Giving Tuesday: Please Help the CDCA Raise Its Goal of $5,400 to Save in the Future

Today is Giving Tuesday, a day fostering giving to non-profits online. The CDCA’s specific project goal for today is $5,400 to set up and maintain for one year an electronic patient record-keeping system for the Nueva Vida Clinic. We have been posting on social media about this day. We have written blogs explaining in more detail why we chose to focus on this project and how you can help. So far, these are the blogs we have written if you want to check them out:

1. a blog about the two hurricanes hitting Nicaragua in two weeks, climate change and why going green is important.
2. a blog about how typing data electronically makes for less mistakes and more time for patient care. 
3. a blog about HOW we are able to do this now and how appreciative we are, 
4. a blog on climate change and saving paper 
5. a blog about how much space and time we will save 
6. and today I will write on the importance of statistics and a summary of why we need this service.

With Hikma Health, a non-profit organization, working to provide “Smart Care, Everywhere,” we are now able to have access to an on-line software and cloud storage area designed specifically for all our patients’ health information... their paper charts. It is true what Hikma Health says on their web page “As of now, health data management systems are not designed to support low resource settings - and need to be adaptable to these increasingly common conditions.” 

Every time we tried to think of ways to move our information to on-line storage and have all our information not on paper, all the programs available were too expensive and too detailed. Creating one that we would have to code and set up is beyond our capabilities.

HIKMA Health also say, “Under acute conditions, populations are disconnected from health care providers, and humanitarian organizations have difficulty tracking rates of disease and the amount of equipment/medications they need to order.”

Josefa, our administrator, does a great job of knowing what we need for our patients in the clinic. She knows what medicines to order according to what the doctors prescribe monthly (available funds allowing)…but tracing diseases is difficult for us. We just do not have the means to really follow-up as we would like. This electronic records service will make that more possible.

“Under protracted conditions, chronic illnesses get worse because they go under treated and preventable complications occur too often.”

This too, is true. Many of our patients get some medications from the government as well as our clinic. Being able to record ALL the medications they are taking will allow our doctors to plan a strategy with the patients who suffer with chronic illnesses.

This service will also provide for us - at our finger tips - what is working and what is not. Statistics. Finding out if the medications are consistently lowering diabetes or not; and if not, why not. 

It will allow us to go through patients’ files and develop not only strategies for individual patients, but also methodologies for the future of service for the clinic. It will allow us to tap into grants and provide for the Nicaraguan government accurate statistics of the diseases we are seeing for their own nationwide public health programs.

In summary, this service:

• will save the clinic money in paper, file folders, printing costs, and maintenance on the file cabinets.
• will save trees and energy…we will go greener and with climate change (two hurricanes category 4 and 5 within two weeks), Nicaragua needs our clinic to be more ecologically sound. 
• will save on space in the lobby area as well as with storage of all the files…which means better social distancing. 
• will also allow us to make fewer mistakes because everything will be typed and not hand-written. 
• will save us time which will mean more patient care. 
• and will allow us to track and keep records of diseases and patient statistics to use for better public health and grant writing as well as developing strategies for the patients. 

Dr Jorge with patients... charting by hand

This is a win-win scenario. This project is valuable to us.  We would love to be able to just spend the money for it to happen; but the CDCA is struggling to pay payroll for staff and bills as well as buying medications and sending out hurricane relief. THIS is why we need YOUR help today. Help us reach our goal of $5,400 today.

Together we can solve problems. Thank you!

- Kathleen

NOTE: If you are reading this blog using the mobile version,click on "web version" to see the full blog with all the features including "subscribe to blog by email".  

Please join us and also share on your social media.

Donate here to the ongoing work of the CDCA with the poor in Nicaragua:

https://donatenow.networkforgood.org/jhc-cdca 

Giving Tuesday: Time, Money, and Space Savings

Tomorrow is Giving Tuesday, a day fostering on-line giving to non-profits. The CDCA sets a specific project goal for that day. Though Nicaragua has suffered with two hurricanes in two weeks, the goal we set awhile back for this year was $5,400 to set up and then maintain for one year an electronic patient record-keeping system for the Nueva Vida Clinic. We are posting on social media about Giving Tuesday and we are writing blogs explaining why we chose to focus on this project and how you can help. So far:  

1. a blog about the two hurricanes hitting Nicaragua in two weeks, climate change and why going green is important;
2. a blog about how typing data electronically makes for less mistakes and more time for patient care;
3. a blog about HOW we are able to do this now and how appreciative we are;
4. a blog on Future Friday and saving paper;
5. and today's blog about how much space, money and time we will save. 

We have seen well over 30,000 patients in our clinic …getting closer to 40,000. Files in the medical part of the clinic, dental clinic, eye glasses, and therapy areas take up a great deal of space. We have file cabinets everywhere: 

• in the lobby space,
• in a storage room,
• in the therapy room,
• in the warehouse,
• and in the vision correction room. 

Space we could use for other purposes, like:

• more social distancing inside the clinic,
• storing medical supplies and equipment,
• And more room for play in the therapy room, 

We jam files into limited space and as a result many patient charts get misfiled.  For years this has been an on-going problem…we spend so much time trying to find misfiled charts. For this Giving Tuesday, one donor gave a gift in honor of his friend, who has actually spent her visits in Nicaragua helping us refile all the files into correct numerical order. 

