Saturday, November 30, 2019

#Giving Tuesday: Protecting Tiny Teeth is... Within Our Reach

This #GivingTuesday, Protecting Tiny Teeth is... Within Our Reach.

In the first years after we moved to Nicaragua 25 years ago, I asked, “Where’s Pat?”

“She’s translating for a dental brigade in Roberto Clemente,” I was told.

“Pat?  She’s terrified of dentists!”

And sure enough, Pat returned home soon after.  She had fainted while shining a flashlight in the mouth of a patient getting a tooth pulled, which is the procedure most volunteer dentists and local dentists who worked with poor Nicaraguans do… they pull rotten teeth to give relief.  One right after another.

In our dental clinic we do so much more than extract teeth, in fact we do a great deal of preventive care… cleanings, fluoride, and sealants.  Out of our 8,688 dental procedures from Jan. - Oct. this year, 5,406 were preventive procedures or 62%, while only 10.3% were extractions, and of those an unknown amount was extracting primary teeth to make room for the permanent teeth.

Out of all the patients that came to our clinic, a little over 40% received cleanings…and amazingly enough over 10% of them received TWO cleanings…a cleaning every six months.

What does this mean?

Our dental clinic is making an impact on teaching people about good oral hygiene.  It means children and adults can keep their teeth.  It means that their over-all health will improve.

Unfortunately, we have not had toothbrushes, tooth paste, and dental floss to give to our patients.  Our dental supplies are getting low with only one or two delegations coming a year.

66% of all our dental patients are children under 12 years old…and most of these children are the poorest of the poor, who come from feeding centers run by ORPHANetwork all over the west coast of Nicaragua.  Help us help them.  


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Friday, November 29, 2019

#GivingTuesday: A Sympathetic Ear is... Within Our Reach

This #GivingTuesday, A Sympathetic Ear is... Within Our Reach.

When our youngest, Joseph, was in school, he and we struggled to help him survive school.  Joseph has Attention Deficit Disorder.

When our kids were small, the Nicaraguan public schools were short-staffed, had no textbooks and had 60 plus kids to one class who had to carry their own desks to school.  Not to have our kids take the precious spots, we sent ours to private schools, and even the private schools had no idea how to deal with a child with ADD and very hyperactive.

When Pat was alive and working as a therapist in the Nueva Vida Clinic, she treated lots of kids.  She saw 376 people last year and 76% of them were kids from ages 6-12 years.  Many had family problems and behavioral problems and about 15% had problems with development, learning disabilities.  ADD in Nicaragua falls within the purview of psychology as opposed to education.  The teachers here are not trained to educate children with learning challenges… like our Joseph.

After Pat died last December, we were fortunate to have Dr. Dominga Soto come and volunteer with us.  She has filled in the gaping hole that Pat’s death left.  In 2019, just through October, Dr. Soto has seen 404 people:  including 1/4 children 6-12 years old; 1/4 teens; 1/5 little kids under 6 years old; and 1/5 adult women. She has provided tutorials for parents with children with learning challenges and behavioral problems, as well as tutorials in the schools in Nueva Vida.

After a year, Dr. Soto needs a part-time salary and for just $450/month we can pay her, with benefits, including her 13th month pay required by Nicaraguan law.  Let’s put aside all the help she gives to those grieving, surviving trauma, domestic violence, sexual assault, etc. Let’s just consider those children who cannot focus, cannot sit still, cannot read because of dyslexia… these are the poor children who actually go to school and might be able to move out of poverty if they could study… they deserve help… just as much as our Joseph.


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Thursday, November 28, 2019

#Giving Tuesday: Controlling Blood Sugar is... Within Our Reach

This #GivingTuesday, Controlling Blood Sugar is...Within Our Reach

As the number of people with diabetes grows worldwide, in Nicaragua type 2 diabetes is exploding.  Diabetes is a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine.*
23% of our adult patients are treated for diabetes.  Almost one in four patients.

