The Landmine Victim Assistance Component Implemented by the OAS in Nicaragua
by Carlos Orozco, National Coordinator, OAS
The Dimension of the Problem in Nicaragua
In 1990, Nicaragua registered approximately 135,000 mines buried within its national territory and another 133,435 mines in military stockpiles as a result of the internal conflict witnessed in Nicaragua during the 1980s. Although I will not touch on the details related to the operations, it is important to note that Nicaragua is the most heavily mined country in Central America and on the whole continent. As of June 2004, approximately 27,400 anti-personnel mines remain buried within Nicaraguan territory.
There are several departments that are considered the most heavily impacted areas, including the departments of Nueva Segovia and Jinotega. The Organization of American States (OAS) program has verified that a total of 262 communities in Nicaragua, where, as of March 2004, approximately 52,000 inhabitants reside,1 are located at a distance of five kilometers or less from 211 minefields.
Concerning the area of health, in Nicaragua, it is a constitutional right. In fact, as it tends to occur in countries that are highly impacted by anti-personnel mines, Nicaragua is:
But what are the profiles or the characteristics of these survivors?
The Mine Action Program of the OAS
It should not be a surprise that the OAS Program, initiated in Nicaragua in 1993 to support humanitarian demining operations, identified another challenge that would become one of the five principal functions of the Comprehensive Action Against Anti-personnel Mines (AICMA for its initials in Spanish): "Support for landmine survivors including physical and psychological rehabilitation as well as support for their socio-economic reintegration."
The Mine and UXO Victim Assistance Component has supported 538 anti-personnel mine survivors since its establishment in Nicaragua in 1997.
Since its initiation, the program has been able to attend to the needs of affected communities, providing survivors with support in emergency medical assistance, treatment in physical rehabilitation and psychological attention.
This support also includes transportation from their communities to rehabilitation centers, lodging, nourishment and medication. The program maintains a registry of victims that includes information concerning their personal identification, community of origin, type of injury, type of prosthesis, an account of their accident and photographs of the victim. In 2004 alone, the OAS program attended to the needs of 174 survivors.
One of the most recent initiatives in this area is the Social Reintegration Program. In collaboration with the National Technological Institute (INATEC) of Nicaragua and within the framework of the National Demining Commission (CND for its initials in Spanish), the program has developed and implemented a concept for post-rehabilitation training. The objective of this project is to provide technical job training to mine survivors that have received physical and psychological rehabilitation through the OAS program.
The first phase, implemented with seed money and directed at a limited number of survivors, was highly successful. Together with the CND, the national mine action authority, one of the most difficult (but important) components of mine action was developing technical training and reintegration of victims as productive members of society.
As a criterion of the program, this training offered a new perspective into the concept of comprehensive assistance to survivors. During nine months, the OAS program provided training as well as medical assistance and physical and psychological rehabilitation in order to reduce the immediate and long-term effects of anti-personnel mines on survivors. Likewise, the implementation of community support mechanisms began.
In the past year, about 20 percent of the registered survivors from 30 different municipalities of the country have received assistance.
The Case of Agustin Matey
The process described above can best be illustrated with a specific example. Agustin Matey was an agricultural laborer, head of family, and father of five children, who was illiterate, lacked proper housing, and had an income of less than $40 per month. He was originally from the community of Aranjuez San Fernando, a municipality of the department of Nueva Segovia, where, according to official numbers, an estimated 73 percent of the rural population lives in "extreme poverty."
On May 15, 2001, Agustin was working in the fields with four colleagues in La Finca La Española located in San José del Bayuncún-San Fernando, property of Rene Paguagua. As he was walking the outline of the terrain of the Finca, he stepped on an anti-personnel mine causing serious injuries to his left leg, as well as injuring his right leg. One of his colleagues, Pablino Gómez Amaya, received slight injuries in areas of his head and back.