Bucknell Brigade students and professors have spent hours upon hours helping us find files on patients who have not been seen in the clinic in the previous five years. They pull those files and archive them to make room for newer files, and we then mark them on the computer as no longer active.   North Anderson Community Church Presbyterian volunteers have also done their fair share of standing at the file cabinets and ordering one file after another.

Filing has taken huge amounts of time, space, and money in purchasing file folders and hanging file folders. For many years we could not buy them here and so delegations would bring them down in their luggage instead of using the baggage weight for medicines. Plus we have spent money on fixing file cabinets as they break under the weight of so much paper.

With the digital on-line service we will slowly but surely remove the old files and have more space. We will not have to search and search for missing files at the start of every shift. We will not have to collate all the daily charts into the proper file and then find space for them at the end of every shift.

Time, space and money from the on-line service will save the staff of the clinic:

• time best spent with patients and developing good public health;
• space best used to maintain more social distancing;
• and money best spent on medications and supplies instead of file folders and cabinet maintenance. 

Please give this Tuesday. In the long run, the clinic will save money. 

Together we can solve problems. 

-Kathleen

NOTE: If you are reading this blog using the mobile version,click on "web version" to see the full blog with all the features including "subscribe to blog by email".  

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Donate here to the ongoing work of the CDCA with the poor in Nicaragua:

https://donatenow.networkforgood.org/jhc-cdca 

Assembly of PIGS: HOPE

I love this time of year here in Nicaragua. The rains have usually slacked off which lowers the humidity, but the land is still green with foliage. The temperatures are pleasant, the skies are blue and clear, and everyone is getting ready for festivities.

Sarah and Daniel start decorating for Christmas and adorn our house with lights and decorations. On the first Sunday of Advent, we begin hanging our Advent banners, made long ago with Brethren Church volunteers, when we were in the States running shelters. These banners are 34 years old. Sewn on the banners are the different themes for each Sunday. The first banner is HOPE and the image we chose was of Central America. 

In the 1980’s, Kathy, Sarah, Mike and I all went to Nicaragua during the Contra War. One would think that a war zone would not represent HOPE, but it did for us.

In the States we worked with the poor, the homeless, the battered, and the outcasts. These folks were taught by our U.S. society that they lived as they did due to their own bad choices…not as a result of our society’s priorities.

In Nicaragua, the people had had a revolution and had overthrown a dynasty of dictators and were now in charge of their own destinies. With the Nicaraguan citizens actively participating, the government back then was filled with HOPE for a better future. Investments in education and health care were reaching people in the most remote areas. Land reform was giving landless peasants swaths of earth on which to grow food for themselves and for others who were hungry. Local leaders in communities were given authority and resources to make real changes in their communities. It was a land of endless possibilities. HOPE was high.

Then the United States, with the help of exiled, wealthy Nicaraguans killed the HOPE as they killed Nicaraguans working for change. The CIA Handbook for the opposition…the Contras…instructed them in how to destroy the nation’s infrastructure….and how to target nurses, doctors, teachers, community leaders, etc.…and torture and murder them. Amidst all the death and fear, HOPE was slowly choked to death.

This process has happened all over Latin America, when the people actually get control of their own governments. They make changes towards socialism and the lifting up of the poor, then the U.S. with the wealthy of that nation join together to kill HOPE. The best way to break anyone is to take away their HOPE. Torturers know this. Taking away HOPE is much more effective than pain.

Political leaders know how powerful HOPE is. Pres. Obama used HOPE to ignite the Afro-American population of the United States; while Pres. Trump has used HOPE to ignite the White Supremacy Movement. Both embodied the HOPE that there would be change…HOPE is powerful.

The four Sundays of Advent highlight the four things people need to not only survive but flourish: HOPE, peace, joy and love.

HOPE helps us get up in the mornings…otherwise we stay in bed wasting away in our misery. Depressed people struggle to feel HOPE.

HOPE helps us to continue to work…hopefully for the good of our world. If we have no HOPE, then why bother?

HOPE helps us see the light at the end of the tunnel. If we have no HOPE, we can wander aimlessly.

So where do we find HOPE, when life feels so hard?

This is hard for me. I struggle with depression and struggle with HOPE. But when I look around, I see HOPE everywhere…

In Mike, who picks up his phone EVERY. SINGLE. TIME. it rings to talk to buyers, farmers, and the organic agriculture cooperative in hopes of making this year’s crops profitable for the farmers.

In a family member who struggles with mental illness but still struggles to get in control.

In my 91- year old mother, who tries her best to enjoy life to its fullest even though she is losing more and more of her hearing and eyesight while being stranded in our home.

In the passion of the youth to demonstrate and protest for racial justice and climate change.  

In the staff of the clinic, who work hard to kindly meet the needs of the patients even when the patients grump and grouse.

In the farmers, who year-after-year continue to plant while climate change messes with their crops over-and-over again.

And in the poor, who do NOT lie in bed and curl up in a ball and die.

Maybe I’m confusing stubbornness with HOPE or maybe the two are connected. We won’t give up. We won’t. Is it HOPE or stubbornness? Or does the stubbornness feed the HOPE, or is it vice versa?

You decide. Whichever it is, stubbornly hang on to that HOPE or all is lost. The torturer wins.

-Kathleen

NOTE: If you are reading this blog using the mobile version,click on "web version" to see the full blog with all the features including "subscribe to blog by email".  

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Donate here to the ongoing work of the CDCA with the poor in Nicaragua:

https://donatenow.networkforgood.org/jhc-cdca 

GivingTuesday and Future Fridays and Climate Change and...

 It all seems to roll over me in one giant growing ball of complications... we won't have many Future Fridays if we lose our trees and can't breathe... our children won't have many Future Fridays if we can't stop climate change.  Scientist say that unless we change, apparently we're going to keep having more severe weather patterns like the hurricanes that just swept over Nicaragua.  And we are creating environments that encourage the emergence of toxic pandemics, with their ongoing after-effects on the increased health needs of our patients... and with COVID-19 protocols and social distancing in place, how do we even attempt to continue to meet those needs?  And... and... and.... 

But that path of thinking is too big... the more the problems cycle around the bigger the ball keeps getting... problems too huge to wrap my head around. 

Instead...

One tiny step in the right direction: Using less paper in the Nueva Vida Clinic.  NOW.

This Giving Tuesday.  NOW.  

One attainable goal that we CAN help do, and can do it NOW. 

We can save eight trees each year starting NOW. We can create more space for patients by using less space for paper files. And we can protect our health givers and our patients in the process by switching to a digital patient record-keeping system.

We just have to get it in place... get it started... and then this ball of action can itself begin to roll and grow.  But we can not do it without your help.  We've been promised $1,350 so far.  We are a fourth of the way there.  It won't fix hurricanes.  It won't keep viruses from forming.  It isn't a magic answer.  BUT it is a real place to start, to help, to make a difference.

  https://jhc-cdca.org/givingtuesday/

Together we CAN tackle problems.

- Sarah

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Donate here to the ongoing work of the CDCA with the poor in Nicaragua:

https://donatenow.networkforgood.org/jhc-cdca 

Giving Tuesday: Thanksgiving

Today is Thanksgiving in the United States. It is also the day before Black Friday (a horrid tradition that has made its way down here to Nicaragua), and four days until Giving Tuesday, an opportunity to give to non-profits through social media. The CDCA sets a specific project goal for that day. Though Nicaragua has suffered with two hurricanes in two weeks, the goal we set awhile back for this year was $5,400 to set up and then maintain for one year an electronic patient record-keeping system for the Nueva Vida Clinic. We are posting on social media about Giving Tuesday and I am writing blogs explaining why we chose to focus on this project and how you can help. So far:

1.  a blog about the two hurricanes hitting Nicaragua in two weeks, climate change and why going green is important. 
2. a blog about how typing data electronically makes for less mistakes and more time for patient care. 
3. and today, a blog about HOW we are able to do this now and how appreciative we are.

We are grateful this Thanksgiving Day for the Hikma Health organization, whose philosophy is "Smart Care, Everywhere".  They found our website and asked if we were interested in having an electronic patient record-keeping system for the Clinic…duh!

Through the last eight years, we have been exploring many ways to do this, but we just did not have the expertise to implement this idea of moving from paper to digital. We finally started having internet in the clinic in 2018, thanks to Philip and Lydia, who came to volunteer from London.

Hikma Health volunteer staff have been working with Sarah who works with Ligia, our dental hygienist. Ligia also understands computers and has had more available time away from dentistry for this project, because she is pregnant; she needs to be extra careful about exposure to COVID-19, and so has not been working in our dental clinic. Thanks to the two of them, information collected from clinic administrator Josefa and from me has been interpreted into understandable data language and passed onto to the coders at Hikma Health who are custom-designing an electronic record-keeping system specifically designed for the Nueva Vida Clinic! This work will ensure that we have what WE need and not what a clinic in Kenya, for example, might need. 

For this online software program to work, we need tablets and smart phones.  Thanks to Hikma Health donations we have already received some which they managed to ship through Peaceworks (NJ) and Quest for Peace (CT)…to whom we are also most grateful.

We are extremely grateful to Hikma Health for all their hard work at: 

• custom-designed coding,
• working with lay folks and older folks to develop the best program for us, 
• seeking grants to allow us to use their services free of charge for six months,
• and donating tablets and phones. 

What a gift sent to us from The Divine to our clinic! That they choose to do this work and that they found us is a wonder.

And amidst all the needs of the world with hurricanes, fires, droughts, floods, economic loss with COVID-19, we are deeply, deeply grateful that many of you would choose to help us in this endeavor. It will save us money in the long term and help us limit our effect on climate change.

Thank you because together and ONLY together can we solve problems.

-Kathleen

NOTE: If you are reading this blog using the mobile version,click on "web version" to see the full blog with all the features including "subscribe to blog by email".  

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Donate here to the ongoing work of the CDCA with the poor in Nicaragua:

https://donatenow.networkforgood.org/jhc-cdca 

Giving Tuesday: Controlling Mistakes in the Health Clinic

Giving Tuesday is in six days is Giving Tuesday, an opportunity to give through social media to non-profits. The CDCA sets a goal for that day for a specific project. Though Nicaragua has suffered with two hurricanes in two weeks, the goal we set awhile back for this year was $5,400 to set up and maintain for one year an electronic patient record-keeping system for the Nueva Vida Clinic.