My daughter-in-law, Dr. Cassie Iutzi, was helping students on a delegation learn about the diabetic patients they had seen in their home visits by explaining,  “Having high glucose in the blood and kidneys is like have glass running through the body.  It tears up organs.”

As most of you know, a high sugar and carbohydrate diet with low cardio exercise leads to type 2 diabetes.  Throughout Nicaraguan history, the poor have survived on sugar and carbohydrates as a cheap source of calories, energy, as they toiled in the fields under the hot tropical sun.  Nicaragua grows sugar cane and it is cheap.

Rice and corn tortillas, carbohydrates, fill the belly.  Sometimes when drought hits, people survive on hand-made corn tortillas with salt.  Fish and chicken are too expensive to add to the diet more than for special occasions.  Tropical fruit which is really high in fructose is used as a drink… blending the fruit, straining it, and then adding sugar and water to make refresco.  Remember sugar is cheap, fruit is more expensive.

Vegetables, except maybe yucca which is just starch and fiber, are also outside the budget for the very poor.  Sometimes cabbage is added to a meal, and perhaps tomatoes.

We teach people about what they eat and drink, but when your money is limited, so are your options for what you eat.  We are looking forward to having a kitchen** to train people on cheap ways to eat, with good nutrition, and have the food still taste good.

We teach about exercise, but when it is blistering hot, when one has to guard one’s hut or house, when one is depressed, when one has children overflowing in a tiny yard… exercising seems impossible.

Therefore, consistently, we provide diabetes medications, monitoring, and monthly doctor visits… it is the least we can do to minimize the “glass” flowing through these wonderful people’s veins.

*Oxford English Dictionary
**We have the funds to finish a training room and kitchen in our unfinished third clinic building.

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Wednesday, November 27, 2019

Giving Thanks from the JHC-CDCA in Nicaragua

Today is Thanksgiving in the United States.  We celebrate this day in Nicaragua with our Community, extended family, and friends.  Mike and I miss our Nicaraguan celebration, but are enjoying celebrating with our son Coury and his family in California.

 (photo: Thanksgiving 2018)

When we are at home, we gather before the evening meal and hold hands in a big circle and each say one thing for which we are thankful.  This year, far away, I gather with them and say how grateful I am for all of you who keep this important work going.

  • For those of you who pray for this work
  • For those of you who give in response to speaking engagements, newsletters, and pleas in times of stress
  • For those of you who pledge and give monthly and quarterly
  • For those of you who come to Nicaragua to volunteer and see the reality there
  • For those of you who collect and ship donations to this work
  • For those of you give what you can when you can
  • For those of you who help with the buying of organic crops
  • For those of you who support those of us on speaking tours
  • For those of you who tell others your impressions of Nicaragua and this work… to spread the news
  • For those of you who read our posts and blogs and share them
  • For those of you on our Board of Directors
  • For those of you who routinely cover dozens of small and large volunteer tasks
  • For those of you who love us and care for us…

For YOU we give thanks today and always.  THANK YOU!!!

Tuesday, November 26, 2019

#GivingTuesday: Reading Medicine Prescriptions is...Within Our Reach

This #GivingTuesday, Reading Medicine Prescriptions is...Within Our Reach

“C’mon, Mom!”

“I’ll be there in a minute.  I can’t find my glasses.”

“Mom, they’re on top of your head.”

For years this was the conversation we had as we headed out the door for school.  I have glasses for reading, computer work, and driving.  I am that rich.  I can afford glasses to see clearly.

Children in schools who cannot afford glasses and yet need them fall behind quickly.  People who work with machines but cannot see can details lose not only their job but their fingers and hands.  Older people cannot read the prescriptions of their medications.  When you can’t see clearly, you miss so much.

Our health clinic has a vision check and eye glasses clinic.  We were given an auto-refractor that measures the patient’s prescription need, to match with pre-ground lenses, and we have donated used eye glasses to give to people who can’t afford to buy their exact prescription.

