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Women of Nicaragua: the unique burden

By Darcy Sprague

On Jan. 4th, a group of 29 health science and mass communication students journeyed into small communities in the Nicaraguan jungle where they met some of the locals and received some of the warmest welcomes of their lives.

The people who gave these welcomes were mostly women who were home with their children. Smoke billowed as they cooked or burned trash, and soapy water from washing dishes and clothes ran in the streets.

A 2015 report from the United States Agency for International Development states, “we know that women are vulnerable to extreme poverty because they face greater burdens of unpaid work… and are more likely to be forced into early marriage —all factors that reduce their ability to participate fully in the economy and to reap the benefits of growth.”

During the 2017 College of Health Sciences study abroad trip to Nicaragua, the team met many different women. Some were living in extreme poverty and some spoke candidly about their or their parent’s struggle for a better life.

The group that conducted house visits in Los Rio or Butter as it was referred to by the students, saw few men that first day. Many of the men were out working. Most of the men who were home were ill, leaving their wives to both earn money and do the house chores.

In Nicaragua, low income women are 12 percent less likely to work than men. Middle class women are 30 percent less likely, according to the World Bank Gender Portal.

Petronila Melendez, a 90-year-old woman who visited the Butter clinic, had 14 children and outlived nine of them. She still cooks, cleans and occasionally works in the fields to earn money.

She had three husbands in her lifetime. Two of them died and one left her. She lives with her son who does not currently work and does not help support her.

“I had a lot of children so I worked all the time,” Melendez said through a translator. “I wasn’t a very lucky lady.”

Melendez carried heavy baskets of fruit on her head from her village to the local market for 40 years.

She had her first child at the age of 14 after being raped. She married at 22.

“Your son will probably die before you do,” the doctor who saw her joked.  “Is your house older than you or are you older than the house?”

Melendez admitted she had little education. She lived her entire life in the same area.

In contrast, Massiel Acetune Vilchez, the 33-year-old International Learning Service team coordinator who assisted the group on the ground, lives in a four-bedroom house. She does not work in a labor intensive position. She has no children and is not yet married.

She said this is because she wanted to get her education and career in order before she settled down.

Vilchez’s mother grew up in a village similar to Melendez, but she had an “I deserve better” attitude, Vilchez said.

Her mother moved to the city and graduated from one of the free public universities. She met and married her husband, but continued to work. Her father lost his job so her mother moved to Miami to get a job. She sent money back so that Vilchez and her siblings could have a good life and education.

Vilchez said her parents always expected her to be in the top of her class. She received a scholarship and was able to attend a private university.

“My mom and dad raised me to be independent,” Vilchez said.

Vilchez said she has a different view of gender roles than many of the women who came through the clinic.

“I believe in 50/50,” she said. “I can cook, but so can a man.”

She added that her older brother cooks and cleans for himself.


Vilchez (left) poses with Eddie, Alyssa Gonzales, Roland and Darcy Sprague


“It’s not about gender,” she said. “It’s about how you can be independent in every way. I want (my daughter) to be a powerful woman. I want them to fight for their dreams and for them to want to accomplish more.”

Olga Fonseca, 69, was another of the local women who came into the clinic and who had a life similar to Melendez’s.

Fonseca had 13 pregnancies and raised eight children. Now a widower, Fonseca lives with her 41-year-old son and supports herself by baking desserts in a wood hole in her house similar to a pizza oven.

Every morning she wakes up at 3 a.m. to make coffee and sweep the house. She prepares the desserts and cooks bean and rice for her and her son. She cooks until lunch, then begins cleaning again. She does not rest until after dinner when she reads her Bible. She goes to sleep at 11, resting for four hours before starting again.

Fonseca was never able to have an education. She has struggled for as long as she could remember just to make ends meet.

Fonseca lives off of 60 cordova a day, which is about $2 USD. Her son does not work or help with expenses.

Olga Fonseca, 69, and Vilchez talk about the puppy Lucio

Struggling is not unique to the women of the village.

