Breakthrough Patient Recruitment

: A Different Kind of Mobile Health—Portable Education Kits in Rural Nicaragua

A Different Kind of Mobile Health—Portable Education Kits in Rural Nicaragua

Project Manager

In March of this year, my mom, Dixie Havlak, a registered dietician, went on an 11-day trip to the rural river regions of Nicaragua to share nutritional and other public health knowledge with the local communities.  We typically think of mobile health as technology-driven interventions, but this project was centered around portable plastic boxes filled with a variety of educational materials. To learn more about the project, I conducted this Q&A session.


Tell me about the project. What are the key areas it is addressing?


The project is funded through an I-CATCH grant, which is designed to fund the support or creation of community-based activities for child health or to increase access to health services in low and middle-income countries. The grants are awarded to programs that have potential for replication in other communities, but the projects must originate in the community in which they are implemented. Working together with a group called Accion Medica Cristiana, (AMC) I applied to create mobile health education kits that provide resources for health education in hard-to-reach locations.


The target community was a minimally literate community along the Prinzapolka River in Nicaragua. Most of the residents speak Miskito, although some also know Spanish. The only electronic access that these communities have is some radio access originating from larger towns along the river. There are no roads-all the access is by boat. AMC had previously identified significant need for improvement in nutrition and sanitation. Health services in the area are provided by mostly illiterate midwives.


The grant is small-$6,000 over three years-but that goes a long way in Nicaragua. During this first visit, the focus was on nutrition for pregnancy and lactation, designed for training midwives. We also created kids' nutrition kits for teachers, which provide materials for use in the classroom. These will be loaned out among the communities.




Tell me about the trip.


I spent four days just learning about what foods were available and common and what public health services were available. I went to farms, stores, and other local hangouts. I spent time with the AMC staff and met with the nurse who would be implementing the kits. Then for six days we traveled by boat up and down the river, camping in schools and churches and visiting seven communities. In each one, I met with the midwives and teachers to introduce them to the kit material.


We tried to maximize the use of local health professionals by providing them with tools, educational background, inspiration, and encouragement. Encouragement is very important because their daily tasks and obstacles are often overwhelming-they work in areas where people are ignorant of the basics of health, nutrition and sanitation and have minimal resources. Getting an infusion of ideas and enthusiasm really helps keep them going.


What is in the kits?


The kits are portable, highly visual, and hands-on. The contents are designed to be as versatile as possible so that they can be used with a variety of audiences and through a variety of media. The information is presented in two forms: simple statements and support material. Among other things, there are felt boards with Velcro items, such as pictures of food with very basic nutrition information. One of the most fun things in the kits are puppets that could be used in a show or on the felt boards to illustrate big nutrition ideas.




What were the biggest challenges you faced?


The concepts of nutrition and nutrients are not well understood. There is no Miskito word for nutrition, so we introduced both the Spanish word and the concept. It was a challenge to keep the concepts very simple but manageable. For example, you can't just abolish junk food; you must establish why it is bad and make reasonable guidelines surrounding it. Although some towns have bilingual people, the smaller towns mostly just speak Miskito. One big issue on the global health level is that although there is a wealth of information and resources in developed countries, it is hard to translate the information and make it useful for other communities.


We also found that there was a pretty severe avoidance of protein post-partum, which caused a lot of problems for both mother and baby. They often wean babies with sugared beverages, which can lead to health and dental problems.


What are your goals for the future?


I really hope that the mobile education kits will continue to be used within the communities. I hope that the materials and the concept of these kits can be used by other non-profits working in Central America and elsewhere. I actually got an email from a pediatrician in AAP after I got back who had a colleague going to another Central American country, so I forwarded all of my main materials to her so she could make her own kits!




Despite all the great public health advances that can be made with technology (what we typically think of as mobile health), there are still plenty of areas of the world in which, for example, a text message-based intervention to improve maternal health is simply not feasible. In these areas, you can often get the most impact by going back to the basics.



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