by Susan Cotton, Executive Chair of the Board.
When I talk about The Lily Project and describe our early success in helping prevent cervical cancer in rural Nicaragua, people often assume we operate as a medical mission, with doctors and volunteers flying in to provide medical services for a couple of weeks at a time. I explain while we share some of the same measures of success, we are fundamentally different from that known model.
The Lily Project works to empower lasting improvements in the health and wellbeing of women and girls in rural communities where health-related issues are greatest. Nicaragua has one of the highest rates of cervical cancer mortality in the world both due to its inadequate health care system, with PAP screening available to less than 10% of women, and prevailing machista behaviors that propagate HPV, the virus that causes cervical cancer. To resolve this inequity, The Lily Project must provide access to preventive care (a structural issue) and advocate change in sexual behaviors (a cultural issue). Social change this significant requires an understanding and appreciation of the environment, clear vision of the future, adaptive model that brings them together and ability to sustainably scale. The Lily Project will achieve its goals by first going deep, then going wide.
We are grateful to the Friends of Lily for making our inaugural year a great success. We have relied on their expertise and resources to build out our solutions, and their financial support to staff our first Lily health team and equip a mobile health clinic.
Lily Is Saving Lives.
The Lily Project hosted its inaugural health event in February in a small fishing village on the Pacific coast of Nicaragua. When executive director and chief clinician Anielka Medina screened the women for cervical cancer using visual inspection with acetic acid (VIA), more than 10% had precancerous lesions and were treated immediately with cryotherapy. Julia, just 28 years old and a mother of four, had multiple high-grade lesions and needed to be referred to the hospital in Leon, many hours away, for treatment. Understandably Julia was terrified but after talking with Anielka, she agreed to go. The doctor found she had cancer, which had advanced to the point where she needed a life-saving hysterectomy. We checked in with Julia last month and are pleased to report Julia's recovery is going well. She asked Anielka to thank all of the Friends of Lily for making it possible to "mantenerme sana y con vida por el bien de mis hijos" (stay alive and healthy for the sake of her children).
Thanks to the Friends of Lily, Lily is on track meet its goal to screen 1,000 women in 2015.
# of Women Screened to date:
Eligible for treatment:
Lily is Empowering with Knowledge.
Shortly after we launched a curriculum to teach women about their reproductive system, we realized that we were hearing women describe their monthly menstruation as a ‘disease’ and despite having multiple children had no understanding of its relationship to fertility. With this new perspective, the Lily team introduced the “pulsera de poder” (power bracelet) as a tool for women and girls to better understand how their body works during their menstrual cycles.
· 3 educational sesions utilizing the power bracelet were held during school with girls in sixth grade. A total of 60 girls participated.
· 95% of the girls knew that the menstrual cycle was a normal part of how the women’s body works. 100% responded that they learned in school. The other 5% of the girls knew that the cycle was normal, but they considered it a disease.
· 100% of these girls have never talked to their parents about issues regarding their menstrual period, sexual health, contraception or family planning. All they know or have learned has been in school.
· 3 sessions with adult women utlizing the power bracelet were held during Lily Health Events. A total of 40 women participated.
· 90% thought that their menstrual period was a disease.
· 80% of these women did not know that menstruating was normal and 70% did not know they had one menstrual cycle each month.
· These same women are the mothers of girls who go to school. Since they did not have the opportunity to attend school, they do not have enough knowledge to teach their daughters and do not want to teach because they feel ashamed of their lack of knowledge.
News of Lily’s pretty “pulsera de poder” has traveled fast and draws women and girls to Lily Health Events. They come for the bracelet and leave empowered with knowledge about their bodies, and results of their cervical cancer screening plus treatment if necessary.
Lily is Engaging Communities
We are pleased to introduce our newest board member, Dr. Alvaro Garcia, Nicaragua’s leading expert in cervical cancer prevention. He believes sustainable solutions involve the entire community, especially men. Proof of this is in the results we are achieving through our collaboration with Enliven, a business incubator working with local cacao farmers in Nicaragua. As part of their experience with Enliven, farmers are being educated on the need for The Lily Project and asked to encourage their wives and others in the community to attend the events. Lily Health Events that have support from the men in the community are more successful than those where men are not involved. Dr. Garcia and The Lily Project board are working on a strategy to expand these types of collaborations and deepen our partnerships by offering sexual health education and tools specifically for men and boys.