According to the World Bank, in 2008—the latest complete data available—roughly 42 percent of Nicaraguans live in poverty. Sixty-three percent of people living in rural areas are poor while only 27 percent of those living in urban areas fell below the poverty line.

Raquel Ramirez worked as a translator for the group, but most days she is a doctor. Currently pregnant, she is having a hard time finding work.

In her profession she was working from 8 a.m. to 10 p.m. six to seven days a week.

“We make due,” she said. “I like what I do, but sometimes I need family time.”

Ramirez earned $450-$500 a month as a doctor. The poverty line in 2005 was $413.53, according to the World Bank. Ramirez, a doctor, one of the highest paid professions in the United States, barely earns enough money to be above the poverty line.

Women are making some headway in the country, however. Women are eight percent more likely to attend secondary school than men, and female children are four percent more literate than males.

“It’s not about opportunity, it’s about education,” Vilchez said. “Some f these families don’t know about thing else besides their village, they do not try to move on.”


Journey to Nicaragua: Two veteran’s paths to joining the Texas State inter-disciplinary study abroad trip

Two weeks after returning from Afghanistan – his second of two Middle Eastern deployments –  Andrew Pagel, a Texas State University nursing student, was handed his walking papers from the United States Army.

“I was absolutely destroyed and betrayed,” he said.

In 2014 the Army cut 40,000 soldiers, according to a Wall Street Journal article, “How Obama Shrunk the Military.” Pagel was one of these soldiers.

At the time, Pagel, 32, had two children, a wife, a mortgage and livestock on a hobby farm near Florence, Texas. He was preparing to become a captain and had received high praise from his superior officers.

“I had a plan that completely crumbled because of that,” Pagel said. “I didn’t handle it well.”

Two years later he would be in Nicaragua charming elder village women and cheering sick babies.

Jennifer Pemp, 34, a clinical lab science student at Texas State University, was deployed to Afghanistan in 2008 where she tended to Afghanistan nationals detained by the United States military. These individuals were being held for questioning, and many of them had been injured in conflict.

They called her “PT Doc” and “Angel.” To them, she was someone who ensured they received proper medical care. For her, this experience kickstarted her desire to work in global health.

These two military veterans, with a combined four deployments and 13 cross-country moves, recently completed a mission of a different type as part of the 2017 Texas State interdisciplinary study abroad trip to Nicaragua.

A portrait of Pagel and Pemp

On Jan. 2, 2017 Pagel began the trip talking animatedly to whoever sat by him in the terminal and on the 6:42 a.m. flight out of Austin Bergstrom International AirportHe talked about the Lego tattoos on his left arm and how he plans to add more to make a sleeve.

From his physique, to the ruck-style way he carried his Army-issued backpack, to his near-daily workout of throwing sandbags, Pagel distinguished himself from the other 29 students early on. He was older, married, a father, but perhaps more noticeably, he was well traveled, knowledgeable, worldly.

Often he gave students tips about safety or travel. In crowded areas he hung back to watch over the group, successfully stopping a man he believed was trying to pickpocket one of his female colleagues.

During the team’s orientation session in Nicaragua, Pemp, too, set herself apart. She introduced herself as a veteran and that she had served in the United States Air Force in Afghanistan. A palpable sense of surprise rippled among many of the group members. For many, going to Afghanistan seemed impossible.

Pemp fit in easily with her colleagues and quickly made friends.

Pagel, too, was quick to talk with everyone. He told anecdotes from his life and even if he was talking to just one person, it felt as if he was inviting the group to join in.

“He will strike up a conversation with anyone who sits down next to him,” said Cassie Thompson, one of Pagel’s fellow nursing students who often sat next to him on the yellow school bus that took the team all over the country.

He was often content to sit on the bus alone listening to “Winds of War” by Herman Wouk on Audible, though he indulged anyone around him in conversation or showed them pictures of his children when asked.



Pagel joined the military a few years after he graduated high school. He moved five times for the military and deployed twice – once to Afghanistan and once to Iraq. He started in infantry then became an intelligence officer. When he separated from the active Army he was a captain. As part of his separation package, he transitioned into the Texas National Guard and is now a major.

For his first deployment, Pagel was sent to Iraq in 2009. One day his squad received information about a disturbance in a pomegranate grove on the edge of their territory.

The enemy had beat them there.

Every man in the village had been beheaded and every body had been left in a shallow grave dug among the rows of trees. The bodies had been arranged by family: grandfather, father, son. These macabre rows of family lineage had been left to rot, or maybe left so that men like Pagel and his Iraqi translator who both broke down sobbing, would see.

“I saw some things…Night, day, it doesn’t matter, I see them again,” Pagel said. “I smell them.”

Pagel, who talked lovingly about TVless Sunday mornings making pancakes with his children and who danced shamelessly with elders at the nursing home, looked far off when he spoke. There was almost a look of acceptance on his face.

“It is what is is,” he said. “What happened happened.”

Pagel returned to Alaska where he was stationed in 2010. Between his return and 2014 Pagel had his first child, moved to Arizona where he joined a search and rescue team and had his second child.

Then he deployed again.

This time Pagel was sent to Afghanistan as an intelligence officer. He mostly stayed on the base during his deployment. He returned to the states after three months.

Two weeks later Pagel’s superiors called him in to talk. He thought he was getting promoted. Instead, he was handed his walking papers.

“I didn’t know what I was going to do,” Pagel said. “I thought about being a vet for a few minutes.”

While Pagel served out his last few months as an activity duty Army officer, he took stock of his life. He has a degree in criminal justice, but after a number of high-profile police shootings he decided he did not want to be an officer.

He created a list of qualifications for his next job. He wanted to work in the service sector and create a tangible impact in society.

Pagel crossed paths with an army nurse and after the man told him about his travels and work, Pagel realized the career move was right for him and he enrolled in nursing school.

“The goal is flight nursing,” Pagel said. “I definitely need that adrenaline rush.”



Life wasn’t always easy for Pemp.

In 2004 she met and married a man in the army. That same year he was deployed to Iraqi as an Army Combat Engineer. He was shot in the leg a few months later and was sent home for a month—the bullet still lodged in his leg. He redeployed and Pemp deployed for the first time at the end of that month.

Though their deployments were only an hour away, they lived in different worlds.

Pemp was escorting local nationals on base and only left the wire fence once. Her husband was directly involved in combat and had his vehicle blown up by an improvised explosive device.

As her deployment ended, Pemp requested retraining to become a physical therapist. She packed up and left their apartment three weeks after she returned home. She was on her way to attend school to get her associate degree in Wichita Falls, Texas while her husband was still overseas. She was determined to get the training she needed to help him recover.

“When he came home all of the other guys had their spouses or families there and I couldn’t be there for him,” Pemp said. “It was very traumatizing to him.”

Her husband was sent to Tacoma, Washington to have his mental and physical health evaluated. They tried to reintegrate him into society but came to the conclusion that he suffered from post traumatic stress disorder.

Meanwhile, Pemp was working on her associates degree in physical medicine at a technical school in Wichita Falls, Texas. She was painfully aware of her husband’s condition. She tried to contact his superiors but was ignored. She had no choice; she put her nose in her books and focused on making it through school.

“I don’t even know how I graduated tech school,” Pemp said. “I was so stressed out.”

After she graduated, the Air Force wanted to send her to Maryland, but she applied for and received permission to go to Washington to help her husband.

She found her husband to be a changed man. He fluctuated from happy to angry to sad in minutes. He was “unhinged and erratic.”

“We were not supposed to become a statistic,” Pemp said.

They divorced in 2006, and Pemp threw herself into work.

“One of the things they teach you in the military is resilience,” Pemp said. “You have a choice: be resilient or let the world get the best of you.”

In 2008 she deployed to Afghanistan with a medical team where she worked as a physical therapy assistant in a detainee facility.

“One of the things we had to keep in mind was that we were not there to interrogate them or judge them,” Pemp said. “We were there to provide quality health care as if they were any other patients.”

The detainees were given very little – as little as just one blanket and one towel in their cell – and many of them needed medical attention. Physical therapy was hard to practice due to the limitations on their freedom to exercise.

