Project #2680

Healthcare for Pregnant Women in Nicaragua

by Clinica Verde
Thank you for supporting Clinica Verde!
Thank you for supporting Clinica Verde!

Dear Awesome Supporter,

It’s not too late to make a difference! The clock is ticking down to the end of 2016, but there’s still time to contribute. Your donation in support of Clinica Verde will have its impact multiplied by the chance to compete for bonus prizes in GlobalGiving’s Year-End Campaign. And, if you set up a new recurring donation, your first contribution will be matched 200%! We think that's pretty awesome.

Give because you care about health for women and children. Give because you want to help. And for whatever noble reason you give, don’t forget that all donations made by US donors are tax-deductible – so give by 23:59:59 EST on December 31.

We appreciate any donation, no matter the amount. It’s only thanks to you and your continued support that we are able to provide the critical services that we offer. 

Best wishes for 2017! We look forward to working with you to keep spreading good in the world.



As we shared with all of you earlier, Clinica Verde is partnering with the Ministry of Health of Nicaragua to redesign two of their rural health posts (puestos de salud). The broader hope is that the work we do together can serve as a prototype to expand throughout the country’s network of over 1,000 rural health posts. It’s a big and exciting endeavor, and we’re working thoughtfully through every step, along with our partners at the Ministry and the communities we serve.

We’re very excited to introduce you to the architect who is leading this project: Amanda Martocchio, with her team at Amanda Martocchio Architecure + Design. We asked Amanda to share a little bit about herself and her approach to the work with Clinica Verde:

First, tell us a little bit about your history and Amanda Martocchio Architecture + Design.

Amanda: I grew up in Colorado, the daughter of a philosopher whose academic engagement centered on international development ethics, with particular interest in Central and Latin America. Childhood dinners included discussions about the importance of aiding developing communities from within rather than from without.

With a love for drawing, my personal academic interests turned to architecture, receiving degrees from Cornell (B. Arch) and Harvard (M. Arch). Professional life as an architect began in NYC working on large-scale institutional and commercial buildings, including the Mashantucket Pequot Museum and the Stanford Art Museum Renovation.

When my first child was born with a brain injury and developmental delays, it was clear that my former work place would not be consistent with the work-life balance I would need, so, rather than returning to the firm, Ennead, I started my own practice in 1995, renovating the apartments of my husband’s colleagues in my closet-sized home-office. I soon established the office of Amanda Martocchio Architecture + Design, LLC (AMA+D) in Manhattan’s Union Square Park, later relocating to Connecticut where the architecture and interior design firm has thrived, earning numerous awards for residential projects and being awarded the prestigious Connecticut AIA Emerging Architectural Firm Award.

AMA+D creates designs that are inspired by the project site and the ideas that emerge from an ongoing dialogue with our clients. Our approach is rooted in simplicity and craft. We design environments in which the occupants experience wellbeing due to the prevalence of natural materials, an abundance of daylight, and a connection to the outdoors. Our goal of contributing to a sustainable future is evidenced by a commitment to resource preservation, innovative technologies and the latest developments in building science. An AMA+D-designed home has recently qualified for LEED certification, requiring rigorous standards of energy efficiency and thermal performance.

Shaun Gotterbarn and Cameron Cole Carcelen are members of my studio who will participate on the design team for the Puestos de Salud. Cameron, who has lived in Ecuador and is married to an Ecuadorian, will be our translator, and will be joining me during our visit to Boaco in November.

What about the Clinica Verde project attracted you?

Our clients, for whom we design single-family homes, are well-educated and affluent. In the U.S. they have been referred to as the “1%”. While we are fortunate to have the opportunity to design environments that enhance the lives of their occupants, we are eager to turn our design thinking into making a difference in the lives of many who have much less.

I have been aware of Clinica Verde since it was just an idea in the mind of my cousin, Susan Dix Lyons. I have watched as the goal of supporting maternal and infant healthcare in rural Nicaragua evolved from concept into built clinic. As a mother of a child with a chronic illness, I am all too aware of how lucky we have been to have received outstanding medical care from the time of her infancy. I am personally moved by the challenges overcome by mothers in poor regions of Boaco to access healthcare for their infants.

As architects, we have been thinking about and implementing sustainable building practices into our architectural design practice for some time. We look forward to expanding this mindset and experience to a very different environment, community and building tradition.

Clinica Verde’s mission is to provide community-based healthcare where members of the community are encouraged to take responsibility for and pride in their own and their children’s preventative health. The design solution for the individual puestos will likewise be community-based. We will be guided by the local users’ needs, cultural biases, and building methods, so that members of the community will take pride in the puestos as their own.

We will be guided by the local users’ needs, cultural biases, and building methods, so that members of the community will take pride in the puestos as their own.”

Share a little bit about your approach to collecting information about the community and the puestos, and how that informs your design.

