Health in Latin America: Personal Account, Education (Honduras)
Access to education and the willingness to learn are crucial ingredients to improve the health of women throughout the world. Good health depends on an understanding of the human body, but also requires the knowledge to maintain a healthy lifestyle. However, access to that knowledge is often dictated by social and economic standing within a society. As a result, poor or rural women need to rely on different strategies than, for example, middle-class women in urban centers.
This source, the voice of a nurse and self-appointed educator in rural Honduras, makes clear that knowledge means survival. Her insights depict the lack of education, the limited motivation, and the lack of confidence among poor rural women. Ramirez’s story offers insights into the divergent and myriad needs of both rural and urban women in Latin America as they confront challenges to their health.
Consider the ways that class, geography, and urban and rural lifestyles affect how women learn about health. What additional circumstances in women’s lives should policymakers address when trying to improve women’s health?
IT ALL DEPENDS ON THE TEACHER
By Francisca Ramirez
I am a nurse. I have chosen to work with rural communities at this lowest level, especially the women, because this is where approximately seventy-three percent of our population is located. My goal is to help as many as possible to improve their lives, to take at least one step up. I am able to relate to these poor rural women because I have spent the majority of my years with them; I am one of them. I have found it to be a great advantage in my work with rural health clinics because there are no communication barriers between us. We speak the same language; they are comfortable with me and I with them.
The truth is that I have not always been equally as comfortable with professional people as I now am able to be, because my family was very poor. As a child, I wanted to be a nurse and was always pretending to treat my dolls, giving them injections, taking their temperature. As I grew older, I knew I had to do something constructive with my life. I am sure that this feeling was probably because my parents worked for missionaries who became my ideals. I was only able to become a nurse because they gave me a helping hand at the right time.
Motivating the rural woman—making her aware that she is not making as much of her life or helping her children as much as she is capable of—is one of the important things which must be accomplished before any real progress can be made toward moving our country from the past into the future. Motivating the woman to do something about her situation, to use her potential, is impossible if those who might help her cannot communicate with this shy, withdrawn person who lacks education and fears all figures of authority. Gaining her confidence and trust is imperative; she has to know you are her true friend. And you must never betray that confidence.
Any successes I may have had in my work are directly due to the time I have spent and the close relationships I have developed with these poor rural families, building their confidence and trust in me, not as their nurse, but as their friend. The successful running of a rural health clinic is a very personal affair. It is imperative to convince the people who come to you that children should be loved, cared for, fed, given medicine when they are sick, and educated. You are privy to intimate family problems and expected to give advice on everything.
It is difficult to work with poor rural women with no education and very little knowledge of their own bodies. Building their confidence and trust is essential, but an approach that requires time and great patience. Little by little, their confidence in me must be reinforced by experience. When they can see that they have a healthier baby because they have more milk, and that they have more milk because they changed their eating habits at my suggestion—then they are willing to trust me to make other recommendations. It takes time to change their ways, to convince them to incorporate new ideas into their daily lives, especially when you consider that by doing so, they risk the criticism and ridicule of their families, friends and neighbors. Sometimes, the old ways are so imbedded in their customs, that it takes years to prove a point.
Motivation plus confidence and trust has been the only successful approach to ridding “campesinas” of old wives’ tales and superstitions passed down to them from their parents and grandparents. Some of these ignorant beliefs are completely irrational and cause grave problems in their relationships with their children and other people, not to mention their eating habits, attitudes toward illnesses and family planning.
The poor “campesina” woman in Honduras is, without doubt, the longest-suffering element of our society. From earliest childhood, she has been forced to work. She has never had the chance to play with other children or to develop the ability to relate to other people through the kind of social contact that comes from school affairs and playground games. Almost since she was able to walk, she has been regarded by her parents as another pair of hands and feet. Because she is female, they also know she will not be able to bring in any money; therefore, she mainly represents another mouth to feed—something they don’t really need. As a result, they have no hesitancy in requiring her to carry out the most menial and degrading chores, which in turn, places her in the lowest esteem of any family member. From the viewpoint of the family, she is something to be used, but not worth much in the way of attention or upkeep. She almost never gets to go to school, and even when this is possible, she seldom passes beyond the second or third grade.
