JULIA GUTH ON COMMUNITY ENGAGEMENT AT ROBERTO CLEMENTE CLINIC

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Julia Guth is Chair of the Board of Roberto Clemente Health Clinic located in Nicaragua. Founded by Ms. Guth and representatives of Rancho Santana, a for-profit residential development on the Nicaraguan coast, Roberto Clemente Clinic was meant to provide medical services for investors, residents, and workers of the development, while also serving as a way to “give back” to the impoverished communities surrounding the Rancho Santana development. However, under Ms. Guth’s leadership, Roberto Clemente has become more than another CSR initiative. Ms. Guth describes the community outreach strategies that have led the small nonprofit clinic to reach thousands of patients a year and that, more importantly, have led the Roberto Clemente Clinic to be genuinely valued and trusted by the community.

What problem was the Roberto Clemente Health Clinic created to address? What is the mission of the clinic today?

When we arrived in 2003, we realized there was no healthcare in the immediate area; the closest healthcare providers were the [Nicaraguan] Ministry of Health clinics that were hardly manned and had poor services and medicines. The hospital was over an hour away on a bad dirt road. The need to do some kind of health clinic was really evident. At the time, it was inexpensive to get the resources together, and a lot of people wanted to help. We opened the doors of Roberto Clemente Clinic in 2004.

The original mission was to help with emergency care. Because we are on the coast, we have both workers and visitors with emergencies. There’s a huge surf community, and we help a lot with the surfing accidents. We’re still mainly an urgent care clinic, stabilizing patients to get them to the main hospitals. Along with that, we also do some primary care, such as helping pregnant women and helping kids, who in this area have asthma from the dusty roads. A lot of people have stomach problems from drinking bad water, or—since they don’t want to drink the bad water—have diabetes from sugary drinks like Coca-Cola.

You’ve been with the clinic since the beginning. What was the initial process of engaging the community like?

Exterior of the clinic, located in the town of Limon 1 in Nicaragua.

Exterior of the clinic, located in the town of Limon 1 in Nicaragua.

Exterior of the clinic, located in the town of Limon 1 in Nicaragua.

We decided that the clinic would have a sliding scale, meaning not everything is free. The clinic is still very low-cost—it costs less than private clinics or the hospital. If we get donated medicines we give them for free, and children and seniors are free. For everything and everybody else, we charge a nominal amount; we really believe in that so the community values the clinic. It was confusing at first for people; people were afraid to come, because they don’t have a lot of cash in their pocket.

One story comes to mind. The first baby born in the clinic was named Bertha Juliana, and after she was born, the clinic nurse and I went to visit the baby’s family. The mom handed the baby to me, and I could see the baby had pinkeye and scabies. We explained that these things were really easy to remedy—we have eye drops for the eye and cream for scabies—so we asked the mother why she didn’t take the baby to the clinic. She said it was hard to get transportation and she was afraid she would be charged a lot. The next day I saw her at the bus stop, and she came to get the cream and the eye drops, so I was happy about that.

But I was still dismayed—the child must have been miserable!—and I knew we had to do a lot more outreach to make sure we were reaching everybody. The nurse worked in the community and the doctor lived at the clinic, so that all helped. And we would do fieldwork. We would all go around shaking hands, talking, reminding people to drink water and take vitamins. I took my son and daughter from house to house handing out flyers, cold medicine, aspirin—little things like that. Slowly everybody got to know us and got to know the clinic has a sliding scale and will help you in an emergency. They got to trust us after that. It was a relationship thing. The network is out there now, but it has taken 12 years.

Why is community engagement so important? What mechanisms do you use to keep the community engaged?

“We can’t do enough out there. We have to keep pushing outward, networking, and trying to meet more people.”

It’s important for two main reasons. First, it’s a huge rumor mill down there. You have to get ahead of it, otherwise things spread that aren’t true—like the clinic is shutting down, the hours are being reduced, or the clinic is raising the prices on pharmacy medications. We also have to fight against weird prejudices. In one case, people took their dehydrated baby to a new-age healer. The baby died when it could have easily come to the clinic and gotten treated.

Now we have community leaders we meet regularly. We have something called the Clinic Community Council (CCC) monthly to meet with workers from the [Rancho Santana] development. The CCC represents 600 workers, and we meet the CCC to see if the workers have any issues, want to change a policy, or have any suggestions. In addition, Roberto Clemente Clinic covers 15 coastal towns, so we also meet with community leaders from those towns. Sometimes we meet the mayor to get suggestions and get ahead in our communications. We also have to work with the [Nicaraguan] government on emergency response and with the Ministry of Health on legal compliance and international health protocols. We work in schools and we partner with local NGOs. We can’t do enough out there. We have to keep pushing outward, networking, and trying to meet more people.

The staff of Roberto Clemente Health Clinic.

The staff of Roberto Clemente Health Clinic.

What are the challenges of running a clinic in your operating environment?

There are several challenges. The biggest challenge is that our facility is too small—it’s very cramped for patrons and staff. The issue is funding. Costs of materials, labor, and transportation have gone up a lot. The dollar is really strong, yet oil and commodity prices are still really expensive, and labor has gone up. To build the whole clinic and staff in the first year was $60,000 dollars. Now to build the extra facility that we want to build is over $200,000 dollars.

The other challenge is that the area is in a big drought. Rancho Santana is letting us tap into their well, and with a donor we invested in clean water treatment, so we’re getting clean water. We use some of the water for the organic garden and for the clinic itself, and we distribute water in the community. The community loves it. It’s a lot cheaper for them to get water through us—we charge a token amount—but with the drought, the demand is greater than what we or Rancho Santana can currently provide.

Another challenge is preventative health. We’re trying to do outreach to show people how to have their own healthy eating plots, to grow vegetables, and to drink and eat properly. We see people on motorcycles going fast without helmets, people drinking and driving, and a lot of big problems. We have to keep doing prevention education.

What are the ways you measure the success of the clinic?

“For me, [success is] when we talk to the community leaders and they say that everyone values and appreciates the clinic.”

For me, it’s when we talk to the community leaders and they say that everyone values and appreciates the clinic. We hear specific stories about someone who got great care, or somebody had an accident and their leg was saved because of the clinic’s response. That’s our biggest success and always what we want to hear first. The second measure of success would be bringing expanded programs and doing things that people have never heard of. For example, our organic gardener is also a beekeeper. He is teaching people about honey and beekeeping. Being able to educate people in new ways about healthy living is a great success.

There’s the clinic team itself, making sure that they have gainful employment, they are from the community, they want to stay there, they feel like they’re doing something valuable, and they are building their skills. A lot of young people who specialize medically want to go to the big city rather than this kind of coastal country facility. But right now we have somebody in the community who’s just about to graduate from nursing school and who wants to work at Roberto Clemente Clinic. It makes me excited that people are looking at the clinic as their dream job when they get out of school.

The last thing would be the experiences of the volunteers who come to the clinic. When volunteers see that they have been able to contribute to the community and clinic, and when they are impressed with the services and quality that the clinic provided, that is another measure of success. …We do the statistical reports but they don’t really motivate me as much. I like to hear how many babies are born, but it’s more important that we’ve saved a life, helped a family, or educated somebody.

Community members attending Roberto Clemente Clinic's annual Community Health Fair.

Community members attending Roberto Clemente Clinic’s annual Community Health Fair.

What is your long-term vision for the clinic?

“We want to provide not only first-rate urgent care like we do now, but primary care, pediatric care, and holistic wellness education and services”

We want to become a primary health center in the community and we want to be able to provide pediatric care and specialization. Our long-term goal is to provide a full spectrum of care in this region. Nicaragua is still seriously lacking in providing access to quality healthcare. We want to provide not only first-rate urgent care like we do now, but primary care, pediatric care, and holistic wellness education and services. We also want to expand our volunteer and child-sponsorship programs. I think it will take around five years to reach but that’s our vision—to go beyond urgent care to having specialization.

This interview has been condensed for clarity and brevity. All photos were provided by Roberto Clemente Health Clinic. To learn more, visit the website and Facebook page of Roberto Clemente Health Clinic.

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