In 2009, NDI created the DIOSA (“goddess” or “beautiful woman” in Spanish) program as a response to the increase in prevalence of cervical cancer on the island, and began providing quality health education to women as well as free gynecological exams (including pap tests). Since DIOSA’s inception, NDI realized a need for more comprehensive psychological care for women and children, and in 2013, we added a full-time Nicaraguan psychologist to our staff. Lic. Lilliam Zacarias expanded the original DIOSA program and provides three essential psychological services to women, children, and families: individual consults, DIOSA group formation and facilitation to women in 10 different communities, and accompaniment services for victims of sexual and domestic violence. Our volunteer doctors provide holistic health services including diet and nutrition counseling, massage and spinal adjustments, nutraceutical and pharmaceutical prescriptions, and acupuncture. We are currently the only free integrative medicine clinic on the island, and the only clinic providing psychological care and a program for victims of sexual and domestic abuse. Since 2005, the NDI Clinic has served more than 25,000 patients, and from 2013 to the present date, 1,746 patients have been treated in the psychology program alone.
The purpose of the DIOSA program is to educate women in a variety of subjects, from healthcare topics such as the importance of nutrition and exercise to osteoporosis and menopause as well as issues pertaining to domestic violence and human rights.
Educational classes about safe sex practices and pregnancy prevention at an early age are offered in secondary schools for young people and adolescents. The Ministry of Health estimates that 40% of pregnant women are adolescents and 12% are cases of sexual abuse (some are not denounced because they have remained with their partners). These presentations are currently being delivered at five secondary schools in the municipality of Moyogalpa with an average annual participation of 300 adolescents.
Charlas or group chats are organized and offered in health centers, and cover various health topics such as maintaining healthy pregnancies and managing chronic illness. In coordination with the Ministry of Health (Moyogalpa Hospital) monthly activities are carried out in each community to address emotional stability and well-being; specifically, with a goal of decreasing the risks for postpartum depression.
Currently, NDI has trained 15 promoters in different communities on the island. These promoters educate women on health topics, issues regarding human rights, and strategies for preventing domestic abuse and violence with an average of 10-15 participants. Participants are provided with travel compensation and refreshments.
Amongst the many activities of the program, one of the most important is crisis care and support in the judicial process for women victims of intra-family violence and sexual abuse. The DIOSA program is currently the only program available on Ometepe that offers comprehensive care, emotional and judicial support in the process of filing a case and going to trial. Many sexual and domestic abuse cases are not reported due to the economic expense involved in traveling off the island to carry out forensic examinations, to initiate trial proceedings, and to see a case through to completion. Providing economic support to the victims and their families is critical in obtaining justice for victims.
According to reports from the Ministry of Health, Nicaragua has the highest teen pregnancy rate; however, the general population still does not understand that, in most cases, teen pregnancy is synonymous with sexual abuse. On the island of Ometepe, the MINSA Pregnancy Club reports that six to seven out of 10 pregnant women are adolescents including girls 13-14 years of age. These children are treated as adults in the program and do not receive the much-needed attention that should be tailored to teens.
The program begins by providing “accompaniment” support by our team for the victim during their initial filing of a formal complaint to the police, followed by necessary medical examinations and forensic psychiatrist exams needed for a court case (all which occur off the island). Support continues until the conclusion of the trial and the sentencing of the aggressor in the state courts in Rivas, the same place where lawyers and prosecutors represent the victims. DIOSA has maintained an average support of three victims per month, covering expenses for the victims, their support network (usually family members), and any witnesses. NDI psychologist Lic. Lilliam Zacarias has brought an end to five trials in which the perpetrators have been captured and prosecuted in favor of the victim. Both the victims and their families are grateful for the confidence and strength they have found in the DIOSA program. With the program’s growing reputation, more victims are referred every day from other institutions on the island such as the Ministry of Health and the national police.
NDI continues to work with other institutions; namely, the national police, the Ministry of Families, the Ministry of Health, Ministry of Education, and has been central to creating stronger institutional relations in matters of solution and support for victims of intra-family violence, establishing a better system regarding transfer of care.”
What can be learned from a global health experience?
“Kindness and hope have been my two biggest take-a-ways. I am privileged. My needs have always been met. For many, my life is not reflective of the norm. Everyone has the ability to be kind. I have been on the receiving end of the most genuine kindness from so many who have been afforded less than I, and in many ways, they are far richer than I will ever be. I have learned that hope is the greatest gift. Hope is imparted in many different ways. Hope is trust and when we strip patients of hope, we inadvertently take everything away from them.
My work in global health has reinforced my understanding of cultural competence and how important culture is in the delivery of healthcare, and the relationship between the patient and healthcare provider. The patients are the most grateful, appreciative, and loving people I have ever met.”
Advice for aspiring NDs
“Mentally and physically, working in global health is exhausting and burnout is inevitable. Taking good care of yourself is absolutely essential. However, emotionally and spiritually, working in global health is by far the most rewarding experience I have known.”
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