Following the mine explosion, Agustin was transferred by stretcher to a location where there was access to a vehicle. Seven hours following the accident he received medical attention in the Modesto Agurcia Hospital in the city of Ocotal. The attending doctors stated that the injury to his left leg was irreparable and he required a transtibial amputation. The director of the hospital immediately notified the offices of the OAS program in Ocotal, initiating the medical assistance process. Notification of the program can be transmitted through the CND, police, mayors, or Nicaraguan army, which in several cases has supported transportation and emergency treatment with the army's demining unit. If necessary, the CND may contact the Red Cross for the acquisition of blood.
A week later, an infection developed in Agustin's limb, and the OAS program coordinated his transfer to the Fernando Velez Paiz Hospital in Managua. There, a series of surgical cleanings was unsuccessful in reducing the infection that led to a transfemoral amputation of his limb.
Through the victim assistance component of the OAS program, his medical, hospital, surgery, medicine, nutrition and surgical cleaning expenses were covered. Additionally, the program covered per diem for his wife, who accompanied him. After 15 days of hospitalization, the program transferred him to his home community.
In September of the same year, three months after the accident, he was transported from his community to Managua and registered in the National Prosthesis Center (CENAPRORTO) for a two-month period in which he was prepared to use his prosthesis. In this particular phase, the program can transfer the patient to any of the three entities that have the capacity to provide rehabilitation to survivors.
Following the corresponding appraisal by the physical therapist, he entered the period known as pre-prosthesis for four to six weeks. During this time, Agustin learned different mechanisms to strengthen his limb, overcame the trauma caused by the amputation of his legs, and practiced the different movements of his limb that would facilitate the use of his prosthesis.
Once this phase was concluded, his limb was measured to produce the prosthesis. Agustin was then given leave for a week before initiating the prosthesis phase for a three-week period. During this phase, the survivor learns to utilize the prosthesis, practicing for hours in the morning and during the afternoon on terrain that includes a few obstacles similar to those he would encounter in his community.
By December 2001, Agustin was already able to utilize his prosthesis. In addition, ophthalmological assistance was provided due to damage to his eyes caused by the blast wave of the mine explosion.
Three months after completing his physical rehabilitation, on April 4, 2002, Agustin registered in the first phase of the Social Reintegration of Anti-personnel Landmine Survivors Component. For nine months he studied woodworking. On November 6, 2002, he received a certificate of recognition for having graduated from INATEC's woodworking course. During his stay, in addition to being trained and receiving psychological attention, he learned to read and write.
On February 25, 2003, Agustin was provided with a revolving fund established for the participants of the first phase as part of the inauguration of the second phase of the program. Additionally, Augustin received basic woodworking tools from the CND to support his reintegration.
By April 2003, Agustin had already established a partnership with another survivor and established a woodworking workshop in their community of Aranjuez-San Fernando. He first invested in a motor for a winch, basic tools, wood and other materials. By June 2003, Agustin had been able to establish an income for his family and as he himself expressed, the customers are very appreciative for the installation of his workshop in their communities; now they do not have to search for carpenters from other communities to carry out work.
Projections and Challenges
Apart from these achievements, there still remains enormous challenges in the area of victim assistance. The component, in coordination with national authorities, is projected to continue offering medical assistance, physical and therapeutic rehabilitation, as well as psychological attention to all of the survivors that are identified and require support.During 2004, 67 survivors were assisted. Additionally, it is projected that 100 more survivors will benefit from the Training Component.
In the particular case of Nicaragua, it can be noted that success is not due solely to the participation of the OAS program in victim assistance but to the coordinated action of the different entities involved to assist each survivor. The objectives of the OAS program do not aim solely to accomplish a mine-safe Nicaragua, but also to continue relieving the suffering caused to survivors by promoting physical, psychological, social and economic rehabilitation. With the continuing support of the international community, the joint efforts of local, national and international institutions can advance this aspect of the broad, noble vision of the overall mine action effort.