Cellphones in pockets; cellphones in hands; cellphones hidden in women’s brassieres: if you take a moment to look around, you’ll notice that in Nicaragua, cellphone users are everywhere.
In fact, according to the International Telecommunications Union, in 2011 there were 4.8 million cellphone users in 151 out of the 153 municipalities of Nicaragua. That represents over 82% of the population.
But this is not a story about cellphones. This is a story about what can be done with cellphones: they can be used to empower Nicaraguans to lead healthier, safer, and more productive lives through ChatSalud, an SMS-based sexual and reproductive health hotline.
ChatSalud will harness the pervasiveness and popularity of cellphones and text messaging to connect Nicaraguans to sexual and reproductive health (SRH) education, as well as to existing healthcare services by putting those resources directly into the hands of Nicaraguans. It will deliver culturally sensitive and contextually correct information on five central themes: reproductive health, safer sex, HIVaids, STIs, and domestic violence.
While sex is a sensitive topic, it permeates every aspect of our lives in the form of relationships, self-esteem, pregnancy, health, gender dynamics, and more. There are few themes that are as vital to our health and wellbeing, yet so unequivocally difficult to discuss openly. Pena, a Spanish word closely related to embarrassment, shame, and awkwardness, is one of the biggest cultural barriers that Nicaraguans have in accessing SRH information. This means that while people are engaging in sexual activity, few are engaging in an open discourse about their sexual health.
ChatSalud’s goal is to bypass the “pena barrier” by providing a completely anonymous way for Nicaraguans to access SRH information. Think about it: whether rich or poor, urban or rural, everyone has questions about their sexual and reproductive health. Yet in developed countries, answers to those burning and potentially embarrassing questions are easy to come by anonymously: just Google it and the information is yours. How empowering.
However, in a country like Nicaragua where only 10% of the population has internet access, most people do not have that luxury. So why not use cellphones to provide Nicaraguans with that same pena-free access to information? Think of the possibilities:
Imagine, for example, that you are a 16-year-old girl living in a rural community. Your boyfriend wants to have sex, but you are not sure if you are ready. You’re too scared to ask your parents for advice, so you text ChatSalud for more information about teen pregnancy, condom negotiation, and healthy versus unhealthy relationships.
Imagine next that you are a 40-year-old man and you’re concerned that you might have HIV. You text ChatSalud and discover that your symptoms are more typical of an STI, which compels you to go to your health center for a proper diagnosis and treatment.
Now imagine that you are a woman in your mid-twenties. Your husband acts out and beats you on occasion, but then is apologetic and showers you with affection. Your close friends are tired of listening to you complain about your relationship, so you turn to ChatSalud to learn about the cycle of violence and discover resources that can assist you in your local community.
Although these scenarios are hypothetical, they are based in reality. According to the Pan American Health Organization, Nicaragua has the highest teen pregnancy rate in Central America: approximately one in every three adolescent girls will become pregnant before they reach the age of 19. In addition, the United Nations Population Fund reports that gender-based violence affects nearly 48% of women who are married or in a union. Overall, one in three women has experienced physical or sexual violence in her lifetime.
Although Nicaragua has consistently had the lowest incidence of HIV infections in Central America, the annual incidence of registered cases of HIV has tripled in the past six years. In light of these statistics, ChatSalud hopes to make an impact in Nicaragua by being a resource people can use to make informed decisions about their sexual and reproductive health.
The idea of ChatSalud was initially conceived by a group of U.S. Peace Corps Volunteers who noticed both the need for a secure source of health information and the widespread use of cellphones in their rural communities. Since its inception, the project has grown substantially. Now with the guidance and support of several local and international organizations, ChatSalud is preparing to launch at a national level. The ChatSalud team is still in process of finalizing the content, system, and evaluation tools, but be on the lookout for a launch date in late 2013.
If you are interested in the project and would like to know more, please contact us at [email protected].
Lauren Spigel just finished her Peace Corps service in Nicaragua after spending two years living and working in a medium-sized community in the department of Matagalpa. She is a founding member of the ChatSalud team. She holds a Bachelor of Science in Community Health from the University of Maryland and plans to pursue her Master of Public Health from Johns Hopkins University Bloomberg School of Public Health starting in July 2013.