The female of the very poor rural family generally passes her childhood doing small chores and insignificant work. She has not had an affectionate or close relationship with her parents because they have had to work during the day, and at night everyone goes to bed early because they are very tired and because there is no light. By the time she is an adolescent, she has retreated into herself.
Fear plays an important role in her life. She trembles in the presence of authority, which up to now has been represented by her father and other men such as the village priest. Given the degree of fear she has developed for her parents and others in authority, she has never dared to ask many questions. When she is approached, at adolescence, by a young man who suggests an intimate relationship, she doesn’t know what to do. She doesn’t know whether she should or shouldn’t let him touch her; and whether it’s good or bad. She is afraid to ask her parents and, more often than not, succumbs to his advances because she has been starved for the warmth of a human relationship.
The reaction of the parents to the maturing of the girl and her attraction for the village boys is interesting. Although they have never paid any attention to her before, the parents now start asking who she is going to marry and when. One can suspect than an underlying motive could be getting rid of that extra mouth to feed. In any event, there are very few girls who do not marry—the younger, the better—since she will be considered a family embarrassment if she remains single for long. Once she announces her intention to marry, her parents begin to recognize her as a person; their reputation in the community is saved, their dignity maintained.
Sometimes when no more than thirteen or fourteen years old, this young, timid woman transfers her fear of authority to her husband. His voice alone represents power and command over her life; she must not do anything to arouse his anger. She knows she is supposed to take care of the house, the cooking and the washing; she knows she will bear the children, as did her mother before her. Beyond this, she knows little else.
Her belly becomes filled with children year after year because of fear and ignorance. She is afraid to refuse her husband his pleasure, and she does not know that she has alternatives. If she is made aware that it is possible to plan her pregnancies, fear and ignorance again work against her. She may be confronted by a husband who is unwilling to use contraceptives and refuses to allow her to use them, or a priest who tells her she is committing a mortal sin. If she crosses the husband, she is afraid he will leave her or beat her; if she crosses the priest, she will be condemned to Hell. When women come to me with this dilemma, they want to change their situation but they are afraid.
My role is that of a moderator, and if I am a good communicator, a change agent, as well. I tell her, “It really isn’t necessary to go against your husband—why don’t you bring him to a meeting some time? I’d like to meet him.”
If we are patient, she can usually persuade him to accompany her, and I listen to his objections, which may be rooted in superstitions such as, “I don’t believe in planning because the number of children you have is predestined.” Political propaganda can be blamed for other objections like, “We have to increase the population if we want our country to be powerful,” and, “Family planning is a capitalist ploy to keep the poor countries weak by reducing manpower.” Others are based on simple economics: “I need children to support me in my old age.” And then there is the simple reluctance to do anything which he construes as challenging his masculinity, such as “If she uses these things, what is to keep her from being unfaithful?” “If my children die I must be able to replace them,” or, “If I don’t have many children, my friends and relatives will think I am not a man.” I also suspect that men subconsciously feel their authority is being challenged by programs that are directed at women, and family planning programs almost always are.
Initially, the objections of the men are reflected by the women in their attitudes and their reluctance to discuss the problem. I usually point out that the more children they have, the more they will see die. I show them how fewer children are easier to care for and that when the family is small, life for everyone improves. With patience, most objections can be overcome.
The women I am talking about are those at the very lowest level, socially, economically, and educationally. They are completely out of the mainstream. They make no contribution to society except the dubious one of producing children who, like themselves, probably will barely exist, but not much more. We must help this kind of woman to become a useful person, not just a thing to be used like an animal. We must enable her to be productive by doing something to improve the quality of life for herself, her family and her community; not by producing one child after another to appease her husband’s ego.
Although the need to motivate the “campesina” to do something constructive with her life is a special problem in Honduras, it is not unique to her alone. It is a problem shared by all our women. True, the degree to which we are prepared to do something useful is affected by our access to education, but education alone does not seem to be the answer. Those who are fortunate enough to receive an education, but who are not motivated to use it may be as unproductive as the woman who has no education at all. Both represent a great waste of our human resources. Both are also a great potential force.