Christina is a lay health promoter who has been trained by Becca and Pat to help people obtain the glasses they need.  A Cuban ophthalmologist, Dr. Carvajal, originally trained Becca and Pat, and serves as our reference for our clinic’s work.  In this year alone so far, Christina has helped 798 people, working three mornings a week.  59 were children under 12 years old.

Christina is also trained to shape the pre-ground lenses to fit frames that are a bit more modern… for these we charge a small amount.  She has handed out 918 pairs of glasses, and of these, 107 were hand-made.

With few volunteers coming this past year bringing donations, we are getting low on our supply of donated used glasses.  And we have run out of the most commonly needed prescription strengths of the pre-ground lenses to use in the new frames.  Our patients need glasses for distance, reading, bifocals, and sunglasses (critical in the tropics re cataracts).

Mike and I are with two of our grandchildren in California right now and I love being able to see their smiles clearly and read books to them.  I wish this joy for everyone.  You can help give the gift of sight for #GivingTuesday by donating to restock our lenses and continue Christina’s invaluable work.


Our goal for #Giving Tuesday is to raise $5,000 for the Nueva Vida Health Clinic.Join us on December 3rd… Reading Medicine Prescriptions is Within Our Reach.

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Monday, November 25, 2019

#GivingTuesday: Calming a Racing Heart is…Within Our Reach.

20 years ago, when we first began the operation of a permanent health clinic in Nueva Vida, I was a novice.  I knew absolutely nothing about running a clinic.  I asked questions from anyone who was willing to share their information with me.  One such woman was a nurse who had worked in Nicaragua in the seventies.

One of the questions I had early on was, “what do we do with patients with high blood pressure.”

Hypertension is called the silent killer.  This condition damages the heart and can cause strokes and embolisms, while a person can walk around having a life, without knowing that they have high blood pressure at all.  This I already knew, but … how do we treat them?

The nurse, Ann, said, “Well you have to decide whether you only treat acute diseases or do you include chronic conditions.  Treating chronic conditions is a deep well into which funding goes because the treatments are daily, continuing costs.”

I winced, imagining the amount of money we might have to raise.

Ann said, “But… but most clinics here in Nicaragua do not treat chronic conditions especially for the poor.  And there is a validity in keeping people alive and giving them a quality life.”

So, we started treating chronic hypertension in patients.  At first, we only used donated medications, which meant that our patients were changing their medications about every six months.  That was not effective for providing good treatment.  We then committed to providing up to 150 people with monthly exams, all medications needed, and in return the patients signed a contract to attend monthly 10-minute classes.

We also treat other patients of hypertension, such as pregnant mothers and new patients, which means that a quarter of our adult patients have hypertension.   So far this year we have provided anti-hypertensive medication for 1,727 patient visits.  In the past we received anti-hypertensive medications donated in bulk.  We could give consistent care using the donated medicines, and our costs were held to a manageable level.

Since April of 2018 and the political unrest for a few months here in Nicaragua, and the resulting high travel alert posted by the U.S. State Department, we have not had the 15 delegations coming annually bringing medications, but have had only two delegations.  We have lost approximately $50,000 a year in donated medications.  The result?  This year we are spending $300.00 per month on anti-hypertensive medications alone!

We are committed to giving our patients the quality of life that offers the chance to care for their children and grandchildren.  To look this silent killer in the eyes and say, “no.”

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Sunday, November 24, 2019

#Giving Tuesday: A Better Future for Girls is...Within Our Reach

This #GivingTuesday, a Better Future for Girls is... Within Our Reach.

“We’re pregnant!”  is just something that gets my goat.  As a biological mother of three sons, I - and I alone - was pregnant.  Mike was amazingly supportive during the hardships of pregnancy, but he did not throw up for months, grow an enormous belly, have gestational diabetes, not sleep or have indigestion or need to urinate every 10 mins just to name a few of the “pleasantries of a pregnant Kathleen.”  During labor, he was with me holding my hand, being my coach, never leaving my side…but he did not have contractions for hours on end or push three babies out of his body, and then try to recover from the tears, the loss of abdomen muscle tone, and other unspeakable effects of giving birth.

