Update: The Roberto Clemente Health Clinic in Nicaragua

This VantagePoints issue is an update on the work of the Roberto Clemente Health Clinic located in Limon 1, Nicaragua. Serving the communities of the Tola coast, this clinic has brought life-saving services to the area for 13 years, and it is currently in an exciting new phase of development. This interest in helping these impoverished communities is shared by PASS LLC, and serves as the basis for PASS’ supportive role and partnership with the NICA Clinic.

When the Roberto Clemente Health Clinic was established in Nicaragua in 2004, its founders, Chair Julia Guth and representatives of a for-profit residential development, wanted to help the local communities while serving the residents, workers, and children. Today this clinic serves more patients than ever before, and is in an exciting new phase of development. Seeing an urgent need and impactful opportunity, the clinic wanted to build its capacity to help the people of the Tola coastal communities. It is in this mutual interest that a partnership began between PASS and NICA Clinic (as it is often called) with the support of Dr. Jose Mosquera, who recently returned from visiting the clinic.

The clinic operates 24/7 as a non-profit health center to serve the rural communities of southern Nicaragua with primary care, pediatric care, urgent care, and holistic wellness education and services. It is the only clinic serving the rural areas of southern Nicaragua. The clinic is located in Limon 1, and also serves over 27 of the surrounding underserved villages in the Tola region. The Tola coastal communities are on the Pacific coast of Nicaragua, and are well known for surfing and tourism. However, the Tola region is one of the poorest in the Americas. Located in the tropical zone, the area is prone to cholera, dengue fever, and typhoid. As a result, the clinic works to prevent and treat these illnesses as well as contribute to the general health of the community. Visits to the clinic have amounted to 12,000 per year seeking general and emergency care, minor surgery, dentistry, lab work and medicines. That does not include the additional 12,500 who benefit from other medical services.

Tropical diseases and conditions in the area are especially dire for the local people given the level of poverty in the area. Nicaragua is the second most impoverished area in the western hemisphere, and according to the World Health Organization, only 6.3% of Nicaraguans have health insurance. This clinic is vital to the community as it is the only one serving the rural areas of southern Nicaragua. In an area where health concerns might acerbate due to misinformed perspectives on health care and accessibility—discounted or free healthcare and education mean everything for the people and the vitality of their communities. According to NICA Clinic interns, many people seek medical treatment much later than they might in a developed country like the United States. Given these facts, the new ambulance recently purchased by the clinic make a substantial impact. The roads in this area are unpaved dirt, and can serve as a hindrance to those in need of medical care. On Dr. Mosquera’s recent trip to the clinic, he saw firsthand how NICA Clinic is enhancing their capacity to handle situations which make road travel less safe—local stakeholders responded quickly to clearing roads when a severe weather system made many roads impassable.

Community outreach efforts in education and other services have proved especially important in making both care and knowledge accessible, and the one important recent goal relates to healthy lifestyles. In 2016, the clinic made significant enhancements to the breadth of their community services—in addition to primary and emergency care, services now also include preventative health and healthy lifestyle education. One such program is the organic garden and healthy eating initiative led by cultivation expert, Elizier Holman. On a daily basis, the local people are taught—in organized classes or at their homes—about basic gardening, soil enhancement, nutrition, and natural pest control. It’s quickly improving the quality of food for the community. Over the past six months, a new bio-intensive system for organic crops has resulted in twenty new community gardens over six months. As a result, we were able to start twelve community gardens in a period of twelve months benefiting a total of 804 people—this includes the individuals who attended our workshops on bio-intensive system as well as their family members. In a country where 30 percent of the population live in poverty, and 17 percent of children under age 5 suffer from chronic malnutrition, this is making a big impact. NICA Clinic also has school programs directed towards children. At the Escuela de Limon, children in the 5th to 6th grades maintain an orchard at the school, which provides them with basic knowledge in caring for gardens and teaches them responsibility. At the Escuela de Virgen Morena, there is a program that teaches them photosynthesis, the importance of water for plants, and other important information about cultivation.

The Healthy Eating Initiative includes a beekeeping program, which is vital to the effectiveness of the community gardens. Bee pollination is intrinsic to the success of the gardens—70% of the crops specifically need bee pollination to grow. The program is growing strong. There are currently two bee hives, and it is projected that there will be ten hives in 2017. The plan is to keep multiplying the hives, but the ability of the hives to thrive is dependent on climate behavior. Notably, Nicaragua—along with Syria—never signed the 2015 Paris Climate Agreement. It’s representative to the climate agreement, Paul Oquist, noted “it’s a matter of the developing countries surviving. Four degrees is not a survival track in the Sahel with the Sahara advancing. Four degrees is not a survival track for India or Pakistan with the glaciers melting in the Himalayas. Four degrees is not a survival track for southeast Asia with the typhoons.” The United Nations has noted the link between food availability and climate change, and how it might affect Nicaragua. Recent studies, such as that from Conservation International, support indicate that climate change could have extreme consequences for water availability in Central America. On average, more than fifty percent of income generated from farming and agriculture is sustained by rain. Only two percent of households use irrigation. Many small farmers will have a low capacity to adapt to climate change, and will need to support to do so.

Due to poor water conditions and a lack of quality food in the area, the community often drinks high-sugar soft drinks and other food stuffs which are harmful to their health. The impact of this lifestyle is that many members of the community have high blood pressure, diabetes, weight gain, anemia, and tooth decay. Not only are the community gardens making an impact, but the Clean Water Initiative, which started in late 2014, has made bottle purified water accessible to these communities. A considerable amount of treatments sought at the clinic are the direct result of contaminated water. Many family wells are contaminated by nearby septic tanks or the water is heavily calcified, the latter of which might be connected to the increased diagnoses of kidney stones in the population. Currently, the water treatment plant distributes an average of 1,195 gallons per month. To accomplish this, improvements were made to structure and equipment including the purchasing of a vehicle to transport the water.

NICA Clinic also responds to emergency health concerns, such Zika outbreaks. A threat to the people living in warm weather climates surrounded by water—such as Nicaragua—are mosquitos and the associated diseases and viruses, such as Zika. Beginning with the outbreak of Zika in 2016, NICA purchased fumigators and insecticide-treated nets for use at the clinic, schools, and elsewhere to prevent the spread of the virus in the Tola communities. According to the Pan-American Health Organization, in 2016, over 800 incidences of Zika were reported in Nicaragua. By May 2017, 389 suspected cases of Zika were reported, and these life-saving measures have contributed to stopping the spread around the world.

Communicable illnesses like Zika or dengue fever frequently germinate in these poor, tropical or sub-tropical areas of the world. Dengue fever is a Neglected Tropical Disease (NTD), and is an on-going problem for people in the region. It is also an illness that is commonly treated at the clinic. NTDs are commonly found in poor populations without proper sanitation. People in the Tola regions often live in two-room tin shacks in unhygienic conditions. Another contributing factor to the spread of these communicable illness are the dirt roads. The roads there are made of dirt, which, combined with the heavy rainfall, allows for pools or entirely flooded streets—this stagnant water attracts mosquitos and could make a trip to the doctor even more of a health risk due to increased chances of contracting a communicable illness from them. The fact that the streets were quickly and efficiently cleared after the storm during Dr. Mosquera’s recent visit exemplifies the how the clinic is taking a multi-level approach to prevent medical emergencies on a daily basis.

NTDs affect more than one billion people worldwide, and negatively impact the economies of developing countries by billions of dollars each year. While the Tola communities are poor, the economies are developing due to tourism. Resorts are nearby, and their guests seek treatment at the clinic as well—the money goes to the care of the clinic and helps support the local population. When it comes to NTDs and other communicable diseases, world travelers are the biggest threat to the spread of these illnesses, so having a medical center in a remote area like this could potentially save countless number of lives. Given the increasing economic development of the region from the tourism sector, the clinic stands to serve an increasingly larger role in providing medical services.

The Nica Clinic is expanding its services, and currently is in the process of expanding its physical size. In the first half of 2017 alone, the number of medical services has already reached 14,630. Going forward, one of the primary needs of the clinic is to evaluate the status of its services and care, and complete the physical expansion of the medical clinic and community meeting areas to facilitate reaching goals. An important goal and focus of Nica Clinic is the development of the administrative and managerial functions. The current 2,750 square foot facility is on track to double its size, which will bring enhanced services to the Tola coastal communities.

Across the clinic’s initiatives, Dr. Mosquera saw progress and continued diligence and support from everyone involved in the clinic, which is what’s needed to drive impact. During his visit, capacity building efforts proved successful from a collective meeting of local leaders, the clinic’s Chair, community representatives, and others. In order to help the people on the Tola coast, the inclusion of everyone’s voice is critical. A first-time Nica Clinic volunteer noted that there was a greater sense of community at the clinic from staff to patients in comparison to what they’ve experienced in the United States, and that “everyone is patient, and so happy. Everyone works together.” The staff have a can-do attitude, and the patients are genuinely thankful for the services. The volunteers contribute an additional and knowledgeable voice as the growing number of volunteers, which reached 63 in 2016, are increasingly nurses and pre-medical students from the United States and Canada. The full time staff themselves are all accredited by the Nicaraguan Ministry of Health. The increased number of community engagement initiatives means that the voice of the community is becoming stronger as well—NICA Clinic believes that understanding the people you’re serving drives impact. There are public health clinics in Nicaragua, but they are few and far between in remote areas, and might only have one doctor. Clinics in the cities are too far away, and the expense is too great. This clinic provides much hope and care for the community that they might not otherwise be able to benefit from.

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