Global Health Nursing & Midwifery

Your story is one that is so powerful and thank you for sharing this journey.
One of the questions that most young generations ask is, how did you get to where you are now? – In your case, Nicaragua. Their thought would be was there someone you know from Nicaragua that invited you? How do you build that connection and relationship? Tess

Thank you for living such an inspiring life. What do you feel is the best way for nurses to contribute to the work that you are doing in Nicaragua, and similar situations all over the world? What would you suggest as the best way to train nurses to appreciate the contribution of traditional midwives and CHW’s?

Welcome, Dorothy! We're so excited to have you join us for this discussion.

Dorothy's narrative (attached above) was original published in the November newsletter of the Philippine Nurses Association, New England Chapter. I've included a copy of that issue here, and encourage members interested in learning more about this organization to visit: http://www.pna-newengland.org/

We look forward to hearing your questions for Dorothy this week!

Tess, I came to Nicaragua in June of 1985 in response to a call from Witness for Peace that invited U.S. citizens to live in the war zones to resist and protest the war that the U.S. Government was waging against the new revolutionary Nicaraguan gov't. It seemed a reasonable activity for those of us to believed in a nonviolent response to violence.

Dorothy, when you went to Nicaragua in 1985, you had already been a nurse for many years. Even though you went down in response to a call from Witness for Peace, did you also work as a nurse there right from the start? What was it like being an experienced nurse in Nicaragua in the 80s? Do you feel that your nursing work overlapped greatly with your human rights/social justice work? What was the state of nursing at that time in Nicaragua?
Thank you so much for taking the time to respond to our many questions!

Maggie, When i changed my life-style to live more simply and spend the majority of time in peace and justice projects, nursing took second place and i worked only to support myself. In Nicaragua, I realized that I could combine my experience and passion for nursing as well as my efforts for social justice. I felt more a whole person. Nicaraguan nursing was somewhat behind the U.S. but the Sandinista Revolution provided openings for women and health never before seen here.

Barbara, We welcome Spanish-speaking nurse volunteers to our project SKILLS TO SAVE LIVES. We are trying to broaden the skills and vision of traditional midwives and other community health workers as they serve women. Anything that touches the physical, mental or spiritual life of a woman either detracts or supports her health; lots of opportunities for creative work. Regarding helping nurses appreciate traditional midwives, i believe sufficient time should be spent along side midwives to see how they live, work, solve problems and support the women and families they serve. Nurses should be observant, listen, avoid judgement and be open to new learning and wisdom. We identify so with our "professionalism" but have to step out of those white shoes and be a bit humble to learn from traditional health workers.

Dorothy, I like and appreciate the approach of first observing, assisting and supporting before doing anything else, when working with traditional midwives. Especially in communities where there's historically been a lot of violence targeted at indigenous practices, languages and beliefs. I think that as nurses, in spite of our professionalism, there is a considerable amount of opportunity to be therapeutic in our approach with other healers/individuals, and not only therapeutic with our medicines and tools.

A few lingering questions, which may also be highlighting my deficiency in geopolitical history :)
- Why and how did the Sandinista Revolution provide openings for women and health?
- How did you see nursing change before and after the revolution?
- I think it's fascinating that the clinic in Mulukuku not only provides women with health services, but economic opportunity, education, legal services and consciousness raising. At what point did the clinic begin to encompass more than medical services? And who championed that?
- How do you personally/professionally handle true differences between what your medical training/education has taught you versus how you see nurses practicing in the field? For example, I have encountered a commonly shared belief that in Guatemala infectious organisms are much ...

Dorothy, I like and appreciate the approach of first observing, assisting and supporting before doing anything else, when working with traditional midwives. Especially in communities where there's historically been a lot of violence targeted at indigenous practices, languages and beliefs. I think that as nurses, in spite of our professionalism, there is a considerable amount of opportunity to be therapeutic in our approach with other healers/individuals, and not only therapeutic with our medicines and tools.

A few lingering questions, which may also be highlighting my deficiency in geopolitical history :)
- Why and how did the Sandinista Revolution provide openings for women and health?
- How did you see nursing change before and after the revolution?
- I think it's fascinating that the clinic in Mulukuku not only provides women with health services, but economic opportunity, education, legal services and consciousness raising. At what point did the clinic begin to encompass more than medical services? And who championed that?
- How do you personally/professionally handle true differences between what your medical training/education has taught you versus how you see nurses practicing in the field? For example, I have encountered a commonly shared belief that in Guatemala infectious organisms are much more powerful than they are in the US and require 2-4 times the recommended dose of antibiotics.
- And lastly, as someone who has worked as a nurse in such divergent settings as the Brigham in Boston, to Puerto Rico, the Filipines and Nicaragua, do you see nurses functioning very differently in each setting?

Thank you so much for taking the time to answer my peppering of questions. But I just wanted to get them in before the week concluded :)

Maggie, Thanks for continuing the conversation. Of course nurses bring wide knowledge and a scientific lens through which the world is seen. But first we need to learn to see the world of health from the traditional midwife's view, then gently offer the fruits of scientific training such as why a lesser dose of antibiotics does the job safely.
-Women fought side by side with men to ride Nicaragua of the dictatorship and earned men's respect as equals. New women leaders insisted on laws, programs to assure women's rights in education, health, politics. Modern ideas about women's rights flooded the newly freed society.
-As the society and the health care community welcomed new ideas from internationalists, such as Cubans with their excellent community health model and holistic medicine from many parts of the world, nurses and other practitioners broadened their understanding of health care. Especially natural medicine built on the traditional healers of Nicaragua, but new practitioners brought more modern and scientific learning and practice.
-Mulukuku, we began with reproductive health care. In the process of physical examination we realized that nearly half of the women suffered abuse, could not read and write, didn't understand ...

Maggie, Thanks for continuing the conversation. Of course nurses bring wide knowledge and a scientific lens through which the world is seen. But first we need to learn to see the world of health from the traditional midwife's view, then gently offer the fruits of scientific training such as why a lesser dose of antibiotics does the job safely.
-Women fought side by side with men to ride Nicaragua of the dictatorship and earned men's respect as equals. New women leaders insisted on laws, programs to assure women's rights in education, health, politics. Modern ideas about women's rights flooded the newly freed society.
-As the society and the health care community welcomed new ideas from internationalists, such as Cubans with their excellent community health model and holistic medicine from many parts of the world, nurses and other practitioners broadened their understanding of health care. Especially natural medicine built on the traditional healers of Nicaragua, but new practitioners brought more modern and scientific learning and practice.
-Mulukuku, we began with reproductive health care. In the process of physical examination we realized that nearly half of the women suffered abuse, could not read and write, didn't understand their rights as women and citizens, etc. Thus we began broadening our understanding of what constituted the health of women. Leadership came from the health promoters I trained and myself.
-Nurses in the field do the best they can with the knowledge they have and tools at hand. Most nurses are compassionate and caring people whom I have found open to new learning.

Thank you to everyone who participated, even if only through following along and reading. And thank you to Dorothy Granada, who despite her years continues to tackle new challenges, such as online internet conversations :) Dorothy, your experience and wisdom is evident throughout your responses. I know many of us think ourselves to be global health nursing trailblazers, but that is, in fact, not the case when you've been doing this, and well, for many decades. Even though the week of conversation has concluded, I welcome additional questions and comments and will continue to direct them to Dorothy. Again, thank you to everyone for your participation and support.