciudadano or CPC), either by cell phone or by driving into the community and asking people where the CPC reps live and going on a scavenger hunt

3. Briefly introduce the program and request either to participate in the next naturally occurring community meeting or for an all-community meeting to be called in which the program can be introduced

4. Come for this meeting to which all community members are invited. The recruitment team then presents the program and answers questions.  Attendance at these meetings has varied significantly but some of our best turnouts so far include more than 70 community members!

5. Step out of the meeting to give community members time to discuss whether or not they wish to be involved, and if so, to elect the new promoters

We have 13 confirmed new promoters and 12 visits still to go so it’s looking like we’re going to have a pretty large group of promoters coming in! The community responses have been so positive that we may actually have to hold off on involving some of the communities on our current list until next summer for lack of space in the new intake workshop!

Firefighter Trainings:

Today was the first day of the firefighter workshops, which will include CPR, first aid and first responder training. Attendance was 100% in both the morning and evening sessions and the bomberos were extremely engaged and eager to get started.  They especially enjoyed practicing the repositioning of unconscious victims. All of the practical skill sessions today were quite rowdy, truth be told!

Promoter Workshops:

That’s right, they’re coming! The program assistants and ground team have been reviewing promoter feedback from the program assistants’ last round of community visits and tailoring workshop content and style to account for promoter feedback.  One exciting example of this is the inclusion of a segment on natural remedies during both the new intake and continuing education workshops, to be provided by an herbal medicine center in Esteli. Another exciting change that is the result of some great networking and quite a bit of luck is the inclusion of a fantastic sociodrama about the importance of community organizing and community diagnostics (yup, you read that right, a local group who has already developed a skit highlighting the importance of community diagnoses) to be performed by a group of actors from the San Ramon area as a lead-in to our community diagnosis and action planning workshops.

Nicaragua Ground Team 2011 Update Teach For Health - Health Education for Developing Communities Worldwide

This meeting included a talk by Samuel Núñez on HIV, prevention, and living with the virus. Health promoters did a workshop on community development goals, expanding project goals in family planning, community cleanups, and hygiene. Health promoter Yaneth Molinares did a brief presentation on her current project to bring latrines to her community, and how her current program only has three houses left to cover in her community but is currently lacking funds to construct them with quality wood or other materials that will validate the effort and organization required. Many promoters agreed that finances were a key obstacle in implementing their community projects.

A copy of the report (in Spanish) is available HERE.

June 2011 Monthly Meeting Report Teach For Health - Health Education for Developing Communities Worldwide

The familiar topic of HIV was brought up as a teaching topic at the request of promoters who were aware of the World HIV day that just passed, and while they generally felt comfortable with the basics many wanted to learn some further details. A question and answer session followed with the request to follow up on the theme in the future with a more personal story of the disease outside of the basic science and medical prevention facts.

Promoters requested that Teach for Health investigate potential collaboration with the Ministry of Health to do mobile HIV testing clinics in their rural villages coordination with Health Promoters for education on the topic and long term support for any individuals who are found to be infected.  Promoters also identified the need for hammocks or stretchers to help bring people to the central town for emergency medical care.

The Spanish language monthly report is HERE.

May 18, 2011 Monthly Meeting Report Teach For Health - Health Education for Developing Communities Worldwide