Editor’s note: PATH country program leader Margarita Quintanilla told her story—and that of PATH’s work in Nicaragua—at our annual fundraiser, the Breakfast for Global Health on May 19, 2009.

Buenos días! And, thank you. Thank you, Chris, for that wonderful introduction. The “three of us” are happy to be here today.

You may not be able to see, but I am pregnant! In fact, I am going to have twins in the fall, and I already have a three-year-old daughter.

The fact of having kids makes me feel closer to all of PATH’s work—women’s health, access to vaccines, creating solutions to all kinds of health problems.

But solutions, no matter how good they are, might not reach the communities that need them. So we also work to address cultural norms that affect the success of those solutions.

I want to tell you about one piece of the work PATH is doing in my country, Nicaragua, and in the region. But let me start with my own story.

My mother has always been a very important presence in my life. She was a single mother, raising four kids while she taught classes at the university in gender studies. I remember her working so hard, late at night. I remember her encouraging us and making us feel valued and capable. And, she was always telling me, “Margarita, do what you love.”

When I was growing up, I did not know, but now I realize, that I was so privileged. Not all girls and women in Nicaragua are getting these positive messages. Cultural and gender norms make it impossible for many women to succeed, or even to have a healthy life. This became something I have been working to change for all of my career.

Now, most people at PATH don’t even know that I started my career as a dentist! Actually, it was while I was working as a dentist in a public health center that I became interested in how social issues affect community health.

One issue that caught my attention particularly was violence against women. At that time, there was no evidence of the relationship between violence and women’s health. At that moment, violence was only considered a social or psychological problem. The health issues that were recognized were broken bones and concussions.

But I found evidence of much more. I saw that the violence led to unwanted pregnancies, or to mothers dying in childbirth, or to babies being born too early or too small.

I also saw that violence can even limit a woman’s access to health services.

I saw these things and I needed to learn more. So I stopped being a dentist. (It took some time for my mother to forgive me.)

I got my master’s degree in public health, and I went to work directly with communities. This was like another school for me. It gave me the chance to look at how violence against women affected the health of the women and children I met—and how it affected the health of the men I was seeing, too.

Then, in 2002, I joined PATH as the first staff member of the Nicaragua office. I was there to implement a project called Entre Amigas, or “Between Girlfriends.” This was an innovative project that worked holistically to give preadolescent girls the skills they needed to understand gender-based violence, to protect themselves from early pregnancy and disease, and to take charge of their own bodies and their own health.

It was refreshing for me, working in prevention, to be able to stop the abuse before it happened—and to help the girls feel that they were valued and capable, just like my mother made me feel.

Now something interesting happened. We tried to include the girls’ mothers because our studies showed how important that relationship was. But we were not succeeding—the mothers did not come. Or if they came, they did not speak. So we had to change our approach.

A good example of this is Ana Maria Morraz. Ana Maria is a 33-year-old mother of four children. In Nicaragua, one in every three women is abused. Ana Maria was one of those who suffered from beatings by her husband.

Ana Maria came into contact with Entre Amigas through her daughter, Isabel. At the beginning, Ana Maria was like the other mothers, very shy and quiet. Like the other mothers, she did not participate in the workshops and programs.

We realized that we were speaking to her and the other women as mothers, but not as women. We were using them only as a way to reach the girls. We realized we needed to reach the women themselves, as women.

We changed other things too—we made sure that the men and boys were included in solving this problem.

Because of the changes in the program, Ana Maria was able to stop the violence in her life. She confronted her husband, and he could see that his whole family was learning new ways to live. So he started to change his ways too, realizing how much his family would benefit and that he would also benefit from these changes. He became the first man in the neighborhood to support the project!

And now, here’s a really interesting part of the story. In all of this, the family never heard of PATH. And it may be that the social workers and other community members never heard of PATH either!

That’s because of the way PATH works—through local partners. This is what makes the work sustainable, what makes the solutions last.

I look forward to my daughter and these new babies growing up and experiencing the benefits of all that PATH is doing in Nicaragua. I want a world where—boy or girl—my children have access to health, freedom from violence, and the opportunity to reach their own potential. Where they are free to find their own solutions.

Solutions do start with all of us. They start with me and my wonderful colleagues in Nicaragua and in the United States, with our partners and our collaborators, and with the people of Nicaragua who just want a better life for themselves and their children.

But solutions also start with you, with you being so willing to help. We are inspired by you, by your eagerness to help people so far away. We need you. We need your help.

And, we are so grateful to you for that help. I have seen personally what a difference it can make. I see it every day. Thank you.

Photo: PATH/Dave Simpson.