We are posting on social media about Giving Tuesday and I am writing blogs explaining why we chose to focus on this project and how you can help. Yesterday, we posted a blog about the two hurricanes, climate change, and why going green is important. Today, I want to talk about typing vs. writing. 

Each time a patient comes into our clinic, this is the process Clinic staff follow, printing or writing in cursive at each step:

1. We enter the patient's name and patient number and which doctor they will see on a roster.
2. We accept payment: either a coupon earned from volunteer work, or a token 50 or 60 córdobas (equivalent of $1.43 or $1.72) which goes toward the doctor’s exam, medication, and any necessary lab work. Then we write out their name, patient number, method of payment, check off what they need, and sign the receipt, giving them carbon copies.
3. The intake nurses take a clean daily check-in sheet and write out the patient's name, patient numbers, phone numbers and vitals. 
4.  If they are a new patient, then we add a medical history sheet and a patient card with name, patient number, address and phone number. 
5. The doctor takes the daily check-in sheet and fills in their medical evaluation and the prescribed treatment. 
6.  The doctor then fills out a prescription sheet with the medication that the pharmacy will fill for the patient and instructions for taking the medication. 
7. If the patient needs laboratory tests, the doctor fills out a separate lab exam order. 
8. The doctor then tallies symptoms or conditions treated on a separate pathology form for our records. 
9. The patient takes the prescription sheet to the pharmacy where our staff write separate printed slips of paper for each medicine, including the name of the patient, the medication, how to take the medication, and what condition it is for. 
10.  Afterwards the pharmacy staff write down in a notebook what medications were handed out to be entered into a computer later on to maintain the pharmcy's inventory.

We often see about 100 patients/day and hand out about five medications per person. Can you imagine writing all that down by hand? 

The more patients the clinic sees, the sloppier the handwriting gets…and we have had many doctors and nurses who cannot write legibly at all. This means that if a doctor sees a patient who was previously seen by a different provider, they often cannot read the patient’s chart to know what their medical history is. When we hire new staff OR have visiting doctors, this is a real problem.

We have had to track down patients who have already left the clinic to refill medicine orders because there was a mistake in dosing or the medication itself when the doctor wrote it incorrectly or the prescription was not correctly interpreted in the pharmacy. Amazingly, this has happened less often than you might think.

We often have problems filing or finding paperwork because in the hurry and with the patient moving from one area of the clinic to another, their names or their patient number get written down incorrectly.

With the new electronic patient records system, everything will be entered into a Cloud-based system on tablets or phones. How will this change work at the Clinic? It will:  

• eliminate confusion while trying to fill prescriptions
• eliminate the tedious writing and mistakes 
• eliminate the confusion with patient names and numbers and will eliminate physical filing work
• eliminate the confusion of trying to understand the written data when entering it into computers 
• eliminate the duplication of medications from one doctor to another if a patient has to see a doctor other than their primary care physician 
• reduce check-in time
• reduce the charting for doctors (after getting used to the new system) and allowing for better patient care 
• and mostly allowing other doctors to actually learn what has gone on with the patient by reading clearly typed notes.

For just $5,400, you and we can not only set up the tablets needed for this system, but also cover its internet and cloud-based costs for a year…amazing!

Together we can solve problems.

- Kathleen

NOTE: If you are reading this blog using the mobile version,click on "web version" to see the full blog with all the features including "subscribe to blog by email".  

Please join us and also share on your social media.

Donate here to the ongoing work of the CDCA with the poor in Nicaragua:

https://donatenow.networkforgood.org/jhc-cdca 

Giving Tuesday: Hurricanes, Climate Change, and Doing Our Part with Your Help

A week from today is Giving Tuesday. An opportunity to give through social media for many non-governmental organizations (or non-profits). The CDCA tries to set a goal for a specific project and though Nicaragua has suffered with two hurricanes in two weeks, the goal chosen before they ever arrived was to raise $5,400, to set in place and support for a year an on-line service to get the clinic files and information away from paper printing, instead stored in the Cloud. 

We are advertising GivingTuesday with daily posts.  In addition, I will write blogs explaining why this project is extremely important and why now we can accomplish it in more detail. Today, I want to start with the two hurricanes that just hit Nicaragua in two weeks…the impact of climate change.

Nicaragua produces less emissions than much of the world (in 2016…0.9 metric tons per capita, to the U.S. of A.’s 15.5 tons per capita). Yet with climate change, Nicaragua is at high risk as one of the areas most effected. As a global response to the ever-increasing temperatures and storms, we – as the CDCA – need to do our part.

Right now, we use up about 50,000 paper copies a year for the clinic: daily sheets on each patient exam; rosters for the patient loads; lab exam tests and results; daily tallying sheets for all the different services; patient history sheets; and then other miscellaneous forms. Putting all of this on tablets and phones and storing it in the Cloud will annually save the paper weight from about eight trees (8 inches in diameter and 45 feet high) a year in the paper alone. 

Eight trees saved will produce 1,300 pounds of oxygen in a year and will absorb 13 tons of carbon per year. That is more than what 14.5 people in Nicaragua create in one year.

