While interning for a U.S. foreign aid program in western Nicaragua this summer, I was able to escape my office cubicle for a day and travel up to the department of Boaco to check out Clinica Verde’s construction site and meet some of its future staff. I was accompanied by the clinic’s Project Manager, Johny Siman, whose love of football provided us with immediate and ample grounds to get to know each other over a Uruguay vs. Germany World Cup match over lunch in Managua before heading out to the site.
First, Johny drove me around the department, pointing out some of the other projects he has been involved with over the years. After driving by housing projects, schools, and baseball fields that he built, it was clear that he has been involved in this kind of work for many years. More importantly, after bumping into so many so-called “white elephant” programs plopped in Nicaraguan communities by international aid agencies, it was refreshing to see that local people were still finding these facilities useful to this day. It was also very promising to hear Johny recount some of his experiences using contacts to navigate his way through the Nicaraguan Government’s tedious and, at times, paralyzing regulations. Even before I saw Clinica Verde, I was confident that a non-profit with such local knowledge and expertise is building this with good reason and in a way that actually serves the public need in a sustainable fashion.
We eventually arrived to the Clinica Verde construction site itself, on the outskirts of the Boaco department’s capital of the same name, where I found that my predictions about the project were, in fact, very true. It was a tricky project visit in a way because the clinic is currently just a collection of cinderblocks, steel rebar, and wooden beams arranged in a way that basically meant nothing to me, given my dearth of knowledge in anything related to construction, architecture, and engineering. But, it was my conversations with Johny and the clinic’s Medical Director, Dr. Armando Incer, which shed light on some of the details of the project and the comprehensive set of benefits that will be afforded future patients. For example, it is obviously fantastic that Clinica Verde will offer maternity care to over 80 women daily as well as family planning services to many more (especially considering there are currently only 3 OBGYN clinics for 150,000 people living in Boaco!), but the clinic will also offer other essential functions, such as cooking classes, a demonstration kitchen, and an organic garden offered to encourage hygiene and nutrition diversification in community households. For the sake of sustainability, the clinic will also draw its power from solar panels and water from an underground rainwater cistern.
Dr. Incer also described how dire the current situation is for women in rural parts of Boaco seeking such maternity services, given how under-resourced and over-stressed the Boaco central hospital is. With a growing population and better road access, more and more families (try to) pour into the hospital every year, and after years of extremely low pay and insufficient medical supplies, the Ministry of Health nurses that staff the hospital seem to have become disenchanted with the whole medical system, as well as any patients that enter for services. Furthermore, with the recent politicization of medical services (as well as almost any other public service offered by the Nicaraguan government), Boaco hospital’s administration and doctors will inevitably be chosen according to their political affiliation and not their qualifications. Therefore, given the state of medical services in Boaco and the high mortality rates among rural women in the department, the privately-operated Clinica Verde clinic will fill a critical medical service gap by targeting the very women who need services most and by selecting employees that can best meet their needs.
On the return journey to Nicaragua’s capital, Managua, Johny provided a very telling (and amusing) description of the state of affairs in Nicaragua: “Donde el plomo flota y el corcho se hunde” (Where the lead floats and the cork sinks). After spending this summer working with development programs in Nicaragua, I have come to realize how valuable local knowledge can be in such a setting in fulfilling the needs of the poor when no one else will. With your support, the vision of Clinica Verde can move ever towards being a reality for the families of Boaco, Nicaragua.
Hey, Global Giving Supporters:
Just checking in to share some of the latest photos of construction. Things continue to move forward, despite record rains in August. Locals shared with me that it had been the rainiest August in 100 years! Nonetheless, the building site looked great, and we're still looking at a completion date around the end of November.
Also this month, the Nicaraguan American Medical Association put together an AWESOME fund-raising party for us in Miami. We are extraordinarily grateful for the support of this worthy group, and hope it's the beginning of a long and fruitful partnership.
Here on the West Coast, we're planning our first big fund-raising event for Sunday, October 3, at Solage Resort in Calistoga, California. It's going to be a great event. You can check out our Live and Silent Auction Lots on the links below.
We're working hard to raise funds to equip and operate the clinic. Your support means the world to us! Thanks for your interest in our work, and for your compassion.
An Interview with Clinica Verde Board Member and Former Minister of Health Margarita Gurdian.
Margarita Gurdian was Minister of Health of Nicaragua from 2004-2007. During that time she was in charge of the management of 1076 health units, 25,000 employees and a budget of $182 million US per year. She led the planning process for a National Health Policy for 2004-2015, a 5-year health plan and the Health Comprehensive Model of Care. She is currently doing work in Angola. Margarita received her B.A. in Latin American Studies at the University of California, Riverside, and an M.A. in Latin American Studies with a major in Public Health at the University of California, Los Angeles.
Q: How did you become involved with Clinica Verde?
A: After I left my post as Minister of Health I had a meeting with Susan Dix Lyon and Cristiana Chamorro, to see how could the effort that had started with Susan and her husband helping the Hospital in Boaco, could continue and help provide health quality services to a population with very few resources and a high rate of pregnancy in adolescents. Susan started organizing from scratch and her energy and motivation gave life to the project. I could not step aside. Susan's family was working so hard, the Board was enthusiastic and the proposed project to be a Green Clinic was an innovative, healthy and a tremendous challenge. Nicaragua is very lucky to have friends as Susan's family and all of the Board members.
Q: What about the project attracted you?
A: The fact that it does not matter where you are or if you are in the public or private sector, there is always a possibility of continuing supporting communities with very little resources in Nicaragua and try to provide quality health services as well as working on a healthy project that could be a model not only for Nicaragua but for other countries and communities as well. Also to work with a group of people whose only interest is doing good for people who need health services.
Q: As the former Minister of Health, what do you think Nicaragua's biggest challenge is in terms of improving healthcare for the impoverished?
A: I think that this is a challenge in we are all responsible for. All sectors must contribute to improving health care in our communities and in the country. A healthy population is a key determinant to development. Between 60-80% of the illnesses we have in Nicaragua are preventable. But also there are different factors that need improvement: one is budget. Nicaragua has people very well trained. Being in a country in Africa I can see the enormous difference in the availability of trained resources but the conditions in the rural areas in Nicaragua for trained professionals are not the best, therefore there is a migration of these more specialized human resources to the capital or bigger cities. Payment or salaries to attract health professionals are not high enough to keep them in the rural areas.
Another factor is attitude: if we put ourselves in the shoes of the people we are caring for, even if there are not enough drugs, equipment, people will feel that the provider is doing everything he or she can for them to feel better.
Q: Nicaragua has the highest rates of adolescent fertility in Latin America. What do you attribute this to and what can be done to change this number?
A: According to the DHL 50% of women under 19 are pregnant or already have a baby. Lack of information to youngsters at the schools and at home is a big part. Empower young women and work with them on alternative programs addressed to young women and men in a friendly and respectful environment where they can ask and receive answers to their concerns, their doubts and provide them with accurate information.
Q: Why should people in other parts of the world support Clinica Verde?
A: Clinica Verde is an innovative concept on how to provide quality health care, a holistic approach where you do not only see the individual that comes to the clinic looking for care but you work with the community, see the individual as part of a family and of a community. And this is a model that follows all norms and regulations to be friendlier with the environment and provide a sense of pride to the communities that will serve.