Sitting on the steps of her house– 18 years old and pregnant with her first child– Rosybel Blandon listened to a community health worker sensitize on reproductive health. Motivated by the health promoter’s insight on women’s health challenges , she thought to herself, “hey, I could do this”.
Years later, Rosybel goes door to door, wearing an apron equipped with condoms, charts, and diagrams and a dildo. “Buenos Dias,” she says, “I am a health promoter. Let’s talk about health- health of the family”.
From sensitizing high-risk communities in illicit spaces to creating a network of support for women with cervical cancer, Rosybel is a dedicated community health pioneer whose work inspires a healthier future for Nicaraguan women.
Rosybel Blandon works for Clinica Fara in Matagalpa- a renovated textile mill from the Somoza reign. She has worked with mothers, daughters, cancer patients, convicts, sex workers, boys, and fathers. Through determination and creativity, Rosybel raises awareness about health and increases access to treatment across Nicaragua.
“I dont know what it is about my face” she says, “but people always listen”. It is not only her easy smile and focused gaze that makes her an effective health promoter: she is a good communicator, not shy, loves what she does, and “likes to be listened to”. When she was little she would demand attention from her siblings and give lecturas. By now, they are well versed in reproductive health. She is a “committed woman,” Sue Howe- who works closely as a health advocate with Rosybel- believes.
Committed women and passionate health promoters are crucial tools in combating diseases that predominantly affect women in Nicaragua like the Human Papillomavirus (HPV). As access to medical tests and treatment can be expensive and time consuming, HPV, which develops into cervical cancer, proliferates in the poor and rural communities. As a health promoter, Rosybel has spearheaded initiatives to increase HPV screening and created a network of transportation for women who seek treatment for cancer.
Rosybel travels in a mobile clinic, sometimes three hours on compromised roads from the nearest clinic, to reach communities out of touch with the medical network. There, the mobile clinic screens and diagnosis women on the spot. Typically, a PAP smear takes three months to schedule and another three months to diagnose. Rosybel however, facilitates a naked-eye visual inspection of the cervix with acetic-acid wash (VIA), to diagnose HPV lesions on the spot by trained Nurses, saving women up to 6 months and hundreds of cordobas in transportation fees. Additionally after a VIA exam, the mobile clinic is equipped to treat pre-cancerous lesions using cryotherapy.
Transportation remains an obstacle for treatment of HPV infections that progress to cervical cancer. Women can only receive treatment in Managua for cervical cancer. Through commitment and convincing, Rosybel established a relationship with the bus services across the country to allow women with cervical cancer to travel to Managua for free to receive chemotherapy.
Even as Rosybel has helped make screening, diagnosing, and treatment more efficient and accessible to women, the biggest challenge is helping women come to terms with their prognosis. “Is there something to be done?” women ask. “Yes” Rosybel replies, “”but you have to want it.” Rosybel inspires that together they can fight the cancer. “Sometimes it takes thirty minutes, sometimes they cry, but I wait and say: let me know when you are ready to continue”.
There’s an overwhelming amount of work to be done to advance women’s health in Nicaragua and Rosybel can’t do it alone. According to the World Health Organization, Nicaragua has one of the highest cervical cancer mortality rates: 19.4 deaths per 100,000 females compared to the 3.1 deaths per 100,000 females in the United States of America. As a health promoter, Rosybel helps countless woman perched on steps outside houses and inspires many to don an apron with reproductive health tools. “I believe when women walk,” Rosybel says with certainty, “they leave footsteps”.
-Henry Elliman & Rubén Monárrez