When one adds in the process of making paper by using water to make pulp, the energy to create the paper and the energy to wrap and ship the paper…one ream of paper creates 4.59 lbs. carbon dioxide…so with this new system we are saving 459 lbs. of carbon/year going into the atmosphere (that is 0.23 tons/year). Plus one ream of paper uses 15,000 gallons of water so we will be saving 150,000 gallons of water in paper alone!

Every bit helps. Nicaragua is watching closely as another low pressure in the Atlantic is forming…if it does it will be Hurricane Kappa, the 31st hurricane of 2020 (it looks like it will not…thank God!). If it does its path is headed to Nicaragua.

Remember Nicaragua is the second poorest country in the hemisphere and although the government is doing a wonderful job, there is little money and the need is great (300,000 people need food; one-third of the population lives in poverty; and 70% of the population works in agriculture. Bean crops…a substantial food source…have been hit hard as well as other crops.

Doing our part to limit climate change is a must…and with your help we can.

Together problems can be solved.

- Kathleen

NOTE: If you are reading this blog using the mobile version,click on "web version" to see the full blog with all the features including "subscribe to blog by email".  

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Donate here to the ongoing work of the CDCA with the poor in Nicaragua:

https://donatenow.networkforgood.org/jhc-cdca 

 

 

  

Assembly of PIGS: Giving Thanks

photo Shutterstock licensed

Thursday is Thanksgiving and although with COVID-19 we are keeping to just having our intentional Community together for the meal, it is a day to give thanks. I love Thanksgiving. I love that we stop for half a day to be together, cook, eat, and drink. We sit and listen to Alice’s Restaurant, and though this year we will have no volunteers to whom to explain the song, we will listen, sing, and laugh. That song and time has become holy to us in the Community.

Every Monday, we, the Community, gather to worship. Our worship is loose and flowing; but two things we do faithfully are to start by bringing good things that happened the week before into our circle, and end with bringing people who need our thoughts and prayers into our circle. Lately, it is hard for us to think about good things. I asked Mama the other week, “Do YOU have anything good to bring into the circle?”

“What? Besides the old stuff?” she said shaking her head.

“Bring in the old stuff, Mama.”

“Well, we have food and a house and we are living.”

Sometimes these days, that is all I THINK we have, but we have so much more:

1. We have each other in our Community, and though at times we feel isolated, we still have each other (I can’t wait to be able to hug again!).

2. We do have our basic needs met and have been able to meet the basic needs of the CDCA…though how... a miracle?  Well, I believe, God is helping this work through so many.

3. We have people who pray for us and this work which – I believe - helps with number 2.

4. We have volunteers stateside like Steve selling coffee and being the CDCA’s lawyer, Sue depositing donations, Tracy and Racheal being our legal address, board members helping in various ways, Jessica writing checks, Joseph and Alex dealing with sending paper mail for us, Coury and Cassie dealing with mail for us and the list goes on and on.

5. We have volunteers in Nicaragua like Lila working on legal stuff for us, health promoter volunteers working with the clinic, Dominga working extra hours to provide more therapy sessions, volunteers in the clinic learning and providing care, Steve helping us navigate the future, Neil working with Daniel on social media, and again the list goes on and on.

6. We have a great staff who are there when they are needed both personally and professionally.

7. Though shaky and achy some days, we all have our health.

8. We who have living parents and siblings are fortunate that they all love and care for us.

9. We who have children are fortunate to have children that love and support us.

10. We who have grandchildren are fortunate to have the most adorable and smartest ones in the world 😉

11. We have the greatest friends who make us laugh and who hug us (or will) when we cry.

12. In other words, we have a whole host of people who have our backs.

So why is it so hard to think of good things?

Sometimes we feel so swamped by the bad things…like recently, two hurricanes in two weeks and looking at crop failures…we forget the good.

Two people in my life are great at saying “thank you” and praising people consistently: Sarah and my dear friend, Donna. I’m horrid. I think it, but the words do not come out of my mouth enough.

I used to pick up our boys from school and tell them “good job” about grades they got or something that happened, but the traffic would be heavy and with watching that motorcycle driver trying to kill himself with our car… that would be it. The boys would get home and tell Sarah who would hoot and holler at their successes.

I frequently start to write a letter to someone and will think, “now how would Donna express this?” and my letters would be much better and kinder.

It is not only good to give thanks to The Divine or the universe or whatever you consider that is greater than yourself, but to also give thanks to others for all they do. Lift up the people you encounter. Lift up your family members. Lift up those with whom you work. 

Samantha, our granddaughter is two, and has a will of her own. We have been trying to teach her to say “please” and “thank you” in either language and unless she really wants something, she ignores us…but when I consistently say, “thank you for the frog, thank you for the doll, thank you for the bear, etc.” as she piles high her toys in my arms; then, when I hand them back to her she will say “thank you.”

Thankfulness expressed is contagious…as contagious as COVID-19. I’m going to try and make it a habit… the goodness…not the virus.

Happy Thanksgiving!!!

-Kathleen

NOTE: If you are reading this blog using the mobile version,click on "web version" to see the full blog with all the features including "subscribe to blog by email".  

