By Asociación Tesis Nicaragua, ECPAT Affiliate
In Nicaragua, mobile health teams reach out to young victims of sexual abuse and exploitation at the Mercado Oriental, a sprawling 90-block market complex in the capital, Managua. About 19,000 sellers draw in about 30,000 people daily to Central America’s biggest commercial centre. Many of the children at the market accompany their street-vendor mothers or are sent by their parents to work there alone. Others go to hang out or to find shelter. Altogether, about 4500 children and young people work and live at the Mercado Oriental, which is visited regularly by teams from Asociación Tesis, a direct-care organisation, to identify girls who are victims of sexual harm and to offer them specialised therapeutic care.
Mobile therapy clinics for girls, mostly teenagers, have operated from the market since 2000 under the Care for Children and Adolescents at Risk programme run by Tesis. The clinics use therapeutic processes to focus on building self-esteem so the young people are better able to deal with problems they face daily and to modify risk-taking behaviour. The programme follows a self-management methodology through which participants receive individual care and participate in self-help groups. Partners of the girls also join group clinics.
Group therapy clinics are held for about two hours every 14 days, when the girls are picked up from the market and taken to a ‘quiet’ place. When the clinics began operating, the work with the girls was done in parks. But the open spaces held too many distractions, so the clinics are now held indoors, such as in auditoriums belonging to other NGOs. Meanwhile, individual clinics take place in the same facilities every 14 or 30 days, depending on the individual and her needs.
Group participants decide together on how the group will operate: the rules of participation, the topics to be addressed, the time and location where this will occur, the activities to be engaged in, and the pace and duration of the sessions. As time goes by, some participants begin to show a sense of belonging together as a group, and ask to meet regularly. In other cases, high turnover makes it difficult to achieve cohesion as individuals switch from one group to another. Nevertheless, within each group of about 15, there tends to develop a smaller set of four or five participants whose attendance is constant. Internal intimidation dynamics within the groups can impede cohesion, but facilitation of group work on communication issues helps to limit aggression and violence within the groups and over time tensions can be seen to wane.
Within the groups, the young people establish the guidelines for intervention, facilitated by a therapist. During the sessions, the participants are invited to discuss and analyse various subjects and to look for answers and coping strategies for the problems they deal with daily or that may arise in future. The intention is that the group learns from the experiences of all participants. In particular, the clinics look at commercial sexual exploitation as part of a series of problems confronted by the young people. Within the groups, therefore, the participants work together on important topics such as the factors that put young people at risk of being sexually abused and exploited, manifestations of sexual exploitation and its modalities, and legal tools for defence against sexual exploitation. They also investigate and discuss rights issues, communication, sexuality and perceptions of risk in relation to condom use, sexually transmitted infections (STIs) and HIV/AIDS, and violence and its consequences.
In addition, individual therapy sessions involve providing support to address different areas of concern, including social work, health, education and family matters. An intervention plan and a life plan are developed for the girl. Again, the focus is on strengthening self-esteem and resiliency, providing the individual with tools for getting out of difficult situations and avoiding recurrence of abuse, and assisting the young person’s reintegration into the wider society.
Esteem-building during group or individual work necessarily includes specifically addressing health-care issues. Aside from the therapy, programme workers accompany the young people to health and medical facilities and, over time, the young people themselves become accustomed to seeking medical care independently when they need it. In follow-up by the mobile teams, the young people often reveal the prescriptions and referral notes they have received from doctors or other health workers. This is evidence that the young people are learning not only to trust a doctor’s advice on drug use but also to take responsibility for protecting their health.
The progress of each group is evaluated every six months, based on feedback from the participants and the therapy team, and adjustments are made where necessary. The young people’s own demand for therapeutic services demonstrates that they have an interest in therapy and feel it benefits them. But good therapy requires regularity and time and it takes a long while for the results to be obvious to people who are not familiar with the process. Nevertheless, very positive results can be seen. Some of the young people with whom Asociación Tesis works have rescued themselves from sexual exploitation; they have stopped consuming drugs; they are gaining a formal education and attending pre-work seminars; they are returning to society and living independent lives with a job and a family.
The visible achievements may be small, but we are seeing important changes that will give these young people a far stronger foundation for the future.
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