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Program Proposal
Viaje a Panamá
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Here is the grant proposal that I wrote on behalf of the community.  I apologize for the problems with font and spacing... I'll fix it up a bit more when I have time.   I also wrote it in Spanish and if for some reason you'd rather read it that way let me know and I can send it to you.  
 

II. Project Description

 

A.  Background and Justification

The communities of Altos del Valle and El Valle Abajo (collectively referred to as Los Valles) are located in the District of Kinkintu, which is part of the region of Buri, situated in the Province of Bocas del Toro.  These two communities are part of Comarca Ngöbe-Buglé and therefore operate according to the laws of this political system (a more detailed explanation of this system can be found in the “Beneficiaries” Section).

 

In general, the indigenous population lacks access to basic health services due to geographic, economic, and cultural barriers, which has resulted in high levels of poverty and extreme poverty among this group.  A 2001 study published in La Prensa found that in the indigenous areas of Panama 94.5% of the population lives in poverty, with 86.45% falling into the category of extreme poverty.   The study also found that in general the incidence of malnutrition has a tendency to reflect the ethnic and geographic patterns of poverty, with approximately 66% of children in indigenous areas suffering from malnutrition, and with the highest incidence found among the Ngöbe-Buglés.

 

In reality, the presence of malnutrition within a community projects its influence on a number of social and economic factors, all of which cannot exist independently of one another.   Agriculture, climate, cultural patterns, transportation, education, and religion all influence and are influenced by the presence of malnutrition within the community.  Within those factors most strongly influencing the nutritional status of Altos del Valle, and El Valle Abajo the following can be found:

§ Lack of education (basic education and environmental education)

§ Difficulties in physically accessing the community of El Valle Abajo

§ Limited access to drinkable water

§ Remote geographic location and resulting limited access to services

   (i.e. employment and education)

§ Limited access to food

§ Lack of sources to generate income

§ Very limited access to health services

§ High levels of parasitic and bacterial infections

§ Insufficient Diet

 

MOCELVA volunteers completed an in-depth analysis of both communities in April of 2004 in which the members of both communities were weighed and measured.  An analysis of these statistics found a strong presence of malnutrition, and concluded that children under the age to be most effected.   In Altos del Valle, 62% of the children under the age of five suffer from degree of malnutrition. 38% falling under the category of Mild Malnutrition (Level 1), 20% within Moderate Malnutrition (Level 2), and 4% suffering from Severe Malnutrition (Level 3).   In El Valle Abajo the situation is worse with 81% of the children under five afflicted.  Of these 29% are afflicted by Mild Malnutrition, 33% by Moderate, and 19% suffer from Severe Malnutrition.

 

Table 1: Nutritional Status, Altos del Valle, April 2004*

 

0-5 Years of Age

5-19 Years of Age

Overweight

 

2 (6%)

Slightly Overweight

 

4 (12%)

Normal

9 (38%)

24 (70%)

Mild Malnutrition

9 (38%)

4 (12%)

Moderate Malnutrition

5 (20%)

 

Severe Malnutrition

1 (4%)

 

 

Table 2: Nutritional Status, El Valle Abajo, April 2004*

 

0-5 Years of Age

5-19 Years of Age

Overweight

 

2 (2.5%)

Slightly Overweight

 

2 (2.5%)

Normal

13 (19%)

61 (78%)

Mild Malnutrition

20 (29%)

13 (17%)

Moderate Malnutrition

23 (33%)

 

Severe Malnutrition

13 (19%)

 

*Source:  MOCELVA Survey and Analysis

 

These findings are alarming for several reasons, the primary being that indigenous communities in Panama are experiencing a rapid increase in growth, resulting in an augmented number of children under the age of five, and it is this segment of the population that suffers the most when afflicted by malnutrition.  Numerous studies have found that malnutrition within the first few years of life can lead to irreversible physical defects and permanent brain damage.  The combined effects of malnutrition, intestinal infections, diarrhea, and respiratory infections lead to a high percentage of illness and death among young children and infants in these communities.

