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La salud de los inmigrantes Nicaraguenses en la Zona de Monteverde
Health of migrant Nicaraguans in the Monteverde Zone
Health conditions and health seeking behavior of migrant Nicaraguans in the Monteverde Zone.
Condiciones de salud y comportamiento en la busqueda de salud de los inmigrantes Nicaraguenses en la Zona de Monteverde.
Nicaraguan migrants are exposed to unique conditions regarding labor, hygiene, physical stresses, and appropriate housing. These conditions vary depending on displacement and migrant status (i.e., temporary or permanent.) There is a significant presence of migrant Nicaraguans in the Monteverde Zone (ZMV), and while many of them share similar experiences, the realities of others are quite distinct. This study focused specifically on health conditions and health-seeking behavior, but other important data collected included information about migratory route, employment, and living conditions. The data allowed us to gain a general understanding of the present situation, needs, and perceptions of the migrant Nicaraguan community in the area. With this information we are able to make recommendations for future studies.
Los inmigrantes nicaragenses estn expuestos a condiciones nicas en cuanto al trabajo, el estrs fsico, y la vivienda adecuada. Estas condiciones varan segn su estatus migratorio (es decir, temporal o permanente). Hay una presencia significante de nicaragenses inmigrantes en la Zona de Monteverde (ZMV), y mientras muchos de ellos compartan experiencias similares, las realidades de otros son bastante distintas. Este estudio enfoca especficamente en las condiciones de salud y el comportamiento relacionado a la bsqueda de salud, pero otros datos importantes que se recolectaron incluyen la informacin sobre su ruta migratoria, empleo, ycondiciones de vivienda. Los datos nos permitieron lograr un entendimiento general de la situacin, necesidades y percepciones actuales de la comunidad de inmigrantes nicaragenses en la zona. Con esta informacin podemos hacer recomendaciones para futuros estudios.
Community health--Costa Rica--Puntarenas--Monteverde Zone
Health status indicators--Costa Rica--Puntarenas--Monteverde Zone
Community Health 2003
Migrant Nicaraguans--Health status
Health seeking behavior
t Community Health
HEALTH OF MIGRANT NICARAGUANS IN THE MONTEVERDE ZONE Researchers Rebecca Cashman Elizabeth Geier Roco Lora Rachel Stewart Joan Tucker Cassandra Workman Advisory Professors Nancy Romero Daza Elsa Batres Field Methods for Community Health Monteverde Institute June 21 to August 3, 2003
Abstract Nicaraguan migrants are exposed to unique conditions regarding labor, hygiene, physical stresses, and appropriate housing. These conditions vary depending on displacement and migrant status (i.e., te mporary or permanent.) There is a significant presence of migrant Nicaraguans in the Monteverde Zone (ZMV), and while many of them share similar experiences, the realities of others are quite distinct. This study focused specifically on health conditions a nd health seeking behavior, but other important data collected included information about migratory route, employment, and living conditions. The data allowed us to gain a general understanding of the present situation, needs, and perceptions of the migran t Nicaraguan community in the area. With this information we are able to make recommendations for future studies. Introduction This is a summary of the results of a rapid assessment concerning the migrant experience of Nicaraguans in the ZMV, with a pri mary focus on health. Other variables examined included: migratory route, economic conditions, and employment. The study was completed by a group of students in the Community Health Course at the Monteverde Institute during July, 2003. We interviewed nine teen people, ten women and nine men who live in the ZMV. Monteverde community members had identified the topic of this investigation as a priority due to a lack of information about the migrant Nicaraguan population. The study was an attempt to gain some Objectives The purpose of this study was to describe the lived experience, perceptions of health, and health seeking behavior among the migrant Nicaraguans in the ZMV. Specific objectives included: Detailed descriptions of living conditions. Exploration of risk factors, including a comparison between illnesses experienced in Nicaragua and in Costa Rica. Identification of resources sought/utilized when ill. Collection of participant opinions and pers pectives in regards to desired additional health care resources. The clinical perspective and health care procedures in relation to the attention given to migrant Nicaraguans in the ZMV. ssibility of health services. Methodology This was a qualitative investigation that used anthropological techniques such as Rapid Assessment Procedures (RAP) and direct observation. We used these methods in order to bring to light various aspects of the migrant Nicaraguan situation in the ZMV.
