Unlike most of its Latin American neighbors, Nicaragua has not implemented basic preventive measures such as reducing mobility and concentration of people, testing, or quarantine of suspected cases to slow the propagation of the virus. In fact, public schools have been ordered to remain open and Easter week celebrations are encouraged even though many private schools have closed and the Catholic Church has canceled its events.
For a number of reasons we are extremely concerned if the virus takes hold, the spread of the disease will be relentless in the communities we serve:
- Nicaragua is a communal, not individualist society where extended families live together in small homes and most people rely on the always-packed public bus system for basic transportation.
- Hand washing is essential to prevent the virus but lack of access to water is a pervasive problem in most rural communities making frequent hand washing nearly impossible.
- The national health system is not equipped with the necessary medical supplies, equipment and expertise to screen and treat a major outbreak. Neighboring El Salvador ordered residents to quarantine at home for 30 days, citing the need for intense preventive measures to avoid overwhelming its fragile health system.
With this as a backdrop, The Lily Project is following the World Health Organization (WHO) guidelines and training, American Society for Colposcopy and Cervical Pathology (ASCCP) recommendations, and input from local partners to implement a short-term strategy that protects the health and safety of our team and patients. Currently we have the necessary medical and cleaning supplies to support this plan; however all are becoming very limited and prices skyrocketing. We will be monitoring everything and making changes whenever necessary but as of now we are:
- Canceling regular community health screening events. These events typically have 50-80 women in attendance, many of whom bring their children.
- Continuing, with modifications, Lily’s diagnostic screening and treatment events. These events are invitation-only for women with abnormal screening results who are on our ‘watch’ list, or scheduled to receive cryotherapy or a biopsy. Since the beginning of 2020 The Lily Project has uncovered three cases of invasive cervical cancer; it is essential women continue to receive this care. Each weekly event will be limited to no more than 10 women and enhanced procedures will include pre-screening women for illness (with referral to MINSA), educating about the virus with thorough hand washing for all participants, social distancing in the waiting area, disposable gowns and use of gloves and masks throughout all stages of the process. Lily will bring water if the location doesn't have access. The mobile clinic will go through a thorough disinfection process before and after each event.
- In addition to a weekly event, Lily’s offices in Leon and Matagalpa will be open 2 times a week until 3pm (when streets typically get more crowded) for Lily's nurses to manage the data and participate in online training and education advancing their knowledge and skills in this critical time. The office has Internet access, which is not available in their homes.
- In order to work, teammates are required to wash their hands frequently, avoid crowds and not take the public bus (Lily is paying for taxi service as necessary).
We have to believe that you, just like us started this year with a plan, exciting goals and passion to get it all done. It is so difficult to see everything change so abruptly without any sense in where it is all heading. But our team has found ways to overcome Nicaragua’s turmoil over the last couple of years by staying committed to Lily’s mission and flexible in our execution. We have complete faith we will do so now as well.
If you are interested in staying in touch with Lily and what is happening in Nicaragua, please follow our blog. We will also be posting opportunities for teens and adults to volunteer remotely with Lily during this time https://www.thelilyproject.org/lilyblog.
Thank you for caring about Lily. Believe this: you are helping save lives.
My mom died of cervical cancer when I was 3 years old. She was 37. After she passed, I lived with my dad and my grandma.
My grandma sold tortillas, and I rarely attended school because I had to help her. My dad worked the fields, cutting wood and any other odd job he could get. He always came back to the house drunk. Despite his abusive behavior, my grandma told me I should obey him. After all, she’d say, ”he’s the father God’s given you and it would be a sin to disrespect him.“ My grandma always treated him like a king. He was infallible in her eyes.
I hated being close to him when he was drunk. He always insulted me. He would say horrible things about my mother too. My grandma forced me to cook and take care of him – even when he was so drunk and mean.
When I was 8 years old, my grandma went to sell tortillas and left me waiting for my dad to come home. I knew he’d eventually arrive, drunk and angry. That night I made him dinner, and when I took him to bed, he started to tell me "You're such a little whore just like your mom. If I see you with a man I swear I kill you. “
Then he started to touch me. He took off my clothes and he raped me. When he finished, he told me “Now I'm the only one who can ever touch you.“
I was sad and confused after it happen. My grandma was the only one I could tell, but when I did tell her, she became really angry with me. She said you’re a little liar just like your mother and no one will ever believe you. If you ever tell anyone that story again, I’ll kick you out of my house for good!”
When I was 13, I got pregnant - with my father’s baby. I had my first child when I was 14. My grandmother, so angry about how I was “whoring around with all the boys” kicked me out of the house. I lived on the street without anyone's help for quite some time after. I was forced to take care of a baby boy that I never wanted. I was very angry and abusive. I blamed him for the way people treated me - like a diseased prostitute.
When my son grew up and started to work, he left me. I have not seen him again, and I don’t want to see him. Now, I live in another community. Alone. My dad never faced any consequences for what he did, and my grandmother always took care of him. When I heard he died, I felt happy.
Carmen is the name we’ll give to the woman who shared this story at our event in Momotombo, Nicaragua. She told us “I came to get tested today because I'm afraid of having cancer, but honestly, if I have cancer I'd rather just kill myself then to do anything about it.” We share this tragic story as just one example of many women we’ve encountered who have been sexually abused by their parents or relatives. In Nicaragua, most are never punished for the irreparable, generational damages they have caused. It is so common for us to hear these stories of abuse at our health events that I sometimes think it was merely a stroke of luck not to have been raped as well. Its January 2018, and we [women] still do not have the ability to express ourselves, protect ourselves from our own families, make choices about our own bodies. Our rights are not respected and abusers are not punished. They still teach us to treat men as our superiors, and boys are still raised to be kings. This is life in rural Latin America.
My name is Maryuri Salmeron. When I was little I loved watching nurses and doctors help people. So I said to myself, ”one day I'm going to be a nurse!“ and now I am.
I consider myself a humble person, quiet and reserved. I don’t have many friends, but the friends I do have are sacred to me. I give them my support in whatever they need.
Studying nursing has not been easy. You need to have a big heart and a lot of patience to face the everyday challenges. However, after the long days at University, I always felt that the work was worth it and believed that one day I would see the results of my effort. That filled me with satisfaction.
In 2013 I completed my required social service in Nagarote and participated in a program at the University to complete my training. Yet after getting my degree I could not find a job related to my career, so I ended up working in a supermarket. It was not what I wanted, but I always had hope of finding something that would fulfill my expectations as a nurse one day.
Finally that day came when The Lily Project posted an ad on Facebook. They were looking for a nurse for their cervical cancer prevention program. While it seemed like a stretch, I sent my resume because I wanted to be a part of the work they were doing in the rural communities. I was so thankful when I was offered the job.
In the beginning, the work at The Lily Project was challenging because I’m so quiet. The job required that I speak and teach in front of many women in the community! Soon, I lost the fear of teaching and I began to enjoy the opportunity to talk to women about their rights and taking care of themselves. Now, it is natural for me. I greet them, make jokes and, most importantly, give them the confidence they need and deserve so they can change others in their communities. I feel so content with this work.
I really enjoy being with the women who come to our events, examining them, talking to them, listening to their stories and being part of their lives. Prevention is the key to stopping this cancer and it is the beginning of showing love to ourselves, and to our families.