Emory graduate students Maureen Sanchez and Macklin McBride worked with our staff and community partners in  Jinotega and Los Robles, Nicaragua this Summer on two distinct projects. Maureen created holistic care plans for families and caregivers of our Together For Health program. Macklin assessed the monitoring and evaluation of our Nica Agua program, in preparation for expansion into new communities with a new filter design.

Macklin Mcbride worked with the director of community development, Yarisleidy Cortez to assess the monitoring and evaluation processes of the Nica Agua Program. He examined how the program was measured in the past and offered in-depth suggestions on how to improve these measurements in the future. Macklin’s work is timely as we prepare to expand the Nica Agua project to new communities with a new bio-sand filter model. 

Some of Macklin's suggestions for evaluating and implementing future Nica Agua projects include:
  •  Define diarrhea and the end of diarrhea with the participants using the World Health Organization’s definition of diarrhea when collecting data
  •  Ask about diarrhea in the last 7 days to reduce recall bias, but only ask about diarrhea at baseline and the last visit. Studies have shown that frequent reporting of diarrhea causes reported rates to decline over time even in the absence of an intervention
  •  It is not common to discuss diarrhea. Therefore, asking one person about diarrhea in the entire family will likely lead to underreporting, particularly of less severe cases. When possible, ask each person in the house individually if they have had diarrhea in the past 7 days after explaining the definition of diarrhea
  • Without filters in communal areas, participants will drink unclean water and get sick. Give filters to the following communal areas:
    • Schools
    • Health Clinic
    • Churches
    • Soccer field- soccer matches occur twice per week, many people drink from water spigot
  • Continue brigadista education in the community and monthly household checks. Use the “charlas” to encourage people to consider all sources of contamination.
    • Preventing diarrheal disease requires addressing all the pathways that lead to pathogens entering the body. The following are some common pathways observed in houses in Los Robles:
      • Food hygiene
      • Using unfiltered water to wash fruits/vegetables that will be eaten raw
      • Using unfiltered water in drinks/ice/popsicles
      • House hygiene
      • Animals and animal feces in the house
      • Trash or old food that attracts flies
      • Hand hygiene
      • Touching raw meats before touching other foods and items
      • Not washing hands before cooking and after using the bathroom
      • Feces management
      • Some houses without bathrooms, proper disposal

Maureen Sánchez focused on the Together for Health program and worked to create holistic care plans for patients and their caregivers. The program, founded by Drs Throwers, currently provides a continuum of care for 20 special needs patients which include medicine, transportation, and monthly checkups. With her background in psychology and occupational therapy, Maureen conducted a survey of the patients and their caregivers to achieve a better understanding of their mental states and potential areas for improvement. 

See below for some of Maureen's Discoveries and Recommendations

“Through the results we discovered that nearly half of the tutors (47%) show signs of depression to some extent, ranging from mild to severe signs. This exemplifies that the weight of caretaking may be mentally demanding, and the tutors may need more emotional support than other populations in the community. Several caretakers expressed feelings of loneliness and or worrying that no one else will take care of the patient without them. Additionally, many caretakers cannot, or feel like they cannot, leave the house because of the full-time needs of the patients they are taking care of. This being said, in addition to the individual plans for the tutors, it may be beneficial for others in the community to be trained in taking care of the patients, assist in meal preparation, visit caretakers, etc. to alleviate tutor’s feelings of isolation and stress.

Other findings from the research are that nearly the majority (68%) of patients and tutors reported consuming insufficient amounts of water throughout the day, and usually only drinking café and fresco. Both these drinks usually contain large amounts of sugar, which may cause depression, mood swings, teeth decay, inflammation, type 2 diabetes, heart disease, heart attack, stroke, high blood pressure, increase, and weight gain. In addition to this, 33 out of 35 members reported no fruits or vegetables in their diets and most did not report any variety in their diet. This is problematic because this may lead to depression, mood swings, cancer, stroke, heart disease, obesity, stress prevention, loss of vision, diabetes, high blood pressure, headaches

Community gardens

May be a good solution to the isolation that many people feel and the lack of fruits and vegetables. Depending on the level of accessibility, these gardens may have the potential to bring people, especially women in the community together to form new relationships and support. This also can introduce schedules and routines to the community and those suffering from autism and depression. In addition walking to the garden, in addition to participation in the garden will provide participants with exercise, which is proven to be especially beneficial or those suffering from depression (3). Lastly, these gardens will provide a sense of purpose and tangible rewards for participants which also will be beneficial for those in the community, especially those suffering from depression.
Depending on what is grown in the gardens, they also may be able to provide a good source of vegetables, herbs, or fruits into the diet which would help with the lack of essential vitamins many people are experience, and can help aid in mental and physical recovery maintenance for community members.

Church Involvement
!00% of the 35 patients and tutors who were able to pray reported praying often and only 3 of the 26 patients and tutors able to physically attend church choose not to. These statistics and finding may be beneficial in intervention strategies and mobilization within the community since requires no behavior change from community members. Therefore, it may be beneficial to form a partnership or relationship with the churches, and/or encourage them to host communal events, potentially before or after a service/during the week where community members can form new relationships with one another, such as sharing a meal. Additionally,
the catholic church by the plaza provides visitation and prayer for those struggling with sickness, which may be beneficial for some patients who cannot get out of the house, or who are lonely to feel included in the community and have support.


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