Health
 Nicaragua
Project #2680

Healthcare for Pregnant Women in Nicaragua

by Clinica Verde
Vetted
Daniel Olivieri, center, at Clinica Verde.
Daniel Olivieri, center, at Clinica Verde.

By Daniel Olivieri

“The real question now,” an old Cuban doctor told me, “is looking at what happens when it [universal healthcare] doesn’t work.”

We had just completed 15 interviews in Habana Vieja, when I decided I wanted to work in Nicaragua the following summer.

It will be different, I thought. It should be different, but it should also be particular, fluid, and innovative.

That’s when I found Clinica Verde.

I’m proud to say that Clinica Verde is everything that it looks like on their website, and then some. When you’re at Clinica Verde, in the words of administrator David Narvaez, “eres familia.”

While I came to the clinic to systematically define what ownership means in the context of post-modern development scenarios, I quickly came to realize that ownership and health are only defined by the terms that they are composed of and not the other way around.

In other words, trust, one of the defining characteristics of catchphrases like “ownership” and “patient-centered design,” is what really matters.

What could be more essential that trusting that the services you receive are not only high-quality, but are given with the utmost care, respect, and thoughtfulness?

Healthcare is much more than the medication you receive, the amount of doctors available at a clinic, or if you follow up with your appointments. Health is about the community you live in, the people you surround yourself with, and the way you perceive yourself. Health is about religion, sociology, and governance.

Healthcare is, and will always be, at its core, about justice.

And justice, I’ve learned, is a brutal uphill battle against the current, a unifying cause that brings together doctors from Boaco, patients from Puerto Cabezas, and a researcher from the States.

Just as doctors can be called the lawyers of the poor, clinics should be called on to provide a fair court where the lawyers can work, succeed, and vouch for their patients.

Let me, then, introduce you to Boaco.

In a little over four weeks here at the clinic, we’ve seen patients travel from over eight hours to eight minutes to attend the clinic, always for varying yet valid reasons. Clinica Verde, in convalescing the pieces of a public healthcare system that often garners more skepticism than pride, attempts to toe the line between free and effective care, betting on trust, charlas, and an innovative method to provide a trustworthy alternative to the expensive private clinics and public health posts.

And that’s a bet they haven’t lost yet.

From weekly outreach visits to rural communities surrounding Boaco to cost-sharing for medicine on a case-by-case basis, charlas to consejerias, Clinica Verde’s holistic moxie not only upholds the right to health, but it demonstrates the importance of trust, not money, buildings, or awards, as an effective solution to sometimes ineffective public healthcare.

By framing patients as people and not numbers, the clinic aims to provide Boaco with a more refined approach to care. One day, I hope, holistic healthcare will be tried-and-true, the bread and butter of public healthcare, but until then, clinics like Clinica Verde provide a reprieve from sometimes corrosive systems of care that merely provide biological care without actually “treating” the patient.

Does Clinica Verde have all of the answers? Can they help every patient in Boaco and its surrounding departments? Probably not. (At least not right now, they might tell you).

What Clinica Verde does have is trust.

And as I’ve learned here in Boaco, that can go a long way.

Daniel Olivieri is an undergraduate researcher from the University of Notre Dame in Notre Dame, IN, USA, and was awarded a Kellogg Institute Fellowship to work with Clinica Verde this summer. Daniel has completed research projects in Havana, Cuba, and Rocinha, a favela of Rio de Janeiro, Brazil, and aspires to work in improving the logistics of public health systems in developing countries through a biopsychosocial approach. He welcomes any questions, critiques, or comments, and can be reached at dolivier@nd.edu.

Paige Preston spent a semester researching and advocating for Clínica Verde. Here's what she learned.

You could say that it might be a risky move to give a bunch of college students $10,000. Risky though it may be, this past semester at the University of Southern California, I was in a class tasked with distributing $10,000 to a nonprofit organization, or two, of our choosing. Sitting in the first day of class, all I could think about was how much I wanted Clínica Verde to be a contender for the grant funds. I have always believed in the work that Clínica Verde does, but I knew that my simple belief would not be enough to persuade a class to give, and certainly would not be enough to get me anywhere close to an A on deliverable assignments. I had to do my research—delve into tax forms, critically examine the website, and sift through all information presented via third parties on the web. During this due diligence I would have to go back to my class and report my findings, as well. For me, this process was a breeze. Not only was information about Clínica Verde up-to-date and easy to find, but it was often presented in a very appealing fashion as well. While a few others had similar experiences, others came face-to-face with the inefficiencies, lack of communication, or bureaucracy that some view as a hallmark of the nonprofit sector. When standing in front of the class, the “advocates” for these organizations blatantly informed us not to consider donating to them a second longer.

After much research came the class-wide deliberation—it was time to decide how to divide up the $10,000. It was not totally a free-for-all process. To begin we had to decide upon a class mission statement, evaluation metrics, and giving guidelines. After a semester analyzing the social sector, we had a pretty good idea of what works and what doesn’t. For this reason, coming up with our mission statement was the easy part, Empowering individuals within their communities through sustainable solutions. A fairly broad statement to be sure, but we further narrowed it down by aiming to fund organizations that focus empowerment using skill-building or educational programs. My class felt that a nonprofit that fit this description would truly be doing the best kind of work in the world. Although some people tried making creative leaps to get the organizations they were advocating for to meet these criteria, this was an easy sell for Clínica Verde. After all, empowerment, sustainability, and education are all central tenets of its work. When giving the grant pitch to the class, it wasn’t difficult to show how each and every individual Clínica Verde serves can have a profound ripple effect across the larger community.

Throughout this process I discovered something valuable about Clínica Verde—that it truly is doing the right things in the right way to make a global impact. It is transparent, it is sustainable, it is redefining an industry, it is creating change.

Now, I am sad to say that despite its perfect candidacy for the class grant, in the end Clínica Verde was not selected as a recipient. The class decided to keep the funds more local, and gave to two excellent organizations in the LA area that numerous students in the class had prior connections to. While I understand why my peers wanted to give to a nonprofit in our own backyard, I nevertheless disagree with their choice for a very simple reason. While not in LA or Southern California or the US, Clínica Verde has the potential to scale. It is an organization that could and should be anywhere and everywhere. Throughout this process I discovered something valuable about Clínica Verde—that it truly is doing the right things in the right way to make a global impact. It is transparent, it is sustainable, it is redefining an industry, it is creating change.

 My failure is proof of the greatest thing Clínica Verde is in need of. It needs others to see how Clínica Verde belongs in each of our own backyards, and not just in some far off town in Nicaragua. In this way, each and every one of us who believes in Clínica Verde has an obligation. It is our job to advocate, challenge others to do the research, find a personal connection, share it, champion it, and push those around us to get involved and interested. We need to get others to feel that direct connection that becomes the deciding factor between choosing to donate or not. Let’s create our own ripple effect and get a truly worthy nonprofit the $10,000 it deserves and more. I say with the fullest confidence that Clínica Verde truly is the best type of force for good. As an organization, Clínica Verde, beyond doubt, gets an A from this class assignment (even if I don’t).

 Paige Preston is finishing her junior year at USC, majoring in political economy.

Clinica Verde team members in Nicaragua.
Clinica Verde team members in Nicaragua.
First place winner Jennifer
First place winner Jennifer

In its commitment to educate and inform teens about sexual and reproductive health at Clínica Verde, our team held a contest among members last month to reward not only their knowledge but also their commitment and work with peers in the community. Our first place winner was teen peer counselor Jennifer with 100 points, followed by second place winner Miurel with 99.4 points, and third place winner Eliecer with 98.7 points.

"I'm so happy to have won, thanks to my efforts to study the program and give educational talks and advice to peers in the community," said Jennifer, with tears of joy in her eyes. She said the prize of $50 will go to help her family, who are very poor. Each of the winners come from rural communities and families of very few resources, and the program's acknowledgement is a great source of pride.

We are so proud of our teens!

At Clinica Verde the counseling center and prevention work with adolescents is a priority. We train adolescents in the community and provide them with useful tools for making responsible decisions in their lives, but above all we love to see their efforts to work with other teens in the community. Each step forward redoubles our commitment to make this center a model in the community. 

Clinica Verde and TeenSmart partner in this program thanks to the sponsorship of the Strachan Foundation. Our Counseling Center for Adolescent Sexual Reproductive Health aims to contribute to improving living conditions for the adolescents, young people and their families, through the promotion of sexual and reproductive health, with a focus on life skills and personal development that supports behavioral changes encouraging a healthy life.

As a result of this program:

• 50 young people have been trained in counseling skills and techniques
• The teens have given 97 education talks with 2,247 participants in 2015
• 78 counseling sessions have been provided by the adolescents in the first quarter of 2016

We look forward to seeing this program grow and thrive with your support!

Our TeenSmart winners and team leaders
Our TeenSmart winners and team leaders
Jessie Wheeler + students from CV
Jessie Wheeler + students from CV's teen program

One of the great benefits of working at Clinica Verde is that it introduces us to so many generous and wonderful people who are interested in helping out. Jessica Wheeler is one of those special people. We first connected with her after she made an online donation in 2009, when Clinica Verde was just getting started. She wrote then: “The mission of Clinica Verde rings true on so many different levels and my contribution is the least I could do.” Jessica stayed in touch over the years as we brought the vision of Clinica Verde to life. She is now a graduate student at Columbia University in New York City getting her degree as a Nurse Practitioner, specializing in psychiatry. She also works at a startup called FRND, which is like an Uber for RN’s, bringing on-demand nursing care to people’s homes.

This past summer – 6 years after she first reached out – Jessica and her husband Tim volunteered for 5 weeks at Clinica Verde. We asked Jessie to briefly share her experience.

What drew you to working at Clinica Verde?
As an avid surfer, I have visited (and loved!) Nicaragua for over a decade. A few years ago a fellow traveller mentioned the clinic to me, saying they knew someone from California who was starting a clinic for women in the mountains (I wish I could remember who this person was!). In any event, Clinica Verde was just a concept at this point, but I started donating small sums of money for the building of the clinic. When I became a registered nurse, I wanted to give something back to Nicaragua. I thought spending some time working at Clinica Verde would be a good way to do this! In addition, I’m very interested in global health and I knew CV would give me an education that I could never find in a classroom.

What was the most challenging thing about your experience at Clinica Verde?
The language barrier. I am “conversational” in Spanish but did not have enough of a grasp on the language to understand all of the small interactions that occur between doctor and patient.

What was the most uplifting experience?
Oh wow. I’m not sure. All of it? I suppose the most specifically uplifting experience was the TeenSmart Program and our day discussing contraception. I take contraception very seriously and have been a cheerleader for family planning for quite some time! I thoroughly enjoyed imparting this information to the teens in the program. Parts of it seemed to really resonate with them!

Is there one story/patient who really stuck with you? 
I worked with one mother who had a very sick infant. The infant was not feeding properly, losing weight, and spiked a fever. Ultimately this baby needed to be in the ER and have IV fluids, but the process of helping the mother through it was very rewarding. The mother was nervous but appreciative of the care we provided.

We’re so grateful to have Jessica as a part of our Clinica Verde family!

• • •

This past year, we've served over 10,000 patients at Clinica Verde, providing not just clinical care and medical consults, but education talks on nutrition, hygiene, prenatal care and more. We're particularly excited and grateful for our TeenSmart program, which trains teen peer counselors in sexual reproductive health, and our Prenatal Nutrition Program, which provides young mothers a support network and education on the stages of fetal development, the importance of diet and nutrition, and well baby care.

We couldn't have done it without you.

We want to wish all of our awesome donors and volunteers a joy-filled holiday season. You are helping to make a difference in the world through your kindness and compassion. 

With love and gratitude,

Susan

Maribel at Clinica Verde
Maribel at Clinica Verde

Maribel*, 24, came to Clinica Verde in February of 2014 for her first prenatal appointment. She joined the pilot of Grupo de Bienestar Materno Infantil - our Prenatal Nutrition Program, where she worked with obstetrician Dr. Madellein Reyes, our Nutritionist Mary Flores and nurse Yazmina Diaz. 

Maribel worried that she wouldn't be able to come to Clinica Verde because of her lack of resources and the cost of transportation, so the staff supported her by providing transportation. She was an excellent member of our group, maintaining a great attitude throughout and meeting the appointments for all of her prenatal check-ups.

With her integration into the program, her state of health improved. She always arrived on time and carefully followed the suggestions of her medical team. As a single mother, Maribel's participation was challenging and she is extremely grateful for those who supported her so that she could learn to care for herself and her baby to create a foundation for long-term positive health.

On August 24, Maribel gave birth to a beautiful baby girl via cesarean section. The baby weighed 7.8 pounds and demonstrated normal vital signs. On September 4, Maribel visited Clinica Verde for her baby's first checkup. Thank you for supporting Maribel and her daughter, who we will continue to follow and monitor with love and compassion at Clinica Verde!

More about our Prenatal Nutrition Project ...

Clinica Verde's Prenatal Nutrition Project project uses interactive lectures, food-based approaches and socio-behavioral change curriculum to teach pregnant mothers about the stages of fetal development, ways to care for the health of their child in the womb and nutrition during the pre-natal, post-natal periods and the first five years of life. The program has the following goals:

• To reduce childhood malnutrition and nutrient deficiency (Goal: 80% of mothers can identify 3 symptoms of malnutrition or nutrient deficiency and 2 symptoms of over-nutrition

• To increase the rate of exclusive breastfeeding (Goal: 70% of participants to practice exclusive breastfeeding for 6 months post-delivery)

• To increase knowledge of nutrition and bolster diet diversity (Goal: In final project survey, 90% of mothers can identify 3 nutrient-dense vegetables and health benefits, and a way to cook at home)

• To foster pride in pregnancy (Goal: 80% of mothers give correct responses to 2/3 fetal development questions during the final evaluation)

• To create a supportive community of pregnant mothers (Mothers meet together in a group at Clinica Verde weekly for the 10-week program)

• To increase interest in home gardening techniques and the bio-intensive method (Provide seeds to mothers and do home visits to aid and promote home gardening)

Our pilot showed great promise and we are now starting with our second group of mothers.

Many thanks for your continued support as we work to transform the long-term health of the community we serve.

Nurse Celina with Maribel
Nurse Celina with Maribel's healthy newborn
 

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Organization Information

Clinica Verde

Location: Angwin, CA - USA
Website: http:/​/​www.clinicaverde.org
Project Leader:
Susan Dix Lyons
Staff member
Angwin, CA United States

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