Rapid Assessment Procedures such as anonymous formal interviews enabled us to collect information about culture, habits, and Nicaraguan perceptions in relation to their health in a timely, organized fashion. Equal ly important methods such as observations and informal conversations offered additional information not collected through interviews alone. Keeping in mind the sensitivity of the topic and the vulnerability of the migrant population, we always asked permis sion to have an observer present, and we did not disclose any identifying characteristics of the participants. In an attempt to corroborate the data obtained from Nicaraguan participants, researchers conducted informal interviews with local health care pro viders. With the assistance of community leaders and farm owners who are acquainted with migrant Nicaraguans, we were able to contact participants in the ZMV. Additionally, we visited neighborhoods in which the majority of inhabitants are Nicaraguan. The researche rs went door to door explaining the purpose of the project and requesting interviews. We interviewed 19 Nicaraguan people over the age of 18 who reside in 4 communities in the ZMV. From these communities we spoke with an almost equal number of women and m en. In each household we also collected health related data about other family members. Therefore, in total, we gathered information about 71 Nicaraguan men, women, and children. Processing and Analysis of Information We transcribed and ordered the i nterviews and field notes in three phases: 1. Transcribed and entered data into Excel. 2. Analyzed qualitatively through coding and quantified data through the use of graphs. 3. Interpreted results. The information was processed and analyzed in Engl ish and Spanish. The research team shared results with participants during two informal gatherings in the community on June 29. In total, approximately 40 Nicaraguans attended the two meetings in Santa Elena and Caitas. The purpose of these meetings was t o provide results to the community and to obtain further input before the more formal presentation. Results were also presented to the Monteverde Institute faculty, staff and other community members during a formal academic poster presentation at the MVI o n August 1. Results Demographic Data Information about 71 people, with an average of 3 inhabitants per household. The majority had lived in a province of Costa Rica before coming to Monteverde and has been living in the ZMV for more than 3 years. The ave rage age of respondents was between 18 and 35 years. The level of education is very low: 18% have never been to school and 41% have not completed primary education.
Employment The majority of the population has a job, although 44% have temporary work. T he most common occupations are: agriculture, construction and commercial services. Labor conditions are partially covered: the large majority does not have social security. Few are granted days off, vacation, bonus, or payment for extra hours of work. Perceptions of Health : A healthy person is defined as a person who moves well and is able to work. A sick person is defined as someone who lacks energy, is sad, and cannot work. The maintenance of health is achieved through precautionary measures, mainly c oncerning proper nutrition and personal hygiene. Illnesses Illnesses experienced in Nicaragua compared to Costa Rica were generally more severe, although some illnesses were experienced in both places (i.e., cold/flu.) The most common illnesses experience d in Nicaragua included head ache, fever, asthma, malaria, dengue, allergies, cold, measles, and body/back pain. The most common illnesses reported in the last three months in Costa Rica were cold/flu and stomach problems. When seeking a remedy for the rep orted illnesses in the past three months, 47% of participants visited a clinic, 13% went to a pharmacy, and 20% went to a store to seek treatment. The remaining 20% did nothing. Of the 17 reported cases of cold/flu, 4 people went to the clinic, others w ent to a pharmacy (5), store (4), or went nowhere (4). Of the 11 reported cases of stomach problems, 5 people went to the clinic; others went to a pharmacy (1), store (3) or went nowhere (2). Perceived causes of illness were most commonly changing of clima te, coldness, viruses, and parasites. Perceptions of Resources Needed for the Improvement of Migrant Health. Most frequently noted include: Attention to migrants without documents and/or insurance (Seguro Social). Access to free services or improvement of current financial state (i.e. better jobs). Cultural sensitivity and the abolishment of discrimination and xenophobia on the part of the community at large. A need for more health care providers. Access to insurance for Nicaraguan migrants. More governm ent involvement in fostering equality and equal services for all. Improved communication between health care providers and Nicaraguans. Experience with a Health Technician The majority of the participants (73.5%) received medical attention within the last 5 months. 10.5% have never received medical care in the ZMV.