Chloe Lew is a current Peace Corps Volunteer in Nicaragua and is serving in a small community in Nueva Segovia. She serves as ChatSalud’s public relations advisor. She holds a Bachelor of Science in International Relations and Anthropology from George Washington University.
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[...] ChatSalud: Coming Soon to a Cell Phone Near You [...]
Thank you for this fascinating well written article. Look forward too reading more about this topic and those that are trying to make a difference.
Culturally out of range. The teenage girl in the country side, being heavily enamorada by a muchacho, at night in the back porch, says, o let me first get recarga at the Movistar outlet, I have to consult my chatsalud advice on how to avoid early pregnancy. And most chatters dominate the strange orthography of chats, but can’t read nor understand a even slightly sophisticated text. Functional illiteracy, people don’t read, they avoid it whereever possible, nobody told them, taught them serious reading. I think, chatsalud is a concept developed in some Northern office or NGO with – maybe – good intentions, but will not bring down this pregnancy rate or improve female teenagers’ sex life.
Of course, if the peace corps volunteer explains the device and all its advantages, the youngsters like nearly everybody in Nicaragua says OK, approves it, says thank you, pretends to be enthusiastic about it, and then forgets it, throws it away or doesn’t use it. A big project with high overhead costs and nearly no impact, ¿apostemos? Talk would be a lot better, but this is nearly for free, no digital devices included. It would consider dedicate oneself to each individual to whom to talk to. ¿Pena? Nowadays it is a real lot less than this article says it is. Even in the countryside! (I live there, and different initiatives do “charlas” about sex, reproductive health, HIV, condoms etc. even in the remotest hinterland communities.)
First and foremost, thank you for bringing up several legitimate points about our project. We will attempt to clarify a few points below:
Our target population is literate people between the ages of 15-49 who have access to cell phones. Unfortunately, we are aware that we will not be able to reach the entire Nicaraguan population. However, we do aim to reach mainly youth, who are more literate than older generations and who are already chatting via text message. The texts will be short bursts of information, all of which will be verified by experts in the field to ensure that they are both culturally relevant and easy to understand.
In terms of cost and sustainability of the project, the Nicaraguan Red Cross is our main project partner and will support the project as it develops. Furthermore local institutions like Cronos and others in the telecommunications industry have generously donated their time and resources allowing for us to make the service free for the user. Companies like GüeGüe provide tech support and teams of programming students from UNAN work on making a more useful back end product.
The initiative to develop this project started with our own work giving charlas in the campo alongside Nicaraguan counterparts. We have found that pena, machismo, geographic distances, and economic limitations were significant barriers that prevent people from seeking important health information. While we don’t claim to be a panacea to cure all ills, we hope to provide another communications method for easy access to information, allowing the user to inform themselves whenever they want and hopefully use this information to seek out local resources. The whole idea being that the information is accessible, reliable, confidential and free.
Thank you again for your response. We are always looking for more constructive feedback in an effort to make our project more successful. If you would be interested, we would love to chat with you in more detail. Please e-mail us at [email protected].
Best Regards,
The ChatSalud Team
Gosh, Gerd, I must admit that my visceral reaction is similar to yours–more ineffective do-gooders–but even I think you’re a little harsh. This may do a little good for a few kids and surely won’t do harm, so I say a little tolerance if not begrudging affirmation is in order. Come on, they’re Peace Corp kids, mean well, and will probably help a few kids.
My vexation now is the meaning of “pena.” I always thought “anxiety” or just “hassle”–with “embarrassment” etc. being a distinct subset–but I could be wrong (or it could depend upon context).
Where can I sign up? This is a great idea. Four months of the year I’m just outside Baltimore & my wife has surgery occasionally at Johns Hopkins. The rest of the time I’m here in Nicaragua.
[...] For more information about our project, check out our guest blog entry on Frontline SMS and our article that appeared in Nicaragua’s English-language newspaper, The Nicaraguan Dispatch. [...]