How difficult it is to motivate people! If only the women who give parties and get their pictures in the papers for supporting the various orphanages, old folk’s homes and other charities, would put their education to better use! In their way, they, too, are trying to accelerate the progress of their communities and our country, but they do only what tradition allows. They have not broken out of the past. Not that there’s anything wrong with this: it’s just that with their education they could do so many things that would have more lasting value such as helping people to help themselves. Unfortunately, the interests of most women revolve around their comfort in their own social world and at their own social level.
We usually base everything we do or believe on something we’ve already experienced, what our parents or our church taught us, or on what we perceive to be true in accord with our environment and the people around us. If Juan beats his wife, isn’t it mostly because his father beat his mother and the children, and as a little boy, Juan perceived that this was the way men were supposed to behave? Similarly, city women who have an education spend their time with clubs and associations where they can use their social graces and give parties because they perceive this is the lady-like thing to do. Their mothers, grandmothers and other women they admire did these things. Our society is less productive than it should be because we are handicapped by our cultural traditions that no longer serve us. Education is the best tool for changing ideas about superstitions and outworn status symbols, but much depends on the teacher.
Education can be an important element for social change in Honduras. Education, or lack of it, divides our nation. It is necessary to remember that all human beings can learn, and that social development is a process in which even the rich can participate. The woman who has an education and who lives in the city may not understand very much about the “campesina” or the effects of superstitions, poverty and fear on the life of the rural woman. She may find it hard to see any relationship between the plight of the ignorant “campesina” and her own situation, or believe that the poor rural woman has any potential for changing the economy, but the urban intellectual can learn, too. She need not waste her education. With her advantages, she can be of great value in helping the rural woman. Because of her friends and her education, a motivated urban woman who dedicates her efforts to changing conditions for her poor country “sister,” can influence many people, including the government. She can open the eyes and ears of the powerful to our country’s needs, where the problems are, and why. And she can become an educator.
The educator has the opportunity to become an agent of change. Because Honduras’ population is predominantly rural, anyone who plays the role of teacher can either reinforce traditional attitudes, or open up new ways of looking at life. It can be a great challenge. A good teacher learns from her students at the same time she is teaching; it is a reciprocal process that involves two-way communication. The basic elements are:
The communicator (the educator);
The message (the content of what the communicator is trying to get across);
The means of communication (instrument or method);
The receiver (the person or audience to whom the communicator directs the message); and
The effect of the message on the receiver.
The educator need not be a teacher in the formal education system. She might be a “promotora,” an agricultural advisor, a crafts instructor, a nun, a volunteer worker of any kind, or a health nurse such as myself. The important thing is that she must communicate her message successfully, and the measure of that success is whether the message has the desired effect on the receiver. In order to achieve the desired effect, the communicator must really know and understand her audience, as well as her own field of technical expertise. Communication will revolve around technical knowledge because that is the basis of the message, but the essence of its success lies with the ability of the communicator to be tactful in adapting her technical knowledge and her sensitivity to the intangible human elements. Tactfulness and sensitivity are perhaps the most neglected areas with the majority of people who try to establish relations to “teach” “campesino”women.
A message makes an impact on the “campesina” only when there is some possibility that it relates to her needs and she can respond to it. It must be a message that moves her to discuss the information it contains; therefore, it is most effective when it is transmitted with emotion, empathy, feeling—with human warmth and understanding. This requires that the communicator be well-acquainted with the social structure of the specific rural area, the social customs, traditions, problems and interests. The most successful teacher is the one who learns from her students, her audience. She hears what they say, feels what they feel, understands what they suffer and senses the meaning of their silences. She adapts her learning to the technical knowledge she is attempting to get across, and in the process many new ideas occur. When she shares her learning with her students, they become motivated, and the process feeds on the stimulation that occurs. Each fuels the other.
In a rural society such as ours, we desperately need all our resources. We cannot afford to waste anything, least of all our women. The woman who is educated can share her learning; the woman who has special skills can teach them to others. The others can acquire the learning and special skills, and teach them to their daughters and neighbors. The key is a kind of social maturity: the willingness and ability to communicate and collaborate. But it all depends on the teacher.
Ramirez, Francisca. “It all depends on the teacher.” In Latin American Women: The Meek Speak Out. Edited by June H. Turner. International Educational Development, Inc., 1980.