“I’m not just a doctor of the body; I am a doctor of the soul.”
Dr. Maria Isabel Corea Ramirez is a kind woman with a large smile, soothing eyes, and a calm demeanor. As the director of PROFAMILIA’s clinic in Tipitapa, Nicaragua, a small township 22 kilometers east of Managua, she oversees several programs that bring essential health services—such as contraception and prenatal care—to thousands of people each year.
But, Dr. Ramirez informs me in the clinic’s lively waiting room, much of her time is also spent addressing a kind of pain that cannot be cured with a pill or a physical exam: gender-based violence.
“We are always advocating for the rights of those at risk,” explains Dr. Ramirez. “We provide the information and services people need. But it’s also about the right—of youth, of women experiencing violence—to live free of violence and make informed decisions about their lives.”
Founded in 1970, PROFAMILIA is the largest nonprofit sexual and reproductive service provider in Nicaragua. Its 17 clinics provided more than 284,000 services in 2010. In the third poorest nation in Latin America and the Caribbean, many of PROFAMILIA’s services are provided at a subsidized cost or for free. In Tipitapa, where many people work grueling hours in the garment industry for less than the country’s minimum wage, the need for basic sexual and reproductive health care is acute.
According to Dr. Ramirez, PROFAMILIA clinics are the only interaction many people have with the health system, which is why screening for violence during prenatal checkups and general consultations is critical. This is especially true in Nicaragua, where rates of violence against women are high and there is a culture of silence around the issue: less than half of all women who experience violence seek any kind of assistance.
To counter these barriers, Dr. Ramirez and her colleagues developed a two-fold approach to helping those in need: PROFAMILIA Tipitapa hosts a monthly peer support group for women who have experienced violence, and in order to reach the largest number of people possible and eradicate the silence around domestic violence, it provides comprehensive sexuality education in the local schools. The youth program, Dr. Ramirez explains, not only helps young people speak out against violence and built equitable relationships, but also educates mothers about violence against women and encourages them to seek support.
That is how Angela* escaped a violent relationship. She heard about PROFAMILIA’s support group through her son’s school. Now she looks forward to a different type of future.
“Learning about your rights and [knowing] other women who have experienced the same situation has made me more liberated,” Angela says. “I feel like I have a way to move forward.”
When I ask Dr. Ramirez about the impact she’s had in countering violence against women, she takes my hand and walks me over to a large red book that sits near the clinic’s reception desk. Inside, each page is neatly covered with newspaper clippings documenting cases of violence against women — including deaths. To the right of the book, a small notebook and pen gives clients the opportunity to anonymously write their feelings and thoughts about the many women and families that have been affected by violence.
“The pain many women experience is a pain of the soul,” she tells me.
For Dr. Ramirez, a physical examination is only one part of her interaction with patients; she also reads their faces. For example, she watches women when they receive the results of a pregnancy test, to determine whether the news make them happy or upset. Being attuned and sensitive to the emotional needs and troubles of patients, she explains, is critical to ensuring that patients receive the most comprehensive and high quality care.
Dr. Ramirez smiles when she tells me about a young woman—“one of many”—who she met through a referral from the local school. During the initial consultation with the young woman, who stated she was there for a check-up, Dr. Ramirez learned that she needed more than a physical. She learned the young woman had experienced violence and was in need of counseling and support. Today, this young woman is continuing her education.
“She has a new sense of self-esteem, a reason for being,” says Dr. Ramirez. “She knows she is important.”
* not her real name
IPPF/WHR is a recognized leader in the international movement to ensure access to sexual and reproductive health care as a human right for all people.
Leave a Reply