We were first introduced to Clinica Verde, its mission and history by (Founding Board member and development consultant) Peter Stanley and Susan. With the help of Clinica Verde General Manager Rafael Morales and Program Coordinator Mary Elizabeth Flores, their “feet on the ground” support, we are compiling data about the physical characteristics of the puesto sites, documenting them through photographs, map-making, and digital information. During our upcoming visit to Boaco and the clinic, we hope to observe, first hand, the environment and meet with local citizens so that we can better understand the community for which we are designing these public buildings.

We talk a lot about using human-centered design at Clinica Verde, and I know that the culture of charrettes that designers use is similar. Can you address those processes and any parallels?

Human-centered design is just that. As designers, the success of our work is measured by whether it meets the needs and aspirations of the people for whom we are designing. Cameron and I will be visiting Boaco for the first time in a couple of weeks, and although our visit will be short, it will be important for us to observe and to interact with the local mothers, families and children for whom the puestos will be designed. With a greater understanding of what “matters” to the user, and with studied knowledge of the physical conditions of the Boaco sites, we will define the design opportunities and constraints. During initial design we will “throw out” various approaches, without letting ourselves fall in love with any single idea at the outset. We will rapidly develop multiple alternative approaches and test them with the users before settling on a preferred direction.

What do you see as the greatest challenge to this project?

The greatest challenge will be to obtain a level of understanding of the local people from our distance, both physical and experiential. We not only will need to empathize with the people who will be using the puestos for them to be successful, but we will need to engage them in the process, so that they become agents of the project and shareholders in its success.

What’s your greatest hope for this project?

My hope for the project is to expand the mission of Clinica Verde by designing local health outposts within the fabric of the communities that are vital and sustainable, and that community members view them as their own.


The Clinica Verde Team in Nicaragua
The Clinica Verde Team in Nicaragua

Dear Friends and Supporters:

I'm writing to you as the Founder to share some exciting news. After more than 4 1/2 years of operation in Boaco, Nicaragua, Clinica Verde is thrilled to announce that we are partnering with the Ministry of Health of Nicaragua to bring our innovative approach to care to their rural health network. 

What does this mean?

We've entered into a 1-year agreement with the government to expand our model through a partnership in which we:

  1. Design and build 1 new government rural health post and redesign 1 existing rural health post using principles of human-centered and evidence-based design;
  2. Train government medical staff at each site in our compassionate care approach, and;
  3. Implement our Prenatal Nutrition Program, including the creation of a biointensive garden at each site.

(For more information about why this approach contributes to better health outcomes, please take a look at a new section of our website:

In this public-private partnership expenses and resources will be shared between Clinica Verde and the government of Nicaragua – and we're excited by the shared enthusiasm and commitment to making this partnership a success.

The greater vision is that, after the 1-year pilot, we'll work together with the government to expand this model of high-quality rural health to other health posts in Nicaragua.

From the very beginning, we hoped and believed Clinica Verde would create a model that would present a standard of excellence and compassion, improving health outcomes and opportunity for the rural poor. It's been a challenging path to get to where we are today, but we've learned so much along the way – and continue to learn from our patients and staff each day.

None of this would have been possible without the exceptional leadership and dedication of our Nicaraguan staff. The thing I'm most proud of is the culture we've created at Clinica Verde – a culture that is not just ethical, innovative and compassionate, but also mission-driven and passionate about raising the bar in all that we do. Without that culture – and the team on the ground that sustains and nurtures it – none of our goals or vision would have been realized. It's that simple. At Clinica Verde, under the guidance of General Manager Rafael Morales and Medical Director Yolanda Guitan-Paredes, and with support and leadership provided by Administrator David Narvaez and Mary Elizabeth Flores, we have a team on the ground that brings heart and distinction to all that we do.

And, of course, we've always relied on the expertise of our Board of Directors. On top of being some of the smartest and most generous human beings I've ever met, they continue to enrich my life personally and make me better. Their names appear below.

For now, we have a lot of work to do. The next months will be full of new challenges and lessons, and no doubt a fair share of missteps along the way. We're ready for it :)

In emails to come, I'll share with you the plans and approach of this project's architect (someone I'm really excited about!) as well as the work that's being done with partners to implement our programs and approach. In the meantime, we'd love to hear from you, what questions you have – and what information is most interesting to you as our community of supporters. Feel free to also send questions for our Nicaraguan staff and partners.

You have been a very vital and potent part of this work, and all the work we do to provide compassionate care to the poorest of the poor. Each of you has in some way contributed to this journey, and will continue to help determine our path forward. Thank you. It's my sincere hope and prayer that you'll stick by our side and continue to support the work we do as we seek to bring health and hope to families in need. 


Susan Dix Lyons



Board of Directors

Jennifer Wegbreit, Co-Chair

Nikhil Bumb, Co-Chair

Peter Stanley, Vice-Chairman

Cristiana Chamorro

Margarita Gurdian

Dr. Doug Wilson

Colleen Horowitz, RN

Allyson Haug

Susan Dix Lyons


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

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.

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Organization Information

Clinica Verde

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

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