On

HEALTH CARE HERO

Inspired by her mother, Anielka Medina worked with two friends to look after the health of women in Nicaragua.

Written by Julie Jacobs Photography by Jonathan Butcher

a sun-dappled dirt road in a rural Nicaraguan village, a white truck pulls up to a small one-story building. Women of a variety of ages wait expectantly outside, some with children playing at their heels. A few individuals emerge from the truck and begin carting equipment and supplies inside. Within 20 minutes, they have erected a pop-up clinic that includes an examination table and medical tools, neatly nestled under a tent for privacy. They are ready to advise the women about their health and test them for cervical cancer, a highly preventable illness that is the country’s top cancer killer and the leading cause of death among women under age 50.

This is The Lily Project.Established in 2015, Lily deploys female-run teams

to remote villages with the mission of promoting “healthier futures for women and girls in Nicaragua through a women-centered model of development and care.” At its helm are cofounders Anielka Medina, executive director, Jonathan Butcher, operations of-ficer, and Susan Cotton, chair of the board.

“Here in Nicaragua, we have a lot of problems, and one of the biggest problems is health for women,” says Medina on an early Tuesday evening, from the cacao farm where she lives in El Tuma. Medina, whose own story prompted Lily’s creation, often spends weeks in the field conducting team develop-

ment. On this day, however, she is seeing to her other responsibilities, including gathering, analyzing, and updating the data from The Lily Project. Beside her is Butcher, translating her answers from Spanish into English.

According to Lily, Nicaragua “lacks resources to deliver basic preventive health care to nearly 90 percent of its population.” Most of the women served by the organization are young single mothers living with extended family in small homes, usually without running water. Roughly half report they have suffered from sexual, physical, or psychological abuse com-mitted by a family member. And almost all of these women have never shared their traumatic experienc-es before. There are “a lot of adolescent abuses...very young girls with much, much older men,” Medina notes.

Every mobile health clinic visit, which usually takes place at a school, church, or home, starts with education about sexual health followed by group discussion, she explains. It continues with one-on-one counseling to discover each woman’s personal history as well as to discern her medical needs. For many of the community women in attendance, the event marks their first time receiving care and treatment.

Lily’s teams pap test women aged 16 to 28 and 51

Anielka Medina

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HEALTH CARE HERO

and above, who are vulnerable to the HPV virus and difficult-to-see lesions and monitor or follow up with them for treatment. Visual inspections using acetic acid are conducted on women 28 to 50 years old, an age group susceptible to having aggressive lesions, which, when seen, can be treated on the spot with cryotherapy.

“If they are found [to have lesions], then they don’t have to go through this terrible process of having a further procedure at the hospital,” Butcher says of the latter cohort. “We can take care of it.”

Lily’s screening and treatment methodology has been developed based upon recommendations from the World Health Organization (WHO) and is ap-proved by Nicaragua’s Ministry of Health, a critical proponent of the organization in meeting its mission.

“We have an agreement with the Ministry of Health that if a woman does have something that’s more serious than what we can treat, then they will actu-ally respond within a certain period of time and be in charge of delivering the treatment that woman needs in order to get her healthy,” Medina explains. “But we remain in charge of actually arranging everything, up to even the hour that they would be with a doctor...so Lily really does take on the role of being a catapult for each woman who passes through our doors, our mobile clinics.”

The cost per woman for educa-tion and examination is $10 for Lily (the women receive services for free). Financially, Lily relies on the gener-osity of many private donors as well as fundraisers and grants. It also depends on a growing list of local and international partners that provide much-needed services and equipment. Ohio State University, for example, is helping with data collection, analysis, and reporting, while the University of Michigan is developing a tech platform for the data collection and engineering a mobile gynecological bed. Among the other supporters are Gundersen Health System in Wisconsin, which has sent teams of gynecologists to assist in the field, and American Women for International Understanding, an advo-cate group for women that has flown to Nicaragua to volunteer for Lily and made monetary gifts. Lily also recently partnered with Direct Relief, a large humanitarian aid organization based in California, to secure antibiotics and prenatal vitamins.