Therefore, women get to choose.  In Nicaragua, abortion is illegal even including therapeutic abortions, which means…in this blog abortion is NOT in discussion, but birth control is.  Family planning is the topic.

When we moved to Nicaragua 25 years ago the birth rate was more than 4 children per woman.  In 2018, the fertility rate was down to 1.87 per woman.*   It may continue to drop overall, but teen pregnancy remains the highest in Latin America and the Caribbean: in Nicaragua, 1 in 4 teenage girls gets pregnant.**

Last week we had a volunteer ob/gyn***  working in our clinic.  He had a “slip of a girl" come in for a birth control implant.  She was 16 years old and had two children already… the youngest was only 12 days old!

Three years ago we started a project to provide birth control implants - with many of you helping to purchase the implants.  We had been providing IUDs, birth control pills and injections, but implants which last 3 years are a much safer choice for Nicaraguan teen girls, who also are at a higher risk of rape and incest.

Those first implants we put in women’s and girls’ arms 3 years ago are close to their effectiveness expiration date, so in addition all the new women and girls wanting implants, we need to remove the old ones and place new ones… we are anticipating doubling our need for long-acting reversible contraceptives.

Pregnancies are physically as well as mentally hard on teenagers, not to mention the challenges of raising a baby when the mom is just a child herself.  These pregnancies are a higher risk for babies as well.  Teen girls and women are the ones who should choose when they have a child.  Education, wider opportunities, and eliminating poverty are crucial factors impacting that choice, as well as good, safe birth control methods.

We try to do all of that:

***Our staff ob/gyn resigned in 2018 after the political unrest due to her health issues, but because the U.S. travel alert for Nicaragua remains high, we still do not have delegations coming as we once did, meaning we have lost about $100,000 in revenue and about $50,000 in donated medicines.  As a result, we could not hire another ob/gyn.

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Thursday, November 21, 2019

Future Fridays: the Gift of Breath

Last week for Future Friday, we posted a blog on wood cook stoves and how they contributes to deforestation and air pollution.  The air pollution is a serious health issue as most people would agree.  But also, the wood burning cook stoves…again not pot belly iron stoves, but stones and concrete making a fire pit in the house basically…pose many health concerns.

For example, babies and children under five years old damage their lungs and have a higher rate of asthma, breathing in smoke from the stoves that are not well ventilated. Of those children under 5 years of age who come to our clinic for treatment, 28% of them are treated for asthma.

6% of all our other patients are treated for asthma or other pulmonary problems.  We have older women with emphysema and with chronic pulmonary obstruction who have never smoked a cigarette in their lives…but have stood over wood burning cook stoves breathing wood smoke day-in and day-out for their whole lives.

Adding to the smoke, these stoves are dangerous, especially to children.  They are not protected very well, and as a result many children are burned and many very seriously.  Women get many burns cooking and many have discolorations of the skin from burns.

Sometimes a family, desperate to create a fire to cook their tortillas, rice and - if fortunate - beans, will burn other flammable trash, including plastic which is toxic.  Also, the smoke hurts the children’s and women’s eyes.

Our health clinic has rescue inhalers and maintenance inhalers* to help relieve and control asthma.  We have nebulizers**  in 27 homes scattered around the barrios and rural communities so that people can go and receive nebulizing treatments there, as well as in our clinic.

Taking a deep breath of clean air is a gift to someone struggling to breathe.  As someone who has been hospitalized because I could not get enough air in my lungs, wheezing and gasping for air made me feel like a fish flopping on a dock.  It is frightening.

To simply breathe.

*Rescue inhalers are fast-acting to relieve the symptoms of asthma.  Maintenance inhalers are slower acting and used daily to prevent and control the symptoms of asthma.  Inhalers cost $7 each, and prednisone and nebulizing medications cost $10 combined.
 **A machine that relieves breathing issues by turning liquid medicine into inhalable mist.

