One Health Nicaragua
In early 2012, the UC Davis School of Veterinary Medicine established a partnership with the UC Davis School of Medicine and Public Health Sciences, and began a collaboration to develop a One Health project in Sabana Grande, Nicaragua. Acknowledging that human, animal, and environmental health overlap and interconnect, One Health seeks to promote, improve, and defend the health and wellbeing of humans and animals by enhancing cooperation and collaboration between physicians, veterinarians, environmental specialists and public health practitioners. The overarching objective of this project is to foster a One Health approach to international outreach by establishing an evidence based, interdisciplinary community health project and research platform. The specific project goals are: to bring sustainable, interdisciplinary healthcare and economic development to the people and animals of Sabana Grande; to create a model for sustainable health practices that will be applicable worldwide; and to provide an educational and cultural experience for the students of UC Davis, in turn fostering the global health leaders of the future.
The community of Sabana Grande is located in the beautiful, mountainous northern region of Nicaragua, in the municipality of Totogalpa. Sabana Grande is a model community for sustainable development. For the past decade, it has been the site of an array of local and foreign partnerships that have resulted in the creation of a community that is empowered to change their lives for the better. Empowerment groups have formed that foster renewable energy, reforestation and local jobcreation.
Pilot investigation, June 2012:
Our team investigated the overall health of Sabana Grande by conducting a full needs assessment of human, animal, and environmental health conditions and gathered information about the existing health infrastructure in the community, and in the country at large. This pilot investigation provided us with demographic data, an understanding of the human and animal health issues present within the community, and a number of Nicaraguan partnerships that have allowed us to lay the groundwork for a lasting and sustainable One Health collaborative project. We found that the greatest potential for sustainable change in Sabana Grande is in the need for improved access to human and animal health care services and the need for improved community health worker training and education. Minimal animal or human health services are available, with the majority of the health care burden falling on volunteer community health workers, who do not feel adequately prepared to address the greater health needs of their community. Furthermore, surveys identified that livestock and poultry play an important role in household livelihoods as valuable food sources and supplemental sources of income. However, nutritional deficiencies and a high disease burden in cattle and poultry definitively limit milk and egg production. In addition, the human population of the region is afflicted with conditions common to impoverished areas such as diarrheal disease, respiratory illness, malnutrition, and tropical disease. This burden of both illness and limited access to health services places not only a health, but also a financial strain on the community. With effective preventative care and education, it is our belief that these conditions can be sustainably improved, and can have a sizeable impact on the economic growth and health of the community.
Given the receptivity of the community and the existing framework for empowerment groups, our team saw the potential to create a community based health cooperation that would bring together animal and human health workers within Sabana Grande, providing them a platform to tackle health concerns from a more holistic standpoint. Alongside our public health partner, Haley McDermott, MPH, we assisted in the formation of a Health and Welfare Cooperation. This cooperation is a locallydriven group that will serve the community in a standalone format while simultaneously providing a framework for a longitudinal study and platform for UCD involvement.
Our team returned to Sabana Grande with seven new members to conduct preprepared educational workshops aimed to promote the connection between poultry and livestock health and community welfare, and to provide information about communicable disease identification and prevention and food safety. These workshops were facilitated by UC Davis graduate students and overseen by UC Davis faculty members. Participants included the Health and Welfare Cooperation, local teachers and community leaders. We further investigated the health of livestock and poultry through household surveys, physical exams, and fecal flotations to gather baseline data regarding nutritional deficiencies, parasite load and infectious disease. An evaluation of general attitudes and concerns about environmental welfare was also conducted, which revealed great potential for interdisciplinary collaboration. Findings showed that deforestation and trash accumulation are problematic and warrant further investigation.
Two of our team members returned to Sabana Grande for a stakeholder meeting with the Health and Welfare Cooperation. It has proven to be invaluable to maintain biyearly trips to communicate with community members, the Health and Welfare Cooperation, and other community leaders where electronic communication is not possible.
As the project moves forward, the primary goal is to improve health information access by working in close partnership with the Health and Welfare Cooperation to further develop educational modules and clinical workshops and to empower community volunteers to take ownership of the learned material and their role as educators in their community. By implementing a ‘Training the trainer’ program, we will help the Health and Welfare Cooperation develop skillsets critical to effectively disseminating health information throughout their community. A secondary goal is to develop the project into an even more collaborative One Health project, by recruiting graduate student researchers and faculty members from outside the veterinary health sciences. The community of Sabana Grande, where human, animal, and environmental health is inextricably linked, provides an ideal platform to demonstrate the impact of interdisciplinary collaborations. We believe that by starting with a basis of education, communication, and collaboration, we will be laying the seeds for years of successful and sustainable integrated communitybased solutions.