With extra free time, Pemp began doing phlebotomy and giving immunizations. She found that the sickest patients were often not being seen first. The detainees told the religious leaders of their group who would tell guard if they were feeling sick. The guard would make a list of names for the medical center and the center would go down the list.

Pemp decided to create a program called Cell-Side Triage. She visited patients in their cells, assessed them and then helped the medical staff decide in which order the patients should be seen. This earned her the name of “PT doc” or “Angel.”

One day a detainee came in to have a medical procedure done. He did not respond to the medical staff. He just looked at Pemp and smiled. The translator explained to the man that the guard was going to have to escort him out if he was not cooperative. Still, the detainee just smiled. The guard began to pull the man out. The man stopped him and opened his hand. In it lay a small ring woven from threads carefully pulled from his blanket and towel. He asked the guard to give it to Pemp. The guard told the man that it was contraband and that he was going to confiscate it. The detainee threw himself on the floor and started yelling.  The entire floor began to riot.

Later, the guard gave Pemp the ring and said, “I hope you know this entire riot started over this ring.”

Pemp only cared that the detainees were human and that they needed help. This inspired a deep love from her. Throughout her time, they brought her many thread rings and rosaries which are now framed in her house.

“I realized I was very interested in public health then,” Pemp said. “That started my desire to want to go abroad and do this kind of stuff.”

She left the military in 2013.

“Sometimes I wish I would have stayed in, but I wanted to see more than I was seeing,” Pemp said. “After both my deployments I felt like I fulfilled the reason I joined and that why I got out.”

Ever since, she has worked as a physical therapist in Texas attending Texas State University to get a degree in clinical laboratory science.

“I’m going to be a successful veteran,” she said.

Gear from her time in the Air Force is currently being displayed in the “Memories from my Duffle bag” display at Alkek Library.

For Pemp, the trip to Nicaragua was a no-brainer.

“I don’t like ‘out of sight, out of mind,” she said. “I feel like (the health care conditions in Nicaragua) should be acknowledged. I think there is a lot of stuff we ignore because we are afraid to feel the emotions, but I’m not afraid.”

Nicaragua and beyond

For Pagel and Pemp, their stories make them who they are. For Pemp, her hardships caused her to experience life a little more. She laughs easily and smiles readily. She is happy to talk to anyone.

“I really do enjoy life,” Pemp said. “I mean, there is so much to enjoy and learn and take in. I don’t feel like we should spend our lives just going to work and coming home and sitting in front of the TV. I want to explore the world and meet new people and learn new things.”

Pemp’s fellow classmates notice her hard working spirit.

“She always wants to learn more,” said Ashley Wells, a clinical lab science student who worked with Pemp in Nicaragua. “She’s never content. She always wants to go further.”

Patients in Nicaragua

The most memorable patient for Pagel was a 90-year old woman who wandered in during one of the clinic days.

She peaked her head in the side door and asked to be seen. She explained she had walked quiet a distance. She was so thin that her bones showed and she was so elderly that snow white patches of hair grew out of her ears.

The woman in charge of the clinic agreed to let her be seen. Pagel offered to see her during lunch.

While everyone else ate—by that point the group was starving as lunch had arrived late—Pagel examined the woman. He listened to her medical history, which included possibly being cursed—and good naturedly looked at the fungus on her feet and in her ears every time she requested.

The woman, in turn, told him that his Spanish was bad. Despite her griping, the woman stared at Pagel like he had come to personally save her.

“This woman is built like a tank,” Pagel said, as he examined her back. “She’s as crazy as a bat though.”

The woman was given a meal and when she finished, she left the clinic.

“Everyone here has a good heart,” the woman told a translator while smiling at Pagel.

The next day Pagel looked out of the school bus window as it rolled down the dusty road out of the village. The woman was walking through a field.

“Hola abuela,” Pagel yelled through the window at her.

Later, Pagel said this was the most memorable part of the trip.

“I enjoyed working with him because he is very confident,” said Chelsea Fowler, a nursing major who has worked in clinical groups with him before. “His strong personality is going to make him a very good patient advocate.”