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Wednesday, November 20, 2019

At My Very Core

Once when I went to a therapist, he said to me “I think you need to get back to what you believe… where your core faith resides.”  Finding time to center one’s self, to reassert one’s motivations, and to acknowledge the greatness of a Higher Being is critical for me in order to stand on solid ground, and yet as I get older and more jaded, finding that time or that place is getting to be more and more difficult.

Many people go to church each Sunday to reaffirm what they believe.  To hear the word of God, to sing praises, to worship.  And each Sunday, many stand together and recite the Apostles Creed …

I believe in God, the Father Almighty, Creator of Heaven and earth;
and in Jesus Christ, His only Son Our Lord,
Who was conceived by the Holy Spirit, born of the Virgin Mary, 
suffered under Pontius Pilate, was crucified, died, and was buried.
He descended into Hell; the third day He rose again from the dead;
He ascended into Heaven, and sitteth at the right hand of God, the Father almighty; 
from thence He shall come to judge the living and the dead.
I believe in the Holy Spirit, the holy Catholic Church, the communion of saints, 
the forgiveness of sins, the resurrection of the body and life everlasting.  Amen

When standing beside Mama at her church in Rock Hill, SC, I say those words from memory, and because time has lapsed since I last said them, I pay more attention.

There is nothing in the Apostles Creed about how Jesus lived or what he taught.  It very much is a Christmas/Easter Creed…. born, suffered, dead, buried, raised.

What if Christians who stated their creed each week included

“...who was born… and brought in the Kingdom of Heaven.  
To live in peace.  To feed the hungry.  To free the prisoners.  
To love and pray for our enemies.  To clothe the naked.  
To preach good news to the poor.  To love one another.  To heal the sick.  
To welcome the outcasts.  To love the world… all of the world as His Father did.  
And as a result of his proclamation of this new kingdom 
he suffered under Pontius Pilot, was crucified, dead and buried…”

If Christians said that Sunday after Sunday, do you think we might act differently? 


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Monday, November 18, 2019

POP! It works for the Poor!

With Paul, Becca, and the girls back home from their Northwestern speaking tour, it is nice to have the Community together again.  It is amazing how often one or more of us is away speaking or visiting family.

As a Community we worship each Monday evening which means praying for others and giving thanks for the good things that happened the week before.  We are different people of different backgrounds both religiously and in most ways…

We have now four Quakers, 1 Catholic, 1 agnostic, 1 Episcopalian, 1 Presbyterian, 2 ex-religion, and a baby baptized into the Community.  In our 40 years of Community life we have included a Muslim, Brethrens, a Jewish person who was an agnostic, a reformed Orthodox druid lapsed, an atheist, Methodists, Baptists, etc.  The one thing we all have had in common is lifting our brothers and sisters out of poverty.

JHCommunity 1993
Those of us who believe in a Higher Being trust that people living in poverty is not from design but by humanity’s sinfulness and greed.  We believe that there is a special place for the poor in the heart of the Divine.  This doctrine of the Preferential Option for the Poor was given voice by liberation theologians such as Gustavo Gutiérrez*.

Paul Farmer**, anthropologist, infectious disease doctor and founder of Partners in Health, calls this doctrine of the Preferential Option for the Poor “POP”, his shortcut when trying to make a point.   I think POP not only serves as an acronym but is also quite appropriate…

  • Fireworks drawing our eyes upward and dazzling
  • A thunderclap from the heavens shaking our souls with its power
  • Lovingly calling on a father or a grandfather
  • The sound of a bottle cap’s removal, with a refreshing drink to ease the dryness in the throat
  • A bubble of greed surrounding the heart bursting, to free the heart to love

When we focus our lives around ending poverty then we can work together no matter the differences… when we focus on lifting people out of poverty then we shift our whole focus and maybe, just maybe, we will see the Divine in their faces.  POP!