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Donate here to the ongoing work of the CDCA with the poor in Nicaragua:

https://donatenow.networkforgood.org/jhc-cdca 

Future Fridays: Two Hurricanes in Two Weeks

Rescue workers search for survivors in mudslide in Peñas Blancas where 9 were killed.
Photo: Radio la Primerisima 

Nicaragua has been battered by two hurricanes in two weeks. On November 3rd, Hurricane Eta hit as a Category 4, then on November 16^th Hurricane Iota, the strongest storm ever to hit Nicaragua, made landfall as a Category 5 just a few miles from where Eta had made landfall. While Eta was a strong storm with lots of wind and rain, it moved westward across the country more slowly, dropping its rain over several days before heading northward through Honduras and Guatemala, then east to Cuba and Florida. In Nicaragua, two miners were killed in a landslide just before Eta hit, but there were more than 20 deaths in Honduras and more than 150 in Guatemala.

Hurricane Iota came much faster, sustaining 160 mph winds well into Nicaraguan territory and dropping 12 inches of rain over 24 hours in some areas. It quickly headed northwest over Honduras and El Salvador before continuing out over the Pacific Ocean. Although it lasted a shorter time, Iota caused much more damage and caused it all over the country – its winds were stronger, and more rain fell in a shorter time, but also rivers that had not yet gone back down in level flooded quickly, already saturated ground caused many deadly landslides and caused trees to fall in every community in the country. Our own Center and Clinic had several trees fall – just behind our office a large tree fell and damaged a big portion of our security fence.

Lucas analyzing downed tree - just missed the office building!

This tiny country has been dealt a catastrophic blow with these hurricanes: Iota caused 18 deaths, many of them babies and children. Eta damaged 10,000 homes, and we don’t yet have the count of homes damaged from Iota. Eighty-one health centers have been damaged, three bridges have been completely destroyed and there are hundreds of millions of dollars in damage to infrastructure. Devastatingly, not only cash crops but also food crops have been lost around the country, threatening Nicaragua’s hard-won food security.

Authorities evacuated 71,000 people in anticipation of Hurricane Iota.         Photo: JP+

There is good news, too: the Nicaraguan government has responded swiftly to these storms to save lives. Throughout the country 103,200 first-responders were mobilized and worked well before the hurricanes even made landfall to evacuate people in vulnerable areas. In total, 160,000 people were evacuated to 3,700 emergency shelters where they were fed and given medical care. As many of these people begin to return home, there is a huge ongoing need for food, clothing, hygiene supplies, and household supplies. Although the will of the government is to help victims as quickly as they can – they had already sent roofing materials for 14,000 homes to affected areas before Iota hit – the rebuilding task ahead of the county is monumental, and the government’s small budget won’t stretch to accommodate all the urgent needs.

A call for climate justice: on November 15^th as the region was preparing for Hurricane Iota, the Central American Presidents met virtually, demanding that developed countries not only drastically reduce their emissions but also pay reparations to countries who are suffering the consequences of the climate crisis for which they are the least responsible. Nicaragua’s carbon emissions are just 0.02% of the world total, yet this small country is bearing the brunt of the climate crisis right now. It is clear that these storms are a result of climate change – warming oceans create conditions for more storms forming, Iota was the record-breaking 30^th such storm this year, and there are two more possible storms forming right now. For more than a decade Nicaragua – which now produces 74% of its electricity renewably – has been advocating for climate justice, emphasizing that climate financing must take into account not only funding  for mitigation and adaptation but also reparations.

How are folks we work with faring? All our staff and their families are fine. Nueva Vida Clinic operations have continued as usual.  Trees down and roof leaks are the norm. Paul and Becca had to hike into their home because of trees down on the only entrance "road".  All of your emails and messages of concern are greatly appreciated.  Please share this update with others, as we may not manage to reply to everyone individually.

Organic farming families with COPROEXNIC are fine; so far their sesame in the fields is fine. Rogelio reports that some of the co-op’s 140 acres of sesame near our Center is leaning over, but not bent or broken – phew! It should recover just fine.  Peanut farmers are still worried about their crop molding, because too much rain can be very bad for peanuts.

The El Porvenir coffee cooperative reports that everyone is okay. Many of the 56 families’ houses lost their roofs with Iota, but they are able to repair with materials they have. The roof came off the coffee processing building, which will have to be repaired quickly before the machinery is damaged. All of their bean crop for food has been lost, as has their small organic sesame cash crop. Their organic coffee, nearly ready for harvest, has been partially damaged but so far the harvest is still looking okay. For those with fond memories of it, Inés also reports that the latrine that our groups always use when we visit the co-op was blown over.

What are we doing? In the immediate term, we are sending donated clothing to folks in emergency shelters – Monday we are tying sacks of it onto the roof of a bus going to the Caribbean coast - 18 hours overland to Bilwi, crossing the River Wawa in dugout canoes. Our local Rotary Club is raising funds for farmers to re-plant beans in areas where it's possible to still harvest a 90 day crop. We are working with other folks to see not only what is most urgently needed, but what support will be needed in the coming months and years, and will channel hurricane relief donations into those areas.

Please keep Nicaragua in your hearts. If you can help, send your donations here, designating as you wish: https://donatenow.networkforgood.org/jhc-cdca

- Becca

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Assembly of PIGS: Living Love

 In Nicaragua, so much of their society is gracious and kind.  It took me some training to learn some basic courtesies like...

