HEALTH OF NICARAGUAN MIGRANTS IN THE MONTEVERDE ZONE Monteverde Institute Fields Methods inCommunity Health 2003 Rebecca Cashman, B.A. History. Monteverde Institute Elizabeth Geier, International Health Student, Friends World College RocÃo LorÃa, Anthropologist. IRET Researcher, National University Rachel Stewart, Anthropology Student, University of South Florida Joan Tucker, M.A. Anthropology Student, University of South Florida Cassandra Workman, M.A. Anthropology & Public Health Student, University of South Florida
This study concerns the migrant experience in the Monteverde Zone, with a primary focus on health. The variables examined include: migratory route, economic conditions and employment, health. We interviewed nineteen people (ten women and nine men) (n=19) who live in various locations around Monteverde and collected information about seventy one (n=71) people including family members.
The purpose of this study was to describe the lived experiences, perceptions of health, as well as health seeking behavior among the migrant Nicaraguans in the Monteverde Zone . Specific objectives include: 1. Detailed descriptions of living conditions. 2. Exploration of risk factors, including a comparison between illnesses in Nicaragua and Costa Rica. 3. Identification of resources sought/utilized when ill, as well as a gap analysis of available services. 4. Collection of participant opinions and perspectives in regards to desired additional health care resources. 5. The clinical perspective and health care procedures in relation to the attention given to migrant Nicaraguans in the Zone.
Qualitative investigation utilizing anthropological techniques such as Rapid Assessment Procedures (RAP) and direct observation . RAP methods 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. Equally important methods such as observations and casual conversations offered additional information not collected through interviews alone. In an attempt to corroborate data, researchers had casual interviews with local health care providers at a clinic and pharmacy.
Demographics: The majority of migrants have lived in the ZMA for more than 3 years The majority of Nicaraguan immigrants have employment, though 44% have only temporary work Most common occupations include agriculture, construction and commercial service The vast majority do not have Social Security The level of education is very low, 18% have never been to school and 41% have not completed primary education
Observations: Diversity among Nicaraguans living conditions (directly related to employment status) Most dwellings were non standard, multi family homes. All had electricity, running water and outside washrooms
Hazards: Most were small with poor ventilation Close living quarters Grey water run off Exposed wire Problems with construction Animals close (zoonoses?) Chagas?
Perceptions of Health: As work is the primary reason for having emigrated to Costa Rica, it is not surprising that most migrants defined a healthy person as someone who is able to move around well and who can work A sick person is defined as someone who lacks energy, is sad, and cannot work Prevention is important, though often not achieved
Illnesses: Illnesses experienced in Nicaragua were generally more severe, although some illnesses were experienced in both places (i.e. cold/flu) The most common illnesses reported as experienced in the Zone are cold/flu and stomach problems Treatment sought in the past three months: 47% went to the clinic, 13% went to the pharmacy, 20% went to the store, and 20% did nothing
Perceived Causes of Illness:
Information from Health Care Providers: Any person can enter the clinic and receive services, regardless of whether he/she has insurance If a person lacks insurance, he/she will be asked to pay 7900 colones. This price includes medical attention as well as any needed medications. If the patient is unable to pay for the service, he/she has one month to return and pay if possible ( una factura ). Even with outstanding facturas, people will not be denied treatment Pregnant women and children under 18 receive service free of charge Complementary services include: vaccinations, contraceptives, and pap exams
Experience with Health Care Providers: The majority of participants (73.5%) received medical attention in the last 5 months 10.5% have never received medical care in the ZMA Of those 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 between accounts of health care services. While some respondents were pleased with services, others noted frustration and disillusionment, noting that they were underserved
Perceptions of Additional Needed Resources for the Improvement of Health: Attention to migrants without documents and/or insurance Access to free services and/or improvement of current financial state Cultural sensitivity and attention to xenophobic attitudes about Nicaraguans A need for more health care providers Access to insurance More government involvement in fostering equal services for all Improved communication between health care providers and Nicaraguans
Conclusions: Despite initial doubts, a considerable amount of Nicaraguans remain in the Monteverde area year round Those who remain contribute greatly to the economic prosperity and productivity of the ZMA All expressed the immeasurable importance of work All respondents held onto the notion that more secure work would improve their lives Unfortunately, some of their hopes have not been realized
According to the Nicaraguans interviewed, the migrant population has specific health needs that are not being met Preventable illnesses occur, remain untreated, and often worsen due to a lack of resources or free services While some are able to utilize existing services, others are hindered by work schedule, distance from care, or inability to pay
Although the maintenance of health is often compromised, there is reason to hope that the situation will improve Both members of the Nicaraguan community as well as health care providers conveyed a strong interest in improving communication and fostering relationships As evinced by our community presentations, many people are willing to travel long distances if there is a forum in which to exchange ideas
We noticed an interest in community building among the Nicaraguans in the Zone Meetings could be an opportunity for migrants to collaborate and identity goals perhaps giving the migrants a stronger voice over their needs It appears that a full community effort is needed to improve migrant health and general well being
Recommendations: Larger sample size More in depth studies Future studies focusing primarily on the health of migrant agricultural workers (coffee harvesters) migrant Nicaraguans Epidemiological studies
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Salud de los migrantes Nicaragenses en la zona de Monteverde [Power Point]
Health of Nicaraguan migrants in the Monteverde Zone [Power Point]
Health conditions and health seeking behavior of migrant Nicaraguans in the Monteverde Zone.
Condiciones de salud y comportamiento de bsqueda de la salud de los migrantes Nicaragenses en la zona de Monteverde.
Public 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