Note: If you would like to give to the work of the CDCA, focusing on a Preferential Option for the Poor, give online here:

Thursday, November 14, 2019

Future Fridays... to Breathe or to Eat?

Our friends, Becky and Nora, gave us an industrial-size cook stove…six gas burners and a big oven.  When we have delegations…hopefully we will have more in 2020…this stove is an absolute wonder for which we give thanks.  Now we cannot imagine not having it.

And then there is Inez at El Porvenir who cooks lunches for our delegations when they go to El Porvenir, the organic coffee cooperative…On. A. Wood. Cook. Stove.  And it is not some iron pot belly stove with an exhaust pipe that burns wood, no, Inez’s stove is some concrete and blocks thrown together to create a stove, and it sits in their house with no exhaust.

Wood burning cook stoves in Nicaragua are a problem that contributes to deforestation and to health issues.  In this blog, we will discuss just the deforestation.

Our friend, Lillian, went to Cuba many years back.  Lillian lived many years here in Nicaragua and she was telling us about her trip and her observations.  One such observation was that when deforestation got to a critical level, the government started giving people electric stoves.

Gas (propane in Nicaragua) stoves are expensive for the poor… they are a large up-front cost.  The small propane tank costs too much for the poor, but if they are ever able to get a stove and tank, the stoves are much cheaper to operate than buying wood (unless the family is like Inez’s family, who live midst acres and acres of trees where they can forage dead wood).

Solar stoves are not practical here, unless one lives on a huge plot of land with no shade, because the sun’s position in the sky, this near the equator, shifts so much.  There are low-burning woodstoves, but most people do not have them.  So, most people buy wood that is cut down by people in rural areas and brought into the urban areas on horse cart.  Many spend up to 30% of their income on wood.

If Nicaragua had enough funding to give people stoves as Cuba does, if Nicaragua also had funding to research and produce biogas like Cuba is doing, and if Nicaragua had the funding to – at least – supply families with low-burning wood stoves, the forests might start growing back rapidly.  It is amazing how easily plants grow in the tropics.  It all comes down to the funding…


Monday, November 11, 2019

Stepping Over the Line

Okay, I’ve really been trying to keep a great deal of what I think about current events to a minimal in these blogs; but as our Brethren Church volunteer, Caroline, once said to a guy, “You have just stepped over the line, buddy.”

The Middle East is a quagmire and is home to 246 million people…mostly Muslims, but also Jewish people and some Christians.  The Middle East was divided up into countries after World War I, in 1918, by some dudes*  from Britain and France, not taking into consideration the nations that resided there… go figure!  It was like they took a ruler and started drawing.  So, no wonder it is a quagmire… a mess… and yet, we have to remember it is home… HOME… to 247 million people, not just oil wells.

When Pres. Trump said he was going to pull our troops out of “these endless wars”, I was good with that.  We have protested and voiced our opinions over the years to not go to war in the first place.  We have been against the ever-growing military and the industrialized military complex… just like Pres. Eisenhower.  So, pulling troops out is good, but…


During the Cold War, when we ran shelters in North Carolina with our friend quoted above, we had lots of posters on the walls in the common room where the community and shelter guests ate together.  One was a Soviet woman and a U.S. woman embracing with the words, “Can we as Christians – at least - agree not to kill each other?”

We hold in our morals that all wars must end and people must be given a chance to make a home… but will evangelicals**  now break with Pres. Trump to protect their brothers and sisters in the Middle East?

  • The Kurds have allowed the practice of Christianity among their people.  
  • The Kurdish women are some of the freer women in the Middle East outside of Israel.   
  • Even though most practice Islam, they are far from being fundamentalists.  

And yet, all everyone talks about is abandoning our allies… and yes, they were our allies… but they were so much more than that.  So much more.

Is that our reality now?


