Tuesday, July 27, 2010

Snake Oil

During my bus ride home yesterday, a man got up, went to the front, and started to speak to the passengers. These bus speeches are pretty common. Ninety percent of the time the speaker is either talking about Jesus or selling something. This guy was selling medicine. He started off talking about how we need to take care of ourselves, how we get tired and run-down, we can have nervous attacks or trouble sleeping, or just feel worn out. “Well,” he said, “I have a solution for all of you, ladies and gentlemen. Here in my bag I have a wonderful cure for what ails you.” He pulled out a small box. “This, my friends, is what you have been looking for. Inside of this box you will find a syringe, a fresh syringe with a new, clean needle. Inside the syringe is a powerful vitamin.” This man is selling do-it-yourself intramuscular injections of vitamins on a bus. What?!

He went on, “When you inject yourself with this vitamin, my friends, you will feel 100% better. You will feel fresh, young, healthy, and happy. And how much, my friends, do you think this injection would cost in a pharmacy? I invite you, friends, to go and ask. Ask them how much an injection like this will cost. They will tell you, my friends, they will tell you $140 cordobas. That is how much this medicine will cost you if you want to go out and buy it in a store. But I am offering you this wonderful injection, this amazing cure, for only 50 cordobas. And if you buy two, my friends, I will throw a third one in for free.”

Then he pulled out a pamphlet. “But please, my friends, if you’re going to use these vitamins don’t do it until you have cleansed yourself of parasites. I want you to look here at this drawing. This worm, my friends, he lives in your stomach. He has five mouths, he eats and eats and eats, and he never gets full. And this little animal, this is the amoeba. He attacks you when you drink milk. And this one, this one lives in the flesh of the pig. Those who have epilepsy, who suffer from nervousness, they have this worm. And there are many others, my friends.” He indicated a plethora of other drawings of worms and microbes. “So if you are going to take this vitamin, please, please, kill these parasites first. This medicine here” – he produced another box – “will rid you of all these creatures. Do I have any takers? The senora here, yes, and here this man, anyone else?”

He went walking through the bus handing out the boxes. I took one of each, just to look and see exactly what he was selling so I could look it up later at home. The injection was a vitamin B cocktail – B1, B6, and B12. The parasite med was called albendazole. When I got home I went straight to my shelf and pulled out the book Where There Is No Doctor, which is a great medical reference manual for places like where I live. The parasite medication this man was selling works for a variety of worms, which I guess is good if that’s what you’ve got. But it doesn’t work on the two most common parasites in Nicaragua – amoebas and giardia. Not to mention that a lot of what he was saying about the parasites he did mention was flat-out wrong.

But the vitamin is the truly appalling part of his package for wellness. Let me quote from several sections of Where There Is No Doctor. First, from the part about vitamin B12: “This is mentioned only to discourage its use. Vitamin B12 is useful only for a rare type of anemia that is almost never found except in some persons over 35 years whose ancestors are from northern Europe…Do not waste your money on vitamin B12 or let a doctor or health worker give it to you unless a blood analysis has been done, and it has been shown that you have pernicious anemia.”

And from a section called “The Most Dangerous Misuse of Medicine”:

“The common belief that injections are usually better than medicine taken by mouth is not true. Many times medicines taken by mouth work as well as or better than injections. Also, most medicine is more dangerous when injected than when taken by mouth. Injections given to a child who has a mild polio infection can lead to paralysis. Use of injections should be very limited.”

Later, in a section entitled “Medicines Not to Inject”, the first entry is “Vitamins.” “Rarely are injected vitamins any better than vitamins taken by mouth. Injections are more expensive and more dangerous.” Just below, B12 is given special mention. “Injecting [B12] can cause abscesses or dangerous reactions (shock).”

To bill this medication as a cure-all, to suggest that it is good for people to buy a few packages and inject away, is absolutely unconscionable. I can’t believe it is legal (and I’m pretty sure it is. Even if it isn’t, it is quite common) for any old schmo to buy a carton of vitamin B injections and hand them out willy-nilly to unsuspecting poor farmers. It doesn’t help matters that people around here tend to be injection happy. I wanted to stand up myself and tell people not to waste their money or put their health at risk by listening to this snake-oil salesman. Maybe next time I’ll work up the nerve to do it.

Saturday, July 24, 2010

Hot and Cold

Many local health beliefs in Nicaragua have to do with avoiding the mixing of hot and cold. For example, if you’ve just been working outside, you shouldn’t bathe right away or drink cold water. If you’re eating hot soup, you should have a hot drink with it instead of a cold one. If the floor is cool, you shouldn’t walk on it with your warm bare feet.

And people are fastidious about it. When my neighbor bakes, she gets “agitada” (agitated from heat) and cannot come outside for the rest of the day. Sometimes she’ll call me over to accept some rosquillas (corn cookies), and she’ll be standing in the doorway with a towel over her head (to keep the heat from escaping her body too quickly, I presume) holding out a dish of baked goods that I have to go over to get, since she can’t come out into the cool air. And it’s not even cool out. It never is.

On a “cold” day during “winter” the temperature may be around 75 during the day. Still people complain about how cold it is, they put on sweaters, they have respiratory infections, they drink soup, the works. I wish I could explain to people how cold it can get where I grew up. “You can put a glass of water outside and it will turn into ice. That cold,” I say. But it doesn’t seem to penetrate. How could it? How could you understand true cold if you’ve never lived in a place where houses needed insulation or central heating, or even a fireplace (apart from a cooking stove)? How could you understand a North American winter if the coldest night you know of is one that requires two thin blankets instead of one?