Yelba Casco, Medina, and Julia Casco

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For Medina, the care delivered by The Lily Project is especially poignant, given that her mother died from cervi-cal cancer at just 48 years old. Medina grew up in a mining community where women typically make a living doing domestic work. Her mother was a single parent to Medina and her two sisters and four brothers, and the entire family slept in the same room. When her mother became sick, the cause of her illness was a mystery at first. She passed away in 2008, the year after Medina graduated from high school.

“In the final days, when we went to the hospital and we were visiting my mom—it was a hospital for cancer—so I supposed that’s what it was that she had, and came to find out that’s what it was,” she remembers.

Later, in 2012, while Medina was volunteering at her sister’s language school, she met Butcher, who was there learning Spanish. The two kept in touch, and after discovering the need for sexual health education at the school in El Tránsito where Butcher

was employed, she offered to host classes for the teenage students. When the Ministry of Health asked the nonprofit organization Butcher worked for to help transport doctors and nurses to rural areas to vaccinate children, he invited Medina to assist him. Delivering this vital care triggered an “aha” moment for her: Why not bring proactive health services to women living in the country’s villages?

“I was sharing my story about what happened with my mother...when there was a realization that there was a need to offer something mobile to women in rural communities as well,” says Medina.

She and Butcher set about developing the initia-tive, centering it on women’s health and cervical cancer, and naming it for Medina’s mother, Azucena, which means “lily” in English. They would soon be joined by Cotton, who was pursuing a master’s degree in social entrepreneurship at Pepperdine University in Malibu. Cotton was looking to use her business skills for social good, and one of her professors en-couraged her to reach out to Butcher.

“When Anielka explained the explosion of cervical cancer in Nicaragua, I was confused. How could a cancer that has become easily prevented here be such a big problem in Nicaragua?” recalls Cotton. “But it is a problem that can be solved. With her mother’s death, Anielka’s life’s purpose became clear: to help eradicate cervical cancer in Nicaragua.”

Dayneling Blandon, Medina, Angie Rizo,

and Hayde Ruiz

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“It was a very special moment and synergy that happened all at the same time because Susan agreed immediately to start working with us remotely,” says Butcher of their connection with Cotton.

In August 2014, when Lily piloted its model in Tamborcito, Cotton was on hand to volunteer. The test group was small, with only 26 women. But that number was 85 percent of the eligible women from that community, and it demonstrated that Lily was onto something. Even the students at the local school where the event was held played a role.

“We also were able to ask the children to invite their mothers as well, so we got a lot of mothers,” Medina says, then telling the story of a young boy named Pablo who urged his mother to attend. “He was crying and told his mom that she needed to get this exam. It was her first time that she ever had the exam done. So it was just a very special moment for us and The Lily Project.”

Cotton subsequently came on as chair of the board and Lily officially launched the next year, with government approval. Since then, the organization has examined more than 12,000 women and girls, saved more than 900 lives, and visited more than 500 villages. Lily returns to the communities it has served every two years—sooner if there are women on a “watch list.”

What is also noteworthy about The Lily Project is its Leadership Institute, which employs the staff

assigned to the mobile health teams. These young, local women, who are recent graduates of universities in Nicaragua, spend 12 to 24 months in the field as interns and receive skills-based training, personal coaching, and leadership development.

Cotton says, “I find this mission to be incredibly compelling, and I believe with Anielka’s strength, compassion, and innate leadership qualities that Lily will succeed. Anielka’s commit-ment is rooted in her desire to protect other children from losing their mother to this horrible disease.”

As the evening settles in around the cacao farm where Medina lives, she reflects on what her mother would think about all she has accomplished. “I imagine it must have been very difficult for my mom to leave her children at such a young age on their own. And I can only imagine that the ability for other mothers to actually have help in that area and be able to remain on this earth and take care of their children—she’d be very happy that others have that opportunity.”

Medina speaking at a Lily event about women’s health.

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