Thursday, November 7, 2019

Future Fridays - Cleanliness Next to Godliness: Muscles

As I go about my weekly laundry day, I give thanks over and over that we have a washing machine.  When we first moved to Nicaragua 25 years ago, we spent the first two months without the stuff we moved down here while it sat in customs.  Tiny Coury and Daniel, not being used to new viruses, threw up and had diarrhea about every two weeks and I washed linens, towels, diapers, clothes and even a sleeping bag on the pila, which is a concrete wash board.  I not only hated washing, I also was terrible at it.

When our washing machine got out of customs, it was a blessing!  Although all that machine did was agitate with an attached squisher that rang out our clothes as we fed each article of clothing through it.

Washing machines have gotten more energy and water efficient over time, but they are expensive (around $600 for a full-size basic efficient machine).  Our used machine was donated to us years ago and now breaks all the time.  It is rusting out, but I am so grateful still.

The poor in Nicaragua are on-the-whole very conscious about staying clean.  Some of our workers will turn their clothes inside out for work when they have to get dirty and then turn them right-side out before going home.  Their clothes are clean and ironed.  Their clothes are washed on a pila and wrung out by hand.  Clothes are sun-dried and often times because they cannot afford clothes pins or good wire, they hang their clothes on barb wire to hold them in place in the sun and wind.

Because they don’t have closets full of clothes or dryers, the iron is critical.  It dries the clothes as well as making them presentable.  And many Nicaraguans think Europeans and U.S. citizens are grubby and unkempt… fortunately our staff puts up with us none-the-less.  😊

With efficient machines maybe the poor could save some water, but the electricity is not affordable for the poor.  Dryers are not used; only the iron, which is one of the first appliances people buy, to dry and look neat with their limited clothing.

In the wealthier places in the world, keeping one’s clothes clean takes lots of energy: washing, drying, ironing, dry cleaning, chemicals for cleaning, etc.  For the poor of the world the energy is in the backs, arms, and hands… which makes for a cleaner world.


Note: If you would like to give to the work of the CDCA, helping to pay for clinic daily washing needs, washing machine repairs, etc., give online here:

Monday, November 4, 2019

Who Gets the Dregs?

This blog is little longer than most of ours in order to explain health care in Nicaragua.

Watching the U.S. Democratic debates, I was struck by the various proposals to give health care to all in the U.S.  Not endorsing any one proposal, I want to explain Nicaragua’s health system and point out the pluses and the minuses of each…

As part of the Nicaraguan constitution, health care is a right… not a privilege but a basic human right.

The way the current system works was explained very well by my daughter-in-law, Cassie, who worked as a medical intern under the Nicaraguan system.

There are three levels of health care:

  • Universal
  • Single Payer
  • And Private care.

Universal means that ANYONE can walk or be carried into a public hospital or clinic, be treated and leave with no bill.

When Pat had what the neurologist thought was a massive stroke, she fell and cut her jugular vein and her carotid artery on a broken butter plate that she was carrying.

She was rushed to the hospital with our Dr. Flores pushing on her neck (he happened to be there) to staunch the flow of blood.  In less than 5 minutes after she fell, she arrived at the closest hospital and had no pulse. After 4+ liters of blood, ER care, surgery, and three days in the ICU, she died.

We had no hospital bill.
We felt that Pat received the best care possible.

That was our experience, but not all receive that level of care.  Chico, our once-bus driver, went to the same hospital coughing up blood.  He was told to go home to die with stage 4 lung cancer.  After helping him get a second opinion, he actually had TB and is still smoking and coughing but alive and doing fine two years later.

Not all receive good care and for elective surgery the wait is long.

The second tier of Nicaraguan health care is the single payer plan.  Those who work in the formal sector pay into the national insurance1 (INSS).  With this plan, people tend to get a higher level of care, a more consistent level of care, and the waiting period is less, because they stay with the same doctor and have paid into the system.

Jessenia, our health promoter, is in and out of hospitals with diabetes.  She has survived, thanks to the INSS, an infection of the heart and is now battling a failing kidney and an ulcerated toe.