I laugh when people warn me about going to the colder parts of Nicaragua (mainly Jinotega, one of the nearby cities). “Oh, bring a sweater. Jinotega is ‘helado’ (icy).” Which is a joke, because nowhere in Nicaragua is icy, ever.
“I think I’ll be okay,” I say.
This word “helado” makes me laugh because people use it strange ways. I’ve heard people say that a fire is “helado” when food isn’t cooking fast enough, or even that the sun is “helado” on a cooler day. Clearly, we do not share an understanding of what constitutes iciness.

Often people describe illnesses according to hot and cold essences, sort of like humors or energies in the body. One day this week I saw my host mom with a piece of a plant tied around her ankle, and I asked her about it. “Too much heat,” she told me, and she explained that she had recently come down with an illness in which her left foot and ankle become inflamed, and she gets a fever and nausea. She told me the name of the illness in Spanish, but it was nothing I had heard of. “I have to put cold things on my foot to get rid of it. This is aloe. It’s very helado. I got this sickness once before and you know what cured me? Something even colder than aloe.”
“A toad. Wilmer (her son) is out looking for one right now. One time he found me a toad that was so cold, it was heladísimo! I rub it right here where my foot is inflamed.”
“And that works?”
“Yep, but the poor toad, afterwards he dies. Too much heat for him. He’s cold, and it kills him, the poor guy.”
My only response was the one word everyone teases me for saying constantly. “Wow.”

Tuesday, July 20, 2010

Nica Time

Nicaraguans, especially those that live in the countryside, have the tendency to be less than punctual. In Peace Corps we call this “la hora Nica” - i.e., plan for activities to start an hour or so later than scheduled - as opposed to “la hora Gringa” – things start right on time. It can be hard to count on people to be where they say they’re going to be at the time they say they’ll be there. Even when you make a concrete plan with someone, they’ll often throw in the caveat “si Dios quiere” – if God wants it. Basically, with all commitments the idea is that people will show up if they can – provided it’s not raining too hard, they didn’t feel lazy that day, or something else didn’t come up. If a meeting starts at two, the majority of those that are coming will probably be there around three. Some may show up even later.

I am getting used to this part of the culture. I padded the agenda of the community meeting I held recently with ample time to make up for the late arrival of 90% of the participants. You learn that it’s necessary to schedule things for an hour earlier than you actually want to start. You also learn not to try to do more than a couple of things in the day – one activity for the morning, one for the afternoon. And even that may be pushing it.

Yesterday I got a better idea of why people have this mentality. I was going around inviting people to another meeting to discuss the computer center idea, and I had to go out to the farthest house in the community – the last house on the other side of the river. I went with two chavalos (kids) from my neighborhood. We crossed the bridge and started trekking through the mud. I was wearing hiking boots, luckily. The farther out we got away from the bridge, the deeper the mud became. We ran into an older lady resting by the side of the road and offered to help her carry a jug of milk and a bag of tortillas back to her house. The mud got deeper. One of the kids had on sandals, and by this time you couldn’t even tell he was wearing anything on his feet. The bottoms of my jeans were caked with mud.

Finally, we got to the last house. We sat on the lady’s porch for a minute to rest, and we chatted about the meeting. “Well, I’ll do the best I can,” she said. “But I don’t use the bridge, and the water’s up to my waist now.”
“Why don’t you use the bridge?” I asked.
“It makes me dizzy.” It’s a suspension bridge, and it does bounce a bit, but I’m still surprised to learn how many people in the community prefer to ford the river rather than use it. Talking to this lady, I started to understand a bit better why people consider all plans tentative. If it has rained a lot the river may be un-crossable. Also, if the path gets any muddier, even the bridge might not be a good option.
“Ok,” I said, “Well I hope to see you there.”
“I’ll be there,” she said, “Si Dios quiere.”

Monday, July 12, 2010

Community Meeting

This weekend I held a three-day workshop on community project design and implementation. With the help of a counterpart, I invited 25 people who are considered leaders in my community. Over the course of the three days, we talked about the resources of the community - the river, arable land, many educated young people, and some rockin' fiestas patronales (happening next weekend) - and we came up with ideas for ways that the community could be improved.

Before the meeting started, I was really nervous about whether or not it would work. For starters, a prominent man in the municipal head died on Thursday, so on the first day of the meeting only a dozen people showed up. And of course, they showed up about an hour late, so for the first hour I was fretting that we wouldn't have a meeting at all. But even that fist day, things went well. We made community maps and talked about all the positive things about our area, and we discussed past successes of the community.

The second day went much better. All twenty-five invitees showed up. We spent the day imagining how the community could be improved, and we ended up with four project ideas:
1. A new seconday school
2. An expanded health center
3. A recreation center
4. A computer lab

At the end of the third day, we chose two projects to continue working on - the computer lab and the health center. Now I am excited - and nervous - to see what will happen next with these ideas. Tomorrow we are having our first follow-up meeting, and my boss from Peace Corps is coming to visit. Unfortunately many good ideas fall apart for lack of support from the mayor's office or from the community itself. But for now I am optimistic that in my second year of service I can help my community get something concrete done.