Of the respondents who received care, 84% described their attention as good to very good. Of those pleased with their services, the majority did not have insurance. Data revealed discrepancies b etween accounts of health care services. While some respondents were pleased with their experiences visiting a health care provider, others expressed their frustration and disillusionment, noting that they were under served. Observations The observations at the conditions of structures and at potential health hazards and precautions. Although there was some diversity among locations, there were several similarities. For examp le, most dwellings were makeshift, multi family structures, all of which had electricity, running water, and outdoor bathroom facilities. Also, houses had limited lighting due to few windows and sometimes only one door. Notable hazardous conditions inclu ded smoke filled rooms as a result of burning wood for fuel. In addition, waste water from sinks and showers settled on porches or in yards. In many homes there were often holes in the ceilings and walls and window panes were missing. In most cases, flo ors were swept and free of debris. These observations are limited because observers were confined to certain parts of the residence. Information from Health Care Providers According to health care providers at a local clinic: Any person can enter the c linic and receive services, regardless of whether he/she has Social Security. If one is without Social Security, he/she will be asked to pay 7.900 colones. This price includes medical attention and necessary medications. If the patient is unable to pay at the moment of care, he/she has one month to return and pay the fee. Regardless of whether one can pay the fee, he/she will not be denied attention. Pregnant women and children under the age of 18 receive service without charge. Complementary services for a ll include: vaccinations, contraceptives, and Pap smear exams. Conclusions Despite our initial doubts that there were many migrant Nicaraguans currently living in the ZMV, we found that there appears to be a sizeable permanent Nicaraguan community. Alth ough our research was not conducted during the coffee picking season (in which many migrants come to work), we discovered that there is a considerable number of Nicaraguans who remain throughout the year. Those who remain contribute greatly to the economic prosperity and productivity of the ZMV. They work in a variety of jobs, ranging from farm maintenance to hotel reception, and expressed to us the immeasurable importance of work. Many people we encountere d seemed to share the common hope that finding better work in Costa Rica would improve their lives. Unfortunately,
some of their hopes have not been realized finding a job can still be a struggle, as well as receiving a decent living wage. emphasis on the importance of work is important when looking at their perceptions of health as well. Many participants defined a healthy person as someone who is able to work, and work as an action that helps in the maintenance of health. According to the Nicaraguans we interviewed, the migrant population has specific health care needs, many of which are not being met. Preventable illnesses occur, remain untreated, and sometimes worsen due to a lack of resources or of free services. While some people are able to utilize existing services, others are hindered by work schedule, distance from care, or inability to pay. Although the health maintenance of migrants seems to often be compromised, there is reason to hope that the situation might improve. Bot h members of the Nicaraguan community as well as local health care providers conveyed a strong interest in strengthening lines of communication and bettering access to services. While there is much room for improvement, there is also a will to provoke cha nge. We also noticed a potential for community building among the Nicaraguan community itself. As evidenced by our community presentations, people are willing to travel long distances if there is a forum in which they can exchange ideas, and share and re ceive knowledge. The emergence of leaders among the Nicaraguan community might help to facilitate and organize regular meetings. Meetings could be an opportunity for participants to collaborate and identify what they want to accomplish; perhaps they would assist in providing the community a stronger voice. It seems that a full community effort is necessary in order to improve the situation of migrant health and migrant acceptance in the ZMV. Nicaraguans themselves, as well as various community members a nd leaders might consider fostering more education and understanding about Nicaraguan realities, struggles and desires. More widespread knowledge about the migrant experience in general could help to break some of the existing barriers and help people iden tify what this population lacks in the ZMV. Recommendations for Future Studies Conduct the same study using a larger sample size A more in depth study of access to health care services, with a focus on uncovering the realities versus the perceptions of ca re. A study specific to coffee pickers and their experiences and health care access while living temporarily in the Zone. An epidemiological study. Limitations Identifying the pop ulation while keeping in mind their vulnerable migrant situation. We had a very brief period of time in which to collect, organize and analyze information. The majority of the group members are not native Spanish speakers.
Group work among people with a la rge variability in age, profession, language and culture. Acknowledgements The Migrant Health project research team would like to thank the following people: Foremost, thanks to all of the Nicaraguan participants who agreed so generously to share their time, knowledge, and experiences with us. The personnel at the Santa Elena Clinic, particularly Dr. Mauricio Quesada and Novelty Castro, for their time and colla boration. Milena Barrientos, No Vargas, Seidy Torres and Tony Santamara, for their support and for providing contacts. Elsa Batres for her constant attention and for organizing all the logistics of the project. Nancy Romero Daza for her knowledge, advice and insight.
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