• If someone comes into your house, get ready for a visit... offer them a chair and something to drink.
• Always greet people when you first see them and ask how they are.
• Always say por favor (please) and gracias (thank you).
• When someone says con permiso (with permission or excuse me) always respond with suyo (it's yours) or pase (please pass).

And yet there is also a mentality that our Daniel has labeled "the pinata mindset"... In traffic, grab whatever space you think you can grab and the biggest and loudest pushes everyone else out of the way.  It is "me first" and "my agenda is more important than yours".

You can find this "me first" mindset in so many societies.  "MY freedom" trumps yours.  My not wearing a mask is more important than your health or the health of your loved ones.  My owning any type of gun out there is way more important than YOUR safety or the safety of your family.  My desire to drive whatever vehicle I want is more important than future generations' air.

This attitude of "me, my, mine" has even moved into "Love your neighbor as you love yourself".  I have heard sermons on, and read devotionals on "you have to love yourself before you can love others".  It is just another version of focusing on one's self instead of others.

I do recognize that for broken people loving others is hard, but I have known homeless vets suffering from PTSD reaching out and having the backs of other broken homeless people.

I knew a woman with multiple personalities due to intense, excessive child abuse, who showed me love and care.

I have known people suffering from schizophrenia to reach down and lift someone up.

Bossman holding Coury

The word "love" in the gospels is mostly used as a verb.  And no matter how broken we might be, we can always choose to love.

What is "love"?

Love is patient and kind.  Love is thinking of others' needs, not your own wants or agendas.

You've heard "there is no I in team".... Well there is no I or Me in love.

In the gospels the moral of the story of the Good Samaritan was "do unto others as you would have them do unto you.". And what was done?  A beaten, robbed man was left bleeding by "good"  people, while an outcast bandaged him, paid for his housing and food, so the injured man could mend. And then the helper checked in on him later, ensuring that he did indeed heal.  Society's outcast put his own needs, his own agenda, his own time aside for the abused.

The Good Samaritan had the injured man's back.

That is love.

- Kathleen

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From Headache to COVID Test: My Journey through the Nicaraguan Public Health System

Hospitalito Ciudad Sandino before COVID Photo by Jolien Nolmans

In early October I got a headache that wouldn’t go away…and it put me right inside the debate over Nicaragua’s response to COVID-19. Despite being the poorest country in the region, since the coronavirus pandemic hit Central America earlier this year, Nicaragua has consistently had fewer cases, fewer deaths and more successful recoveries per capita than any other country in the isthmus. Our organization, the Center for Development in Central America runs a health clinic in Ciudad Sandino, just outside Managua. Since July we’ve been hearing criticisms that the government is hiding a second wave, but that hasn’t come about yet – folks have been cautiously going about their business, gradually returning to normal life, albeit with masks and hygiene protocols. Still, when I got a headache that wouldn’t go away followed by body aches and fatigue, I was cautious.

Because I work with folks over 60 who have compromised immune systems and chronic conditions, I stayed holed up at home. Uncertain what to do when I still wasn’t feeling 100% a few days later, I called the free 24-hour COVID hotline that the Nicaraguan Health Ministry (MINSA) set up in April. The operator answered on the first ring, no waiting, no hold music. I explained that I wanted to know whether or not I should be quarantining. My husband and I had been sending our 8th and 9th grade daughters to their public school where masks are required, but we were unsure whether or not to keep sending them since I wasn’t feeling well. The operator asked for my name, address, ID number, age, and asked if I had any pre-existing conditions. He went through a list of symptoms with me, then he told me a doctor would give me a callback. Less than five minutes later, a second operator called to re-check symptoms with me. Another three minutes went by, then I got a call back from the doctor. She went through my symptoms and medical history with me and advised me that while I probably didn’t have COVID, I should go in to see a doctor about the headaches.

Two days later when my headaches weren’t better, I’d had a blood test showing a virus so I called the hotline again. As soon as the operator picked up and introduced herself she said, “Is this doña Rebecca? You called us a few days ago because you’d been having headaches? How are you feeling now?” They had my number registered and all my information popped right up. The operator went through the symptom checklist with me again and when I told her about the test result she said, “You should really go in to your health center, your assigned center is the Hospitalito in Ciudad Sandino in front of the police station. I always see that it’s empty there, the attention should be fast. It’s best if you go in.” When I got a call back from the doctor, I asked if they would test me for COVID and he told me that would be up to the doctor who examined me; if I wanted to ensure I got the test, I could go to the central MINSA offices in Managua and pay $150 to get tested.

I found myself hesitating to go in. When the first coronavirus cases were reported in Nicaragua, opposition groups flooded social media with stories of hospital systems collapsing, overrun with the virus. On WhatsApp I was forwarded lists of “recommended” medicines to buy in case my family members got sick. Near my office the lines at the pharmacies to buy these medicines went around the corner and my coworkers were charged $6 for an aspirin tablet. Meanwhile the Health Ministry used TV and radio jingles to counteract bad information: as soon as you get sick, go to your local health center to have a doctor examine you and give you medicine appropriate for your medical history and current condition, all free of charge.

