Economic Dimensions of Children in Central America: Focusing on Nicaragua

Introduction:

I am very honored to be here to share information and experiences about the economic dimensions of children in Central America and in particular in Nicaragua, because as a woman, nurse and a citizen of Nicaragua I am a part of the reality our children live in that part of the world. Therefore, the spirit behind all of these, is to share my own experiences of what I live, see and feel everyday in Nicaragua and other countries of C.A., what are the challenges we are facing as nurses; what is being done and what can we do as nurses, to contribute to bring hope to our children.

Social and political context - Population 4,252.382 (mixing of Spanish and Indians, Afro American Indians)

Nicaragua in the past decade went through a war. Now, the war has ended, in spite, of the fact, that there are groups of armed people that are threatening civilians in remote areas.

Guatemala, still lives under a serious social political situation in which children in general and the indigenous children experience the undermining of their liberties and rights.

According to a report of the Pan American Health Organization regarding Maternal and Child Health in Latin America (1995), there has been a worsening in absolute and relative terms of poverty levels and indigence, a rise in unemployment rate and inequity in the distribution of wealth, giving as a result, an increase of income to 5% of the more richer population, and a decrease to the 75% of the poorer population. There has brought as a result, the reduction of the possibilities for children, adolescents and women, to health education, specially because they represent 70% of the population, and they play a crucial role in the development process of the region.

The political unrest experienced in Central America has had an impact in the social economic conditions of children. Many children in Nicaragua are orphans as a result of the war. There are approximately 24,000 children who have lost one of their parents, and 10% of them have lost both.

The rupture of the family bonds has been mostly the result of the social economic situations that cause the migration from the rural areas to the city and from one region to another. According to a study conducted by UNICEF in 1994, more than 200,000 children and their families have been displaced, having experienced multiple migrations,that have been detrimental to their emotional stability and development.

The foreign debt of the Central America countries, is a burden that has been imposed upon the poorest . Nicaragua, has a foreign debt (1993) of approximately $10,907.2 million dollars, the per capita highest one in the world ($2,700 U.S. per each Nicaraguan). On the other hand, Nicaragua receives one of the highest per capita incomes as a result of foreign aid, however, 90% of the aid, goes to pay the foreign debt. The Nicaragua government, in a effort to reduce public expense has reduced the number of public employees. As a result, we have over 60% of economically active population (EAP) unemployed.(Central Bank of Nicaragua, report, published in Barricada newspaper, 1993, page 11). An average income per year in Central America ranges between $800 to $1000 a year. (A nurse average salary is between $60 to $80 U.S. dollars per month).

The overall economical situation has deprived many children to live with dignity. They have to play the role of the provider in many families in Central America.

A study conducted by UNICEF in Nicaragua in 1994 revealed, that, 75% of the children are qualified as poor, 28% live in "houses" made out of cardboard, plastic, or wood. In rural areas, 48% of families live in very poor housing.

In Central America poverty condemns thousands of children to work from the age of 5. There are many families in which one or two parents do not have a job. In Nicaragua, more than 100,000 boys and girls do some kind of work to secure the survival of their families; 43% of them do not attend school and 50% in rural areas. In the urban area of Managua there are as many as 300,000 street children.

Many of these children are targets for sexual abuse, violence, car accidents. These are the children considered to live under especially difficult circumstances. Many become drug addicts, alcoholics, as a way of escaping form their reality and their unsatisfied needs.

Education of Children in Central America

The children who are poor face the worst condition of pre-school education. In Central America, most children do not receive this type of education. In Nicaragua, 90% of the children do not attend pre-school, and the ones that do, come from the urban areas. In the rural areas only 3% of the children have access to this type of education. In Latin America only 6 out of 10 children who start primary school are able to finish it.

Health of Children

In spite of the improvements that are being made in Central America regarding health and infant mortality rate. There is still a high infant mortality rate. In Nicaragua 81/1000 live according to UNICEF, 1993 a rural report.

Diarrheic disease are still one of the leading causes of death in children below 1 year and the main cause of mortality in children 1 to 4 years (PAHO, MCH goals for 1995).

Malnutrition

Is closely related to the social economic conditions . PAHO has exposed, that in Latin American and the Caribbean, malnutrition is a product of a chronic process and under-feeding, generally associated with environment and heredity factors.

After seeing a not very promising situation there are some efforts being made to help overcome these problems.

1. The health industry of Nicaragua is placing an emphases on MCH at the hospital and community levels, however, very little has been to examine the cause of the problems.
2. There are NGOs that are working with displaced children and orphans. They have been the most effective - other international organizations work in Nicaragua as well.

Challenges Nurses Face in Nicaragua

1. As a professional group- Nurses do not have yet a legislation- therefore we have not established a clear role for nurses in dealing with abused children or children under specially difficult circumstances.
2. We have concentrated our efforts in giving "medicine" to the children, and looking at violence as a part of the culture. Parents can do anything with their children, because of an attitude of "...I gave birth to you."
3. There are no Nursing Pediatric organizations per-se among nurses.
4. There is no "Pediatric Nursing" as an area for specialization in any school of Nursing.
5. There are only 3,000 nurses in the country of 4,252,382.

What can we do?

We need:

1. to reach out for children's organizations and work together in the communities where they have their programs. One example is NGO'S our school of nursing is establishing a relationship with them.
2. to call to the attention of the Nicaragua Nursing Association our responsibly to support the efforts of the government to pass the legislation against violence in children, and to form a plan for economical and social policies - something viable and concrete.
3. to include in the Nursing curriculum in the area of MCH topics regarding children in especially difficult circumstance.
4. to call on other schools of Nursing to get together and discuss these issues and suggest concrete actions.
5. to include the possibilities of having an specialty in Pediatric Nursing in Nicaragua in our school of Nursing
6. to network with other schools of Nursing in Central America and Mexico and USA to seek possibilities of scholarships for faculty to be prepared to teach nurses in the country in order to meet the health care needs of children and their families.