 

Due to these alarming statistics as well as the general nutritional status of the communities, MOCELVA is prosing the following project to assist the communities of Altos del Valle and El Valle Abajo to lower the level of malnutrition among those children under five.   Furthermore, this project proposes to take a preventative approach by providing basic health education to the women and children in the communities which will in turn lead to an improvement in the status of health and well-being among the community members.

Possible Solutions

1.      Strategies that could be used to improve the nutritional status of the communities include the following:

a.       Establishment of educational programs on health and nutrition utilizing government resources and those of various NGOs (i.e. MOCELVA)

b.      Establishment of dietary guidelines adjusted to accommodate available food sources in the communities

c.       Participation of other social organizations and NGOs (Patronato de la Infancia, Nutre Hogar)

d.      Skills-Based learning approach (executed through classroom instruction and one-on-one intervention through home visits)

e.       Case Management and ongoing monitoring of those most severely affected by malnutrition

f.        Curative and preventative assistance from MINSA with:

                                                               i.      Vaccinations

                                                              ii.      Medical Emergencies

                                                            iii.      First Aid education

                                                            iv.      Assistance with control and prevention of intestinal parasites and skin infections

 

It is in the opinion of this organization that when taking into account environmental influences, historical and structural factors, and the social organization of the community, the ideal manner in which to work with the communities is to utilize a participatory program focusing on nutritional education and sustainable solutions.   Additionally, the primary focus of the project should be placed upon improving the nutritional status of those children less than five years of age, as this group is that most strongly affected and harmed by the presence of malnutrition.

 

Current Programs and Projects

At this time there are various NGOs and government groups working periodically with the communities of Altos del Valle and El Valle Abajo including:

 

§         MINSA (Ministry of Health)

§         MIDA/Rural Health

§         Nutre Hogar

§         Patronato de Nutricion

 

Of these groups, Patronato de Nutrition is the only that works consistently with El Valle Abajo and in a manner that will have more long term effects as they are constructing a sustainable farming project in the community that will be managed by the organization for a term of 10 years.    MOCELVA however, is currently the only organization that places a volunteer in the area on a full-time basis and this integration into the community is a strength in the ability of our organization to both recognize the needs of the community, and respond in a manner that will lead to sustainable changes in the communities.

 

A.  Desired Results

 

Final Results

Using the methods outlined in this proposal it is hoped that at the conclusion of one year the following will have been achieved:

§         That the members of the communities will have a better understanding of the human body, the importance of good nutrition, and illness and disease (including forms of prevention), with special emphasis on the needs of pregnant and lactating women, and those children under the age of 5.

§         Increased levels of food and water safety through education on food handling and water purification techniques

§         Development of a preventative focus on health both through the educational seminars and the establishment of Health Resource Center.

 

In all activities and projects a focus will be placed on encouraging and consistently increasing community involvement and participation in order to achieve more sustainable results.

 

For those children under the age of five suffering from malnutrition it is hoped that at the completion of the project the nutritional levels of these children will have seen the following improvements:

     CURRENT                                            AFTER ONE YEAR

Altos del Valle

  38% Normal                                       50% Normal

48% Level 1 (Mild)                                 40% Level 1 (Mild)

  14% Level 2 (Moderate)                   10% Level 2 (Moderate)

El Valle Abajo

 19% Normal                         35% Normal

29% Level 1 (Mild)                 25-30% Level 1 (Mild)

33% Level 2 (Moderate)           25-30% Level 2 (Moderate)

 19% Level 3 (Severe)              5-10% Level 3 (Severe)

 In addition to the general objectives of this project it is hoped the following quantifiable measurements will be obtained at the end of one year:

§         A rate of 40-50% community participation in organized classes and activities regarding health and nutrition as well as with the development and maintenance of the sustainable farming project in the community.

§         70% positive evaluation by students at completion of courses in regards to quality and satisfaction with material produced and presented

§         Informational report reflecting activities and results every three months

§         Existence and operation of a Resource Center

 

C. Beneficiaries

 

General Characteristics of the Ngöbe-Buglé

The Ngobe group is the largest indigenous group in Panama with about 180,000 members, and together with the Bugle inhabits the majority of the Comarca Ngöbe-Buglé, an autonomous region that covers part of the provinces of Chiriqui, Veraguas, and Bocas del Toro.  The Comarca Ngöbe-Buglé is the result of a 40-year struggle by the Ngöbe-Buglé people to attain the right to govern their own territory.

 

The Comarca Ngöbe-Buglé is one of five Indigenous Comarcas that currently exist in the Republic of Panama.  The Comarca was established by the 10th Law of March 1997, and is governed through it’s own carta organica, or regional constitution by parallel traditional authorities and representatives of the Panamanian government.  The guiding principles of the Comarca aim to maintain cultural homogeneity, the traditional cultures and traditions of the people.

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On small farms, Ngöbe-Buglé men practice a style of sustainable farming that utilizes slash and burn techniques and through this produce: corn, yucca, rice, bananas, pixbae, and other fruits.   During harvest season more than half of the population migrates to coffee, banana, and sugar plantations where they are able to earn a salary (about 3-4 months of each year).  The administration of the home and the production of traditional crafts are performed primarily by the Ngöbe-Buglé women.  They also support the men strongly in agricultural tasks and replace them in their absence from the farms.

 

The National Census conducted in the year 2000 registered a population of 110,080 persons in the Comarca.  Within the last 10 years the growth rate for this population has been 4.27%, compared to a national rate of 2%.  This equates to a youth population (under the age of 18 of age) consisting of almost 60% of the total population.

 

The population in Altos del Valle and El Valle Abajo is comprised of approximately 400 people, distributed by sex and age as follows:

 

 

 

Table 3:  Community of Altos del Valle.  Population by Sex and Age (April 2004)

 

Female

Male

Total

Under 5 years of age

15

9

24

5-19 years of age

16

18

34

20+ year s of age

47

25

72

Total

78

52

130

 


Table 4:  Community of El Valle Abajo.  Population by Sex and Age (April 2004)

 

Female

Male

Total

Under 5 years of age

35

32

67

5-19 years of age

31

45

76

20+ year s of age

28

16

44

Total

94

93

187

 

Altos del Valle has both Latina and Indigenous members, while in El Valle Abajo the population is 100% Indigenous.   At the time this proposal was completed, approximately 317 members of the community were visited and statistical information gathered from each.

 

Culture and Religion

Throughout the years, the Ngöbe-Buglé have managed to maintain their core religion, social organizations, and traditions but they are a dispersed population.   They live in numerous separate communities and speak no less than five distinct dialects.  The Ngöbe-Buglé male can have as many wives as he can afford to maintain.   The head of the tribe is called the “Casique” and serves as a priest, advisor, and natural healer.   Once a year, the members of the community gather together to perform “La Balseria”, a traditional dance that coincides with the harvesting of corn and pixbae.    This last activity is seen more frequently among those tribes living in the mountainous regions.  In the coastal areas of Bocas del Toro where the communities in which MOCELVA works are located there has been a greater loss of traditional culture, but efforts are being made to revive this.

 

 

 

Access

Altos del Valle is located along a paved road that runs to several larger cities and is therefore easily accessible by car or bus.   Transportation by bus from the main transportation center of David is $4 each way.  To reach Chiriqui Grande, which is home to the nearest medical center is $2.  

The community of El Valle Abajo has no vehicle access and can only be reached through a dirt path of about 30 minutes in length, which is entered in Altos del Valle

(the trail goes down to reach the community and up to reach Altos del Valle).  The path is quite steep and in poor condition, made worse by frequent heavy rainfalls and large amounts of mud and corrosion.   Maneuvering the path is not an easy challenge when conditions are good, and presents an enormous challenge to those climbing up in the event of illness, pregnancy, or other medical emergencies.