All it takes is $10 to give a woman access to these life saving services
Lily’s model employs young Nicaraguans, recent university graduates with medical services degrees trained in lab analysis, pathology and epidemiology. This serves two purposes: to train and develop high-potential young graduates and launch them in careers; and to help achieve our cost-to-serve target of $10 per woman.
We couldn’t have achieved any of this without the Friends of Lily. Our 2016 goals are compelling – to introduce a 2nd Lily health team and screen more than 5,000 women by the end of the year. Please join the friends of Lily and bring health and hope to women who need it the most.
By Susan Cotton, Executive Chair of The Lily Project
As we were developing our business plan we interviewed leaders from other successful global health organizations and asked them for the ‘one-thing’ we needed to do. We kept hearing back…”don’t try and do it alone – build great partnerships.” And now two years into it, we completely agree. Our partners including the local SILAIS (the regional department of MINSA), which also authorizes and oversees our work, ODESAR - a high-impact local community development organization (http://bit.ly/2sBPOER), Gundersen Global Partners - a La Crosse Wisconsin-based organization that works to improve the health and well-being of global communities by supporting sustainable development through volunteerism (http://bit.ly/2twsPal) and M-HEAL, a student organization at the University of Michigan that fosters interdisciplinary work in global health, design, and entrepreneurship (http://bit.ly/2tetQVi).
With these partners we are able to overcome challenges in reaching women in remote communities, have the equipment and trained staff to deliver quality outcomes in a mobile setting and ultimately reach our shared goal of improving the health and wellness of women in Nicaragua. Check out partnership in action http://bit.ly/2rzOkdP !
At our first event in Miramar, I met so many amazing women. Today, I want to dedicate my blog to a person who has taught me the value of life and has shown me why The Lily Project exists.
I'll call her Julia.
Most Lily events begin with many women just scouting out the project – curious about our team or our procedures; others arrive because a friend told them about the project or because they have a problem and they’ve come for the free advice.
Julia arrived as a curious girl. Just 28 years old, she was a mother of 4 children; she had her first child when she was just 16 years old. Now a housewife, she approached the event with some doubts about whether she would partake in the female health exam.
After participating in our lecture on sexual health and hearing us talk about how we may feel good, but we dont know what’s going on inside our bodies”, Julia decided to accept the free cervical exam we offer – the first PAP or cervical exam Julia had ever had.
When I performed the cervical exam (a visual inspection with acetic acid: VIA) on Julie, I immediately uncovered multiple high-grade lesions (NIC III+). While the Lily Team offers free cryotherapy treatment to our patients at the events to resolve most lesions, I knew right away that this patient was beyond the level that we could treat in the community. After discussing the situation with Julia, I referred her to the doctor in charge at the nearest health center in order to get a PAP completed and registered with the Department of Health. The PAP confirmed our result: Julia had a high-grade intraepithelial lesion (LIAG) a NIC III. Leveraging our relationship with the health department, the Lily Team immediately got an order approved at the hospital to perform a colposcopy biopsy.
In less than 3 days we had everything ready, but the hardest part for me was explaining the test results and the procedures to Julia. She was a strong woman, and I stared into her eyes as tears ran down her cheeks. She hugged me and told me she was not afraid for herself but for her children.
Despite the fear, Julia followed our advice and moved forward with the surgery. The oncology doctor discovered the cancer was aggressive and decided the best option was a hysterectomy. Julia accepted.
Eight months passed by and The Lily Project returned to Miramar to host another women’s health event and perform controls (check-ups) on the women who had received cryotherapy. To our surprise, one of the first faces we saw was Julia. She arrived early to thank us and tell us how happy she was that she attended our last event and made the decision to take the cervical exam. She said the exam changed her life. While the decision to move forward with the surgery was extremely difficult, the resolution of the problem brought her life and hope. Her smile beamed from her face as she enthusiastically told us everything that had happened since we last visited.
The reality for us is that people like Julia are the reason we launched The Lily Project. To see her smile, experience her hope and know she will live a healthy, happy, long life with her children makes every health event worth it.