Who pays the cost?

Volunteers sorting donated medicines with Josefa

Our clinic has more than doubled its expenses for medicines.  This is caused primarily by doubling the number of patients seen by our doctors and dentist, but also because we are getting fewer donated medicines from outside of the country due mainly to the policies set by the Nicaraguan government.

I have read articles and heard people complain about government bureaucracy, and it is true that we are doing more paperwork.  The Sandinista government is cracking down on medicines that come into the country without the proper paperwork and that  does include more work for the donors and for NGOs receiving the medications to file all this paperwork.  They also are cracking down on what can and cannot come into the country…like outdated medications.

So here is MY opinion:  the Nicaraguan government wants to protect its people.  Can you imagine the U.S. government allowing foreign groups to import outdated medications to serve the poor of Appalachia or New Orleans?

Even IF foreigners could bring trunk loads of medications into the States to treat the poor, can you imagine that customs would allow for broken seals, partial prescriptions, drugs that have been taken off the market due to side effects, etc.?  Can you imagine the paperwork the U.S. would require, IF you even could bring them in?

The new regulations in Nicaragua mean more medicine expense at our clinic, and that is frustrating for us particