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In the shadow of the majestic, gaseous crater of the San Cristóbal volcano, Nicaragua’s highest, María Concepción Morán leans back on a plastic chair on the dirt floor of her backyard in the small town of Chichigalpa, calmly recounting the time when her life had sunk to its lowest point.

“My house was made of plastic, cardboard and a few poles – I had nothing,” she says in the shade of some lemon trees and her family’s latest batch of washing. “I was stressed, I had high blood pressure, I used to cry a lot. Every winter the rains would soak my bed.”

That all changed three years ago when she found out about a local microfinance organisation called Pro Mujer (Spanish for “pro woman”), and joined a group of 20 other women, who clubbed together and asked for a loan. She borrowed 3,000 cordobas ($125), paid in fortnightly instalments over six months, to invest in a proper roof and some groceries, which she sold to her neighbours.

But then something else happened. Thanks to an innovative health programme being pioneered by Pro Mujer, which lends to its clients on condition that they take some basic health tests, including a cervical smear every six months, Morán discovered she had cervical cancer.

“If they hadn’t insisted I take the test, I wouldn’t be telling this story,” she says matter-of-factly, explaining that although she knew what the test was, she would never have bothered to have one, as “no one encouraged me to”.

Morán has now borrowed 42,000 cordobas over six months, enabling her to turn her venture into a flourishing local store, selling everything from mobile phone credit to toys, soap, vegetables and fizzy drinks. She has even put aside savings of 15,000 cordobas.

She says: “It’s not much good having money if I don’t have my health. The important thing is that I do still have that.” For that, she thanks Pro Mujer.

Morán is just one of around 41,000 women who are clients of Pro Mujer in Nicaragua, the second-poorest country in Latin America. After being founded in Bolivia in 1996, Pro Mujer set up operations in 1999 in poor neighbourhoods in Nicaragua, where it has amassed a loan portfolio that stood at $9.7m in December 2011.

But Pro Mujer, which has also set up offices in Argentina, Mexico and Peru, is about more than lending money to mostly poor women in need of funds to set up small businesses. At the core of the organisation’s philosophy is also the provision of access to primary health clinics and training in basic business skills, health education and self-esteem awareness.

“The credit is just a means to an end, which is to promote the development of women,” says Gloria Ruiz, who runs Pro Mujer’s operations in Nicaragua. “The wonderful thing about Pro Mujer is that it provides an opportunity to give women training so that they can change their attitudes.” She adds that the practice of linking loans with health services is unique.

“It is not just about lending and debt collecting,” she says. “We didn’t come to lend but to use loans as a way to promote education and empowerment. These services are a powerful way to reduce poverty.”

In Pro Mujer’s clean, air-conditioned offices in León, a city of faded colonial beauty in the north of Nicaragua, women with an air of hope and calm gather to take advantage of the organisation’s three key functions: the provision of credit, training and health services.

In the health clinic, Dr Marta García explains with enthusiasm how Pro Mujer has taken great strides in attacking some of the biggest afflictions facing women in the region, such as cancer, diabetes and hypertension.

“We have saved the lives of a lot of people,” says García, introducing the softly spoken woman she is attending as Doña María, who makes a living selling beans in the street.

“People don’t look after themselves,” says María, who adds she is grateful for García insisting she went to hospital to get her gynaecological problems treated properly. “If it wasn’t for her, I don’t know what would have happened. If I’m ill I can’t work.”

“Prevention is so much cheaper than the cure,” says García. Just with regard to cervical cancer, Pro Mujer has carried out more than 30,000 smear tests in Nicaragua, of which almost 3,000 detected malignant or pre-malignant lesions.

García adds that Pro Mujer wants to provide its services to the wider community. As well as basic tests such as body mass index, blood, urine, pulse and weight, Pro Mujer is starting to offer more advanced services, including dental, optical and gynaecological treatment.

Patricia Padilla, who runs a competing microfinance institution in Nicaragua called ADIM (which translates as the Alternative Association for the Integral Development of Women), is full of praise for Pro Mujer.

“They’re not just good, they’re extremely good,” she says, describing the organisation’s social work as “excellent”. She adds: “They are very innovative and the extent of their client base is impressive.” She admires Pro Mujer’s ability to continue growing during the global financial crisis, the only microfinance institution in Nicaragua to do so.

Nevertheless, she is concerned about the sustainability of Pro Mujer’s non-financial operations, suggesting that unless it expands its health clinic services, and thus is able to charge more (its clients get up to a 50 per cent discount for some services), paying doctors may become burdensome.

Ruiz says Pro Mujer’s non-financial operations are “the key” to breaking the cycle of poverty in which many of its clients are stuck. Nevertheless, she admits Pro Mujer cannot depend on unpredictable donations, emphasizing the importance of making clients aware they must invest in their own personal development, training and health. Ruiz says non-financial products must have a high impact, be easily accessible and self-sustaining. “Any programme that achieves these three elements will last over time,” she says.

Pro Mujer has been uniquely successful in tackling another obstacle faced by microfinance institutions in the country – its left-wing government headed by the populist leader Daniel Ortega, says Padilla. It was the only microlender to win approval from a government-backed group called the No Pay movement that was set up in 2009. The movement allowed its members to keep making payments to Pro Mujer – in contrast to other microlenders. Ruiz, an agricultural engineer by training, says this is because one of its leaders was a client of Pro Mujer.

Still, she accepts private microfinance institutions, though many are often accused by politicians of charging interest rates that are too high, are an irritant for Nicaragua’s government, which has its own microfinance programme, Zero Usury.

Ruiz says: “They don’t want to have competition in this, and Pro Mujer is a very strong competitor.” Padilla reckons that “since the No Pay movement, the government has come to the conclusion that we are a necessary evil”.

That Pro Mujer’s headquarters are in New York, and that in the past it has received grants from organisations disliked by Nicaragua’s “anti-imperialist” government such as the United States Agency for International Development, is further cause for complaint.

Even so, “the organisation has strategic alliances with the government, even if it doesn’t really like what we’re doing”, says Ruiz, who explains that Pro Mujer can only detect serious health problems, and that treatment for cancer or similar life-threatening diseases must often be provided by the public sector.

In the face of such adversity, Ruiz, an energetic, constantly busy woman, remains committed to her job: “There’s nothing more beautiful than arriving at a community and finding poor women who have lost all hope for the future, and to be able to inject energy into them and tell them, ‘Yes you can!’”

Edelma Altamirano was one such woman. She explains from a rocking chair in her sparsely decorated but spotlessly clean living room how she used to be a virtual captive, beaten by her husband. Then a friend at Pro Mujer told her: “You’re no fool – you can make it alone.”

“I remember it well – it was November 30 nine years ago,” says Altamirano. “I borrowed 2,000 cordobas, which for me was a huge amount of money. What am I going to do with all that, I thought?

“I didn’t have faith in myself, but Pro Mujer lifted my self-esteem hugely.” Not only did she discover after using one of Pro Mujer’s smear tests that she had level two cancer – from which she has recovered – but she also had the courage to leave her husband two years ago.

Ruiz says: “We raise [women’s] spirits – they only need a helping hand. To see them with flourishing businesses, that even their husbands will leave their jobs to help out with, is truly rewarding.”

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