In contrast, Diana’s son broke his arm for the second time… or so she was told.  The doctor, scamming the INSS for more payment, x-rayed the arm and put a cast on the boy’s arm.  When Diana wanted the cast off, she got the arm x-rayed again to learn there was no second break at all.  Her son had worn the cast for 6 weeks for no reason.

The third level is private care.  Our Nueva Vida Clinic falls into this category as well as the more expensive specialists and hospitals.  Leaving clinics like ours out of the equation, most of the better trained doctors work in private care.  They also tend to work either with the INSS or as public doctors.  For example, my internist2  is also the government’s foremost specialist in infectious diseases, especially HIV.

There is no waiting in the private sector.  There is an abundance of tests in the private sector for more accurate diagnosis.  And the private sector gets the most income because the private sector is where the wealthy go.

Just like private vs public schools, when the wealthy have options then the public suffer… it is the same in health care.  If the wealthy of the Pellas family who own about half of this country had to go to the public clinics, the clinics would have everything they need.

So, when candidates talk about people needing health care options, remember options mean the rich have options and the poor get the dregs… like always.


1This is what the first demonstrations in April 2018 were about… raising the percentage people have to pay to the national insurance and taking 5% of what retirees get to enroll them in the national insurance, so that they would get better and more consistent care.
2I go to him because I have a compromised immune system, because I lack a spleen.

*If you want to contribute online to help patients at the Nueva Vida Clinic,

Saturday, November 2, 2019

Future Fridays: Wash...Rinse...Dry...Repeat...

When the family gathered in the Vermont to see Joseph graduate from college, flying with Samantha (then age 9 months) was a first for her parents, Daniel and Claudia. As with all new parents, they made a mistake.  They packed her diapers in checked luggage without thinking!  If you have ever been a parent, it is almost certain that sometime or other you ended up without enough diapers!

They realized their mistake en route in Panama, but in that airport NO store sold diapers.  None!

Mid-way through the 6-hour flight on to Boston, they ran out of diapers… here came Nana and experience to the rescue!  Crammed into the plane’s bathroom, I twisted, folded, and tied a receiving blanket into a make-shift diaper that lasted until their luggage came off the belt at the end of the flight.

Years ago, with my little ones, I mostly used cloth diapers.

The poor never use disposable diapers because they are expensive.  Instead most use big cotton pieces of cloth that they wash constantly and hang out to dry.  If lucky, they have enough for 2 days-worth of diapers that are always getting washed.  No rubber pants, just a few diaper pins and large rectangular pieces of cloth.

Disposable diapers make up the third largest item of consumer trash in landfills in the United States and make up 30% of the non-biodegradable trash.  Disposable diapers will break down IF exposed to sunlight and the elements in 500 years, but most are turned over into the dirt meaning it will take thousands of years for them to break down.

Disposable diapers contaminate the water tables with feces and urine from the diapers.  Supposedly, one is supposed to rinse out the diapers in the toilet before disposing of them. Did you know that? I never have done that, but it is written on the side of boxes of disposable diapers.

Disposable diapers are a poor use of oil, gas, and other awful chemicals… and trees… so many trees.

From Small Footprint Family:*

Even factoring in the water and energy used to launder cloth diapers, in the full-cost accounting, from farm to factory to storefront, compared to cloth diapers, disposables:

  • create 2.3 times more water waste,
  • use 3.5 times more energy,
  • use 8.3 times more non-renewable raw materials (like oil and minerals),
  • use 90 times more renewable raw materials (like tree pulp and cotton),
  • and use 4 to 30 times as much land for growing or mining raw materials.
The poor use simple cloth diapers, wash with soap and hang out to dry… no washing machine, no dryer, and no waste and no trees cut down and no crude oil.

Maybe we could learn from the poor and wrap our precious ones in cloth and wash the diapers so there will be a green world when they are potty trained.

-Kathleen (Nana)

Note:  If you care to help provide new mothers at the Nueva Vida Clinic with cloth diapers and pins, give online here: