Top 20 Countdown #2: 100,240 Doctor Visits

Our first medical volunteers, our good friends Nora Laws and Pam Agner, came in the first months we were in Nicaragua.  They stayed three weeks and treated hundreds of patients, giving out medication that they had brought with them.  They were the first of 328 medical volunteers from various fields that have come over the last 20 years.

We started our health care projects with medical help with volunteers… for five years, over 4,600 patients were seen by these volunteers giving their time as well as bringing donated medications.  We would have two or three small groups a year, and then Hurricane Mitch hit at the end of 1998. 

Nora & Pam seeing patients

Nora called and said that if we wanted her, then she was getting on a plane and coming to volunteer for 3 weeks.  When we picked her up at the airport, she was sitting on trunks of medicines she had recruited from others.  And she was not the last to come, volunteers flooded in.

Dr. Don Stechschulte

In February, the Bucknell Brigade came with their 36 members and one doctor, Don Stechschulte.  After seeing about a hundred patients one day in a thrown-together church building in the resettlement camp, I heard him muttering as he cleaned his medical bag of dirt and dust, “What I would give for just a concrete floor.”

Representatives from Bucknell, including Don, went with Mike to the mayor’s office with their commitment to help build a permanent clinic in the camp, Nueva Vida.  While we waited for the mayor’s office to donate land in Nueva Vida, a temporary clinic had been running for six months.  The man who had built the clinic and funded it had promised it would run for six months, and now he was ready to leave, so we could use the building.  By the end of July 1999, we were running a clinic complete with a half-time doctor, Jorge Flores.

Volunteers with Jorge, circa 1999

Temporary Clinic building 1999

Family planning training with nurse Martha, main clinic building

Jorge doing ultrasounds

The Bucknell Brigade folks were true to their word and helped us fund a permanent clinic building.  They came and worked with the community to build the clinic, mixing all the concrete by hand and using materials made by the concrete construction materials business we had
started, and then working back at Bucknell on fund-raising.  While we were moving into the permanent clinic in January 2001, an earthquake hit and while the building did sway, it did not even crack!
 
For many years, our staff was minimal:  Jorge, the doctor; Henry to check folks in and provide wound care; Danelia to hand out medications; Pat, the counselor (part-time);  Maria, the person who cleaned; and volunteers.  We opened charts for each patient, which was not that common back then for clinics that worked with the poor.

In the fifteen years the clinic has been operating, we have opened charts on 20,462 new patients.   Medical staff have examined 100,240 people and treated 210,649 diseases or conditions.  Our staff has grown as well as our space. 

The clinic in 2001 consisted of one building with 3 exam rooms, 3 bathrooms, one office, one check-in room, one pharmacy, one wound care room, a large lobby, a large corridor that holds files, and an even larger room for storing medications.  In 2006, we expanded to a second building that now has a laboratory, two dental rooms, two bathrooms, a room for counseling and eye checks, a storage room and an over flow room, a large lobby and corridor used for trainings and support groups as well as waiting.

We started with a half-time doctor; now we have staff for these services:

• A full-time radiologist who does ultrasounds as well as sees patients as family doctor, including free PAPs in our women’s health program and treats our HIV positive patients…Jorge 
• A part-time pediatrician who sees children but has helped us expand our asthma services
• A part-time general physician who also oversees the patients who have chronic conditions, pregnant women, and PAPs
• A part-time orthopedist who controls pain and works with joints, muscles, and bones…he sometimes does surgery.



Danelia & patient

• A full-time dentist, a hygienist, and a dental assistant who treat adults and children including children in the local feeding centers (see dental blog for more)
• A part-time lab technician
• A half-time counselor…Pat, who also with Becca does eye correction exams and gives out eye glasses
• A full-time nurse who, besides doing nursing, also helps with the public health component
• A full-time health promoter who oversees our public health component (see health trainings blog)
• A full-time administrator who has her degree in pharmacy



Henry Checking in patients

• A full-time pharmacy assistant who also fills in gaps in other areas…Danelia
• A full-time assistant who checks patients in and does wound care…Henry
• Three full-time people who clean
• And me, who looks for money, equipment, etc.  I also help to gather all the staff’s dreams for the clinic and needs and put them into goals and objectives.

We have come a long way from those medical brigades working out of suitcases, but we have a long way to go because the need is so great.

Future Projects:

• Build a third clinic building… awaiting funding, you can help by giving an alternative gift of 1 sq ft for $25!
• Hire a half-time ob/gyn… awaiting funding
• Hire a full-time nurse… awaiting funding

-Kathleen

Counting down to #GivingTuesday on December 2nd, we’re highlighting the CDCA’s accomplishments over our 20 years in Nicaragua. Follow our countdown in this blog, on Facebook and Twitter. Help us keep doing more by giving $20. Our goal is to raise $20,000.

Top 20 Countdown #4: Grown Organic Co-op to 3,000

In 1995 the first farmers we worked with planted sesame in a field that was lying fallow. We worked with the 16 farmers who were part of a dairy cooperative…a cooperative created when land was given to them during the land reform which followed the overthrow of the dictator Somoza.  It was also the cooperative from which we rented our little piece of land where we are today.

We received a grant from the Presbyterian Hunger Fund for start-up money for the planting of that first crop and the next.  By 1996 we had 69 farmers participating, and through us, the buyer Once Again Nut Butter was loaning the farmers capital to plant.   

Sesame crop lost after Mitch flooded the processing plant

By the time Hurricane Mitch hit in 1998 and all the sesame was destroyed in the flooding, we had 2,000 farmers involved!  In four years this agriculture project had grown from 16 farmers to 2,000!

Once Again Nut Butter had lent $142,000 to the farmers and the entire crop was lost.  But they allowed the small farmers to slowly pay back all the lost capital, and unbelievably, in 2005 it was finally all paid back from sesame sales… little-by-little.

Farmers kept coming to us.  Now we work with 3,000 farmers.  Many are members of cooperatives like the original 16 farmers.

Currently, we help these farmers sell their sesame, peanuts, and coffee… all cash crops.*

$1 million was lost by mismanagement of the peanut crop

We help them market different crops because prices fluctuate from year to year, but we and they are fighting an uphill battle with processors and shippers who mess up orders, as happened with the peanuts two years ago.

Over a million dollars in peanuts were lost due to mismanagement of the peanut storage and the processing, mistakes made by the processor and the shipper.  Slowly but surely the loss is being repaid, BUT all the farmers were still paid for their crops…keeping the farmers afloat is our biggest priority. 

The coffee farmers are part of a cooperative up in a remote area.  They do their own processing...which is a huge plus.  Their lives were spared in Hurricane Mitch, even though they are right beside the huge mudslide

El Porvenir processes its own coffee

that killed over 2,000 people, because they had and still have trees…huge trees holding topsoil in place.  They protect their land and produce what should be certified as shade- grown, organic coffee which would receive top price, but shade-grown certification costs in the thousands of dollars. 

We encourage diversification and rotation, so the coffee cooperative also plants sesame, cotton, cacao, and they are also getting into honey production.  Going up the mountain to give medical care 5-6 times a year with volunteer doctors, we can see evidence that even though they are still poor, their lives are improving.  They have a school building.  They have a clinic building.   They have a place for volunteers to stay when they visit.  They have water on the top of the mountain.  They have a nursery of coffee plants.  Their children have better nutrition.


The coffee cooperative is just one example of many that show how our agriculture programs are improving the lives of small farmers and their families.

Volunteers visiting the coffee co-op

Future Projects:

• Continue to add value to all our agricultural products by creating such consumer products as organic peanut butter, organic sesame, organic cattle feed and biodiesel from cottonseed oil...awaiting funding
• Increase access to credits for all phases of our production from field to final product...awaiting funding
• Obtain financing to buy the sesame processing plant which we are currently renting from the state, as it is only available to us on a year-by-year lease basis...awaiting funding

*With our farmers, land is not taken out of food production and no land is deforested to plant export crops.

-Kathleen

Counting down to #GivingTuesday on December 2nd, we’re highlighting the CDCA’s accomplishments over our 20 years in Nicaragua. Follow our countdown in this blog, on Facebook and Twitter. Help us keep doing more by giving $20. Our goal is to raise $20,000.

Top 20 Countdown # 5: First 100% Organic & Fair Trade Clothing Line

Three of our projects were part of the world’s first clothing line certified as fair trade organic from crop to consumer: Fair Trade Zone, the cotton gin, and our cotton farmers.  

Certifying the entire chain was really important because:

1. Fair trade ensures workers are paid fair wages and have good working conditions but other "fair trade" garments on the market only certify conditions for farmers and sewers, leaving workers at the cotton gin, spinners, knitters and dyers to be paid a low wage and treated poorly...except ours, which guaranteed the rights of all workers involved in making your clothing.
   
   
2. A garment can have "organic" on the label as long as the cotton was grown organically, even if it was processed with toxic chemicals and dyes.  Our garments were certified organic every step of the way, ensuring that only accepted eco-friendly dying and finishing processes were used. 

Organic cotton is good for our farmers:  In the 1970s over a million acres of cotton were grown in Nicaragua.   

The conditions for growing cotton here are excellent, but monocropping adjacent fields of cotton led to a boll weevil infestation.  Also, when land is planted in cotton year after year with no crop rotation, the soil is depleted of its nutrients as well as its ability to retain water.   By the 1990s, eighty percent less cotton was grown in Nicaragua than had been grown in the 70s, and now our organic farmers are the only cotton growers in the country.

Farmers growing organic cotton in small fields and rotating their crops with nitrogen-enriched crops can keep their land healthy and the water retention of the land high.  When cotton is grown in small fields it can be monitored by hand, which reduces the number of boll weevils in their fields.  It is because of boll weevils that cotton worldwide is the second most pesticide-laden crop. Cotton makes up only 3% of the world’s crops but uses 25% of the pesticides.
 
What does this mean for farmers and workers who deal with the conventional cotton?  Cancerous lesions, tumors and birth defects for the cotton farmers, workers and those living in cotton-growing regions.
 
Organic cotton is not only healthier for the land and for the growers, it also makes more money per pound for the farmers than conventional…thereby adding value to the farmers hard, back-breaking work.  BUT it can only be exported if it is ginned and baled…which is why we run a cotton gin.
 
Organic cotton is good for those who handle the cotton:  Can you imagine working where all the cotton that was sprayed with heavy pesticides is filling the air, even if you wore masks?  Not very healthy.
 
Organic cotton is good for our children:  Conventional cotton seed that is left from cotton fiber production gets into our food chain. Chemically laden seeds are pressed into oil and 8 pounds of the leftover cake are fed to each dairy cow in the U. S. every day.  Leftover twigs and trash are made into bedding for dairy cows.  Cottonseed oil and cakes are in many junk foods.  Cotton fibers that cannot be spun into yarn for cloth are used in the padding of baby’s diapers.
 
Organic cotton is good for women:  besides the chemicals in conventional dairy products, from which many women get their daily calcium intake, chemically tainted cotton fibers are not only in baby’s diapers but also in many tampons.
 
Some people think organic clothing is just a silly thing or a rip off…but when you consider all the benefits for the health of your babies, your own health, the health of the people handling the cotton, and the small farmers…all these benefits come from buying organic clothing and it does not seem silly at all.
 
Future projects:  

• Increase our organic cotton production to 1.5 million pounds per year by 2017...awaiting $325/acre funding to give farmers the credit they need to plant

• Purchase a de-linter to enable us to make our cotton process more sustainable: we would press our leftover cotton seed into oil to be used in making bio-diesel and would make the leftover cake into organic cattle feed for sale...awaiting funding

-Kathleen

Counting down to #GivingTuesday on December 2nd, we’re highlighting the CDCA’s accomplishments over our 20 years in Nicaragua. Follow our countdown in this blog, on Facebook and Twitter. Help us keep doing more by giving $20. Our goal is to raise $20,000.

Top 20 Countdown #6: Hosted THOUSANDS of Volunteers!

In our twenty years we have had the pleasure of hosting many, many volunteers and delegations. In fact, we have hosted 670 volunteers for short stays and longer stays…the longest stay being 18 months.  We have hosted 163 delegations with over 2,500 people in those groups.

Until 2003, all the volunteers and delegations stayed in our home and we got to know them very well.  We shared our space, which was sometimes extremely limited...like with the first Bucknell Brigade in 1999.  They had 36 members!  We were all packed in like sardines, vying for bathroom time and getting to know each other…maybe more than we really wanted to!  

For our very first delegation in 1995, we sat down with them each morning and said, “Well, what would you like to do today?”  We had no help in the home for cleaning and cooking.  Folks slept on beds in the corridor that we had bought for them.  There was little space for them to store their stuff and we had to warn them to hide their toothbrushes because our Daniel, then two and a half years old, loved to clean the floor with toothbrushes.  The slaughter house was 20 feet away and they listened to cows die nightly…several of them gave up eating meat.
  

Until 1999, we transported our volunteers in the back of trucks or in an ancient ambulance-style Land Cruiser.  It was not uncommon to have to push the trucks to get them started or stop suddenly for a flat tire.  But in 1999, Highlands Presbyterian Church, from Maryville, TN, brought us the yellow bus.  Many, many delegations rode the yellow bus and wrote their comments on the ceiling until this year when we had to retire the poor thing.

In 1999, Becca came as a college student and naturally started organizing the volunteers.  When she came back in 2001 she developed the volunteer coordinator position.  Things have changed.  Though having people in our home made for positive learning situations for volunteers, as we and our children aged, it was becoming more and more difficult for us. 
Becca and a nurse, Jane Thomas, who was volunteering in 2001, suggested we build a space for volunteers.   We started construction on the volunteer dorm using only designated gifts.  The first delegation in the new building was the January Bucknell Brigade in 2003.  They not only inaugurated the dorm, but also poured the floor for the second story for longer term volunteer space. We feel that an important aspect of our work is the education of those in wealthier countries.  It is important for the First World to understand Nicaraguan history because it intertwines so much with U.S. history.  We, from the First World, need to understand that how we spend and invest our money affects the poor here.  We had to learn this, too.  We have speakers now for groups and volunteer coordinators to put things in context for them.

It is also extremely important for people from wealthier countries to put faces on the poor.  When delegations see the poor working harder than they have ever worked…when they see mothers and fathers with their children struggling to get through the day….when they see children being open and loving with them, then and only then do they begin to understand and make changes.   
The most important work volunteers do is inside them…to look, listen, learn, feel,smell, and taste poverty...and then change.

Future projects:
•    Tile and paint the upstairs of the dorm...awaiting funding.

 -Kathleen

Counting down to #GivingTuesday on December 2nd, we’re highlighting the CDCA’s accomplishments over our 20 years in Nicaragua. Follow our countdown in this blog, on Facebook and Twitter. Help us keep doing more by giving $20. Our goal is to raise $20,000. 

Top 20 Countdown #7: Started World's 1st Worker-Owned Free Trade Zone

After the Hurricane Mitch resettlement camp Nueva Vida was established up the road from us in November 1998, we helped folks in that community to identify their most urgent needs.  Employment was top on their list with health care coming in second.  Therefore, in 1999 we started working on two possible businesses with women and men in Nueva Vida.

The concrete construction materials business was the first and easiest to get up and running.  We had much of the needed equipment here…sand was easy to find and dig up…just needed the cement and a block press.  The business hired men and women and they made building concrete blocks, concrete poles, losetas (slabs of concrete to slide into the grooves on the support poles), and concrete paving stones.

The second was a larger enterprise…a women’s sewing cooperative.  Before the project got started, it already had a market, Maggie’s Organics.  Maggie’s Organics needed a cut and sew line for their organic cotton clothing because the last factory they used in the States had closed.

But the market was all we had.  There was no building.  These women built their factory with the those concrete materials, with volunteer labor, with Rogelio and his crew, and with their own hands….they worked hard.

They had no cutting or sewing skills.  They got training and learned.

They lacked production skills and job skills (they'd only worked in the informal sector, mostly as street vendors, so showing up at 8AM and staying until 5PM did not come automatically). They lacked managerial skills, computer skills, accounting skills, English…these were poor, unskilled women living in temporary housing in the mud in the aftermath of Hurricane Mitch…and Becca, Mike, Sarah and others taught and walked them through the complexities of running a business.

Mike found them markets and worked with them on cooperative organization, while Becca worked with them in production and management.

Sarah made them patterns so they could sew unique clothing tops like a cross top.  She learned the machinery and taught them how to cut.  She taught them how to keep up with their count of t-shirts.

In 2002, they completed their first order of t-shirts (their first true order was in 2001 for hair scrunches made out of t-shirt material).  Three thousand t-shirts for Ethical Threads…we ALL stayed up all night with them, counting, boxing, filling out papers, making coffee, overseeing the production and quality of sewing…and the stress of getting it out the door!  What a celebration when those t-shirts were gone!

It wasn’t long before they were sewing 20 - 40,000 t-shirts for an order.  Sarah, with their input, designed them a logo.  Becca and another staff member, Emily, helped them get two grants for their infrastructure and capital.  At one point they hired 76 additional workers.

But like with most businesses, there were setbacks.  The women really had a hard time working together and calling each other into accountability. Getting organic cloth became more and more difficult and it was always imported.  Handling their own sales and markets was hard and exports were problematic.

Photo by Kelly Doering

They applied for free trade zone status and got it in 2004, making them the world’s first worker-owned Free Trade Zone…their name became the Fair Trade Zone, and they could now import raw materials duty-free and export with more ease.  Several of them went on speaking tours and one accompanied Mike to the Fair Trade conference in Mexico.  They talked to CNN, Telemundo, and BBC and their confidence grew.

In 2007 they chose to become independent of the CDCA, to find their own markets, organize their own production, etc. 

But it's been tough.  They have lost clients due to late and incomplete orders, and they've lost members as well.  But they've kept their doors open, and they still go to work each day.  They have not made payments on their start-up loans from the CDCA, which at times has caused cash flow problems for our revolving loan fund.  They have on occasion asked us to step back in to help, but have not written a letter stating exactly what they need from the CDCA. 

Yet, they have grown as women in confidence and pride.

As of this writing, Bená Burda of Maggie’s Organics is hoping to come and meet with the cooperative in December to see if there can be another chance at making something work with them.

-Kathleen

Counting down to #GivingTuesday on December 2nd, we’re highlighting the CDCA’s accomplishments over our 20 years in Nicaragua. Follow our countdown in this blog, on Facebook and Twitter. Help us keep doing more by giving $20. Our goal is to raise $20,000. 

Top 20 Countdown #8: Emergency Aid to 12,000 Refugees

Counting down to #GivingTuesday on December 2nd, we’re highlighting the CDCA’s accomplishments over our 20 years in Nicaragua. Follow our countdown in this blog, on Facebook and Twitter. Help us keep doing more by giving $20. Our goal is to raise $20,000. 

In October of 1998, the deadliest hurricane of the 20th century hit Honduras and Nicaragua: Hurricane Mitch.  Lives were lost, families were torn apart, people were homeless…and the safety net provided by the government then was full of holes…if hanging at all.

Non-governmental organizations (NGOs), were left with most of the responsibility of the emergency aid and many of the organizations one would expect to be right in the midst of things were frequently absent.   

The largest resettlement camp was established in two cow pastures about a mile down a dirt road from us.  1,200 families were moved, given two 2x4 boards and a big piece of black plastic and told here is your new home…there was to be no going back to the Managua lake front where they had lived before.  The mayor named the permanent resettlement camp Nueva Vida…“New Life.” 

At that time, we were such a small organization: César, who was then our community promoter; Rogelio, our construction genius; our mechanic Maestro; one housekeeper/cook for delegations; and us: Pat, Kathy, Sarah, Mike, and me…we were few, but all of us started working with these refugees.  Donations poured in.  Volunteers came from far and wide…medical and non-medical.  Bucknell University sent a delegation of 36!  And that summer, Becca came as a volunteer college student. 

Nueva Vida was settled in stages as more people were relocated.  Working with those areas, we first helped the refugees identify the leaders among them…then - and only then - were we able to address their enormous needs.  We distributed food, clothing, and lavanderos (concrete wash stations).  Our medical volunteers held clinics and treated patients in their tent homes.  Other volunteers helped build temporary housing and dug latrines and grey water catch systems.  We gave out saplings…tens of thousands of them.  The trees in Nueva Vida are now gorgeous.

But these refugees were not the only people who suffered…the farmers lost all their crops from the flooding and flash flooding.  Jeremy and Lloyd as well as others from Once Again Nut Butter came and worked with the sesame farmers to prevent them from losing their land because of the debts they had accrued in planting, and to help plan what to do next. 
With the Ananda Marga organization AMURT in Managua, we also went to remote places hit hard by the flooding…people were starving and in bad need of medical aid.  It was heartbreaking.  One man told our good friend, Kalyan, that he did not want food because he could not eat…he had lost all 63 members of his family in a terrible mudslide killing over 4,000 people… his children, grandchildren, wife, aunts, cousins, in-laws…all of them. 

Here we were - this little organization - and we soon became the showcase for USAID.  Even though they did not give us one penny, we did take USAID’s temporary housing kits, which they had donated to the Red Cross, and with the community put those houses up so fast the Red Cross could not keep up.  By then, the refugees were living in mud…the rains had come again.  Members of U.S. Congress came to see the houses and the work we did.
Why us?  Why could we act so fast?  The reasons are just a few:
•    We are small and we are flexible.  Because the CDCA is supported by many givers and little or no foundation grants, we are able to do a U turn when the need is greater elsewhere.
•    We work with the community which helped us make sure we were working with the people who were getting the least aid.
•    We listen…which helped us then to respond in the best way we could, and it also led us to start the clinic, the sewing cooperative, and other projects.
•    Finally, we will work with just about anybody - including USAID. As one of our seminary professors told us, “When you can take money from rich people and give it to poor people…do it.” -Kathleen

Top 20 Countdown #9: Treated 10,000 Dental Patients

Dentists with head lamps used see patients in rocking chairs propped up with paving stones when they came to volunteer with us in Nicaragua (talk about appropriate technology!). Luckily, conditions have improved since then, but it's been a long, slow road. There was and still is always a need for dentists.  

Nicaragua has so few dentists for its population.  Only 4.8 dentists per 100,000!  In the United States where there is a dentist shortage there are 100 dentists per 100,000 people. 

Dr. Dirk Anderson seeing patients in rocking chairs!

In 2004 dentist Dirk Anderson, who had been volunteering over the years in Nicaragua, donated the equipment to set up a dental room for volunteer dentists.  He had started coming to Nicaragua because thanks to his pastor at St. John’s Methodist Church (Rock Hill, SC) and good friend, Risher Brabham.  Risher brought delegations of first students and then church members to Nicaragua starting in 1997!  Risher wanted people to learn about poverty and the struggles and hopes of Nicaraguans.  Both men became our good friends.  

Risher, Kathie & Brooke Brabham at Masaya volcano

In 2007 we hired our first dentist, Dra. Ana, who worked half-time.  On the 15th of August that year, we dedicated the dental clinic to the memory of Risher who had died the year before of cancer after making one last trip to this country of his heart.  His wife, Kathie, and granddaughter, Brooke were here, as well as other family and friends, including Dirk.  

Dra. Ana plugged along pulling teeth mostly, but also doing some repair work, until she got a Fulbright to study elsewhere in 2010, and we were fortunate to find Dra. Inya, who is still with us.  With Inya, we slowly managed to get another dental room up and running for volunteers. 

In 2012 we hosted dentists from ORPHANetwork who saw children from their feeding centers…some of the poorest of the poor.  We began exploring how we could work together to give these children dental care.  Later that year, we hired our first full-time dental employee, Ligia, to be our hygienist…not a common service in Nicaragua.

In 2013 with ORPHANetwork we were able to hire Dra. Inya on as a full-time dentist and hire her a dental assistant, Fabiola.  Fabiola was one of the first graduates of the only dental assistant program in Nicaragua and who had been part of the ORPHANetwork services.

Currently we are seeing children from 10 feeding centers as well as adults and children from the neighborhood.  Remember how earlier almost all we did were extractions?  Now only 12% of our dental work is extractions! 

Now we save teeth by repairing them before the teeth are rotten.  We focus on preventive care…cleanings, education, and sealants.  Our hygienist goes into schools and the feeding centers and teaches about dental hygiene.
 
Believe it or not, good oral hygiene is critical for a healthy heart and to reduce the risk of type 2 diabetes.  Flossing regularly adds years to your life.  This is one program where we are actually staying ahead in the fight for good health.Future Projects:
To have a third dental room…awaiting funding and equipment

-Kathleen

Counting down to #GivingTuesday on December 2nd, we’re highlighting the CDCA’s accomplishments over our 20 years in Nicaragua. Follow our countdown in this blog, on Facebook and Twitter. Help us keep doing more by giving $20. Our goal is to raise $20,000.