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