The Ministerio de Salud (MINSA) and the Nicaraguan government, in the sixth year of the National Health Policy, can cite some impressive accomplishments in its recent history. In 2006, the Centro de Salud Silvia Ferrufino was built, with funds from the European Union, to attend to citizens living in Managua’s District 6. In 2009, the Centro de Salud La Primavera was constructed as a local clinic to provide medical consultations to residents of the barrio La Primavera. National policy promises free, high quality health and medical care to every citizen, regardless of class or financial situation. As a result, MINSA has an established basic program of care, free, public hospitals and clinics, and medications available at the time of consultation or examination.
This free, high quality of care and availability of medications, although a proclaimed goal and a supposed accomplishment, is not universally available. Various situations, including long waiting time, deficiency of monetary and pharmaceutical resources, and lack of medical personnel hinder national policy from being fully realized. I endeavored to explore how the perception compared with the reality of health care for women living in the La Primavera barrio in Managua, one the poorest areas of the capital city. To do so, I visited the Centro de Salud La Primavera. During my visits I witnessed consultations and spoke with doctors and volunteers working in the center. Since this center most directly serves the women of La Primavera, I felt it would provide me with the most accurate depiction of their ordinary encounters with health care. I also visited the Centro de Salud Silvia Ferrufino to speak with a Nutricionist, a Docent, and health care workers and the Hospital Aleman to speak with doctors and nurses. These two sites are bigger and see patients from a broader area of Managua. By exploring a variety of places, it was possible to see the different sites, resources, and varying levels of care available to these women.
In addition, I interviewed women who are residents of this barrio, many of whom are single mothers and heads of their households. Through a survey and an interview with each of the women, I learned about their personal experiences with illness and medical care, the experiences of their children, household routines to promote good health, community programs to teach preventive medicine, family planning practices, and their general opinions and beliefs about the health situation. These conversations revealed inconsistencies between experiences of individual women as well as between the written and implemented government policy.
As the researcher, I oftentimes felt frustrated by the inability of the health policy to truly effect change in the lives of these women. In almost all instances, health care providers and women receiving care recognize that poverty is the greatest determinant of health, as the National Health Policy also recognizes. Attempts are made to better health by improving, at least in principal, access to and quality of care. Addressing sicknesses as they appear, and even treating chronic illnesses through regular appointments and consistent medication, only begins to tackle the health dilemma. Health and wellness will not improve for these women unless steps are made to drastically change their living situations and the conditions of their daily lives. By treating illness, doctors can only provide temporary relief, without significantly eliminating the cause of poor health.