Hospitalito Ciudad Sandino before COVID Photo by Jolien Nolmans

Unfortunately, in May and June many people were too afraid to go to the doctor and the opposition’s lies were paid for in lives lost. Recently I talked with a friend whose family story shows the consequences of misinformation: her sister listened to government advice and as soon as she had a persistent headache she went right in to the public clinic. She was given medicine and quarantined at home where she recovered from a mild case. A second, wealthier sister refused to go to a doctor. When she got sicker she paid a small fortune at a private hospital, but kept getting worse. Finally she went to the public hospital where she was hospitalized and eventually recovered from a severe case of coronavirus. The third family member, a cousin, was too scared to seek care in the public system and too poor to go to the private hospital. He waited at home until he could no longer breathe, and by the time he went to the public hospital he died before they could intubate him.

It was with those lessons in mind that I decided to go to the public hospital in Ciudad Sandino, reasoning I’d rather overreact to a headache than be hospitalized later. I went after 5 o’clock, thinking it would be quieter with the normal outpatient services closed. I was shown to a separate building where I sat outside on a bench to wait with one other patient. After a short wait a nurse checked my temperature, blood pressure and blood oxygen levels. I was then ushered into the exam room where the doctor sat behind a desk 12 feet away. She asked questions about my symptoms and looked at my lab results. The doctor then examined me, looking in my throat, listening to my lungs. She told me that based on clinical exam and my lab tests, they couldn’t conclusively say whether I had COVID or not, so she gave me an appointment to get a COVID test the following morning. The doctor explained that because the COVID tests require full PPE and room disinfection, they schedule all the patients at one time to simplify the process. She told me that they do six COVID tests per day at the hospital, and that at 6:30 PM I was only the sixth possible case that day that had warranted a test.

The following day I went back to get my test at 8 AM. Three other patients and I waited two hours for the final two patients scheduled – they never showed up. As I was waiting, I thought about how the best epidemiological plan still has to contend with human nature. For example, the two missing patients had a chance to find out – for free! – if they had coronavirus. Maybe they didn’t want to wait, maybe they were scared, maybe they felt better, but whatever the reason, they didn’t show up. As anyone who works in public health around the world can attest, getting people to change habits is difficult. Providing them with access services, however, is something that the current government has been able to do – and for patients in Ciudad Sandino over the past 14 years, it has changed their lives dramatically.

It’s called the “Little Hospital” because the Hospitalito – which serves a city of 180,000 – was technically a health center until just a few years ago. During 16 years of neoliberal governments, one building was designated for outpatient services and the second building sat empty. Our CDCA health clinic employed doctors who also worked at the Hospitalito, and they told us that they didn’t even have gloves to examine patients. Every time I went down the street outside the Hospitalito I was stopped by people begging for taxi fare to take their family members into a hospital seven miles away in Managua because there was nothing to be done for them at the Hospitalito and there was no ambulance.

Now the Hospitalito has full emergency services and two ambulances. When I walked through the gate at 8 AM there were over 100 patients waiting to be seen by Operation Miracle, where Cuban-trained ophthalmologists perform more than 10,000 cataract removal surgeries for free annually. I watched families coming in with food and packages for mothers who had recently given birth there – before, women had to go all the way into Managua to give birth; I drove one neighbor who had patiently waited until morning to ask me for a ride and then gave birth just 10 minutes after I dropped her off! Now expectant mothers don’t have to travel while in labor – they were there watching the morning bustle from the porch of the maternity waiting home where they wait out the last two weeks of their pregnancy, resting and being closely monitored by doctors. I walked through the full outpatient areas – gynecology, psychology, pediatrics, and general medicine. As I stood waiting, I could see the constantly moving lines at the pharmacy to pick up free meds and at the laboratory to get free exams. I watched one of the two ambulances get loaded up with tables, chairs, vaccines and medical students and head out to a community health fair. A mototaxi with the MINSA logo emblazoned on it came and went constantly, taking personnel and provisions to the six related health centers open daily and even two rural health centers that are staffed once a week.

And in the midst of all that bustle sat four lonely patients with possible COVID. At 10 AM when I was called in, the doctor in full PPE had me sit down and explained the procedure to me. He stuck a probe way up each of my nostrils and explained that I would be called within two days if my test was positive. If my test was negative, I wouldn’t get a call. I asked if they’d only been doing six tests a day throughout the pandemic. He said no, they had been doing more, but now many days they don’t even have six patients to test, so they randomly test staff to fill their quota. He told me that patients who are clinically shown to have COVID with physical exam are treated as COVID cases, given medicine and counted in the official coronavirus numbers reported weekly at a national level. Anyone who cannot be clinically shown to have COVID is scheduled for the test, and those patients who test positive are also reported in the weekly COVID numbers.

As I went home to await results, I realized that while we don’t yet know why Nicaragua’s COVID numbers are so much lower than their neighbors – maybe experts will be able to determine whether policies such as not ordering a lockdown played a part in its lower caseload – it is clear that Nicaragua’s public health policy set the country up to successfully battle a pandemic by creating a healthier country overall. Although my COVID test was negative this time, I found myself relieved to know that if I feel sick again, I can count on quality care from MINSA.

- Becca Mohally Renk

NOTE: If you are reading this blog using the mobile version,click on "web version" to see the full blog with all the features including "subscribe to blog by email".  

Please join us and also share on your social media.

Donate here to the ongoing work of the CDCA with the poor in Nicaragua:

https://donatenow.networkforgood.org/jhc-cdca