 

Living Conditions

                Construction of Homes

                The majority of people live in wooden huts with palm leaf roots and dirt floors.  Some of the homes have wooden floors, which are suspended by poles to avoid flooding.  Homes have one large communal room, and an open pit fire inside which is used for cooking.  The huts generally have no walls and henceforth, those living in them are very vulnerable to insects, made worse in El Valle Abajo as they live next to a river.  They sleep on the floor or in hammocks.   There is no electricity, nor telephone lines.

 

                Access to Water

            Less than 50% of the population has water available to them through pipes, and

                In El Valle Abajo, the people drink from the river, in which they also defecate, bathe, and wash their clothes.

 

                Disposal of Feces

                There are a limited number of latrines in the communities, with the majority being in Altos del Valle.   As stated above, the tendency in El Valle Abajo is to use the river as a lavatory.   Previous efforts by a Peace Corp volunteer to encourage the members of the community to use those latrines in existence were unsuccessful.

 

               

Social-Economic Situation

                The socio-economic situation in the Comarca is poor: the average annual income is around $500 (compared to a national average of $2,500); illiteracy is at 46% (7.6% national average 50% infant malnutrition rates (22% national average); and a life-expectancy rate of 63 years (74 national average).     Finally, 95% of the population in the Comarca lives in poverty, with 86.5% falling under the category of extreme poverty – the highest rate in the country.

 

                The 2000 Census found the following to be the situation in Los Valles:

§         14% illiteracy rate in Altos del Valle

§         55% illiteracy rate in El Valle Abajo

§         33% unemployment rate in Altos del Valle

§         49% unemployment rate in El Valle Abajo

 

Basic Services

                                                               Education

                                                               Altos del Valle has a two-room school, two teachers, and is various grade levels.  El Valle Abajo has a three-room school, three teachers, and also is multi-grade.   In general, the quality of education is poor and the teachers fail to come to the community on a regular basis (lack of motivation and desire on their part).  Nutritional and environmental education is non-existent.   MOCLEVA has solicited funds to construct an educational center in Altos del Valle, which will be inaugurated in August of 2004.  Furthermore, an AFS participant (Jessica Erler) has been providing the children with a 12-week series of nutritional education.

 

                                                               Transportation and Communication

                                                               Los Valles are on the way to Bocas del Toro, between kilometers 62-76.  There is public transportation, but as previously mentioned it is expensive.  The Indigenous primarily use walking as their sole means of transportation.

                                                               There are no telephone lines in the communities nor is there a public phone.  The nearest public phone is located in the town of Punta Peńa, which is 25 minutes (and $1) by bus, or three hours by foot.

 

                                               Health and Nutritional Status

 

General Aspects

In Panama, the infant mortality rate is 17.6 for every 1,000 live births.  In indigenous areas the rate is at 60 for every 1,000 with some communities registering 84.1.

Vaccination rates are poor among the infant population, with about 80% of children going without immunizations and statistics indicate that 7 out of every 10 deaths in children under five in these areas are from illnesses preventable by vaccination, or related to lack of hygiene (primarily parasitic infections).

 

Malnutrition, as noted earlier, is also an extremely grave problem among the Ngöbe-Buglé communities, and certainly a concern in Altos del Valle and El Valle Abajo.  While malnutrition affects 18% of the national population, indigenous areas on average rank at 68%.  One of every two children in indigenous areas suffers from some degree of malnutrition, while this rate is only 1 out of 10 in the rest of the country.   This patterns correlates to the presence of poverty in the Ngöbe-Buglé communities, as well as limited access to health services.

 

                                               Situation in Los Valles

                                The illnesses that most affect the communities are:

§         Malnutrition

o       As thoroughly discussed previously, our studies of the community have found this to be a grave problem in Los Valles, especially among those children under five

§         Intestinal Parasites

o       Due to lack of good hygiene, dirty water, and lack of shoes for most members of the communities they tend to be frequently afflicted by two types of parasites:             

§     Ascaris lumbricoides is a roundworm that usually enters the body through the skin or feet, or through fecal contact.   It produces chronic anemia due to loss of blood in the intestines.  If the parasites grow and decide to emerge, they can cause death.  The treatment of choice for this is piperazine, which is expensive and somewhat toxic.

§     Giardia lamblia is another frequent cause of diarrhea among this population.

§         Skin Infections

o   Piodermitis, furunculous, and abscesses are frequent.

o   Leishmaniasis:  Carried by sand flies this parasite enters the body where it can remain for six months without symptoms.  Once it manifests, sores can develop anywhere on the body, even the corneas.  First resembling a pimple, sores swell and grown into festering wounds causing pain, disfiguration, and sometimes death in this population.  Treatment involves a series of injections of glucantime, which is available through MINSA but difficult for the community to access.

§         Diarrhea

The use of non-drinkable water is an enormous problem for these communities as earlier stated, and illnesses resulting from the usage of contaminated water sources often lead to illness and death among young children.

§         Tuberculosis

A combined result of the poverty and poor living conditions in the communities has resulted in a presence of this disease, which causes frequent deaths among the indigenous persons here.

D.      Strategy and Activities

Taking into account the needs and cultural setting of these communities, it is felt that it will be best to take a combined educative and participatory approach in order to achieve the greatest involvement and comprehension among the community members.   Visual aids, as well as personalized instruction, will be needed to work with those members who are illiterate.   Furthermore, usage of both Spanish and the local dialect (Ngoberi) is recommend for written material. 

 

Program emphasis should be placed on the following:

§         Increasing general knowledge ,of health and nutrition

§         Preventative techniques for maintaining health (including increased awareness of traditional medicinal sources available in the community)

§         Food Preparation

§         Food Consumption

§         Conservation of traditional diet and effective means for utilizing available food sources

 

The following methods are proposed to achieve the desired results and objectives of this project (detailed calendar can be found at end of proposal):

1.      Bi-monthly educational seminars for the adult members of the communities focused on various aspects of health, nutrition, and food safety.

2.      Monthly educational seminars for the children in the communities to assist them in developing a basic understanding of the human body, its nutritional needs, and personal health and hygiene.

3.      The formation of a Women’s Group, which places an emphasis on the exchange of information and support.  The monthly meetings can be combined with a Cooking Class that focuses on using traditional foods in new manners and to achieve optimal levels of nutritional value.

4.      Ongoing evaluation and case management of children under the age of five, including the maintenance of growth charts and visits to the home to ensure family participation in improving the nutritional status of their children.

5.      Development and strengthening of partnerships with other organizations currently working in the area including Patronato de Nutricion, MINSA (Ministry of Health), MINEDUC (Ministry of Education)

6.      Construction and usage of a Health Center (both for educative programs and health services) within the community of El Valle Abajo.

 

E.  Monitoring and Evaluation

 1.  Written Report (every three months) including:

a.       Project evaluation:  how has the project met its desired objectives?

b.      Process evaluation:  in what manner has the project been executed?

2.  Final Report: complete and detailed description of all activities completed as well as evaluation of methods and results achieved during the course of the year.

3.  Completion of community evaluation at mid-point and at completion of project

4.  Testing (written and /or oral exam at end of each month)

5.  Feedback Forms

6.  Community Dialogue

7.  Home Visits/Case Management for children under five suffering from moderate or severe malnutrition 

8.  Maintenance of growth charts for all children under the age of five

 

F.    Sustainability

 

Sustainability and ongoing implementation of the presented ideas relies on the following factors:

1.      Desire of the community members to implement and maintain the proposed plan of action

2.      Capacity of MOCELVA to send additional volunteers/participants to work with the community

3.      Delivery of clear and consistent messages that can be easily implemented by the community members

4.      Presentation of information that is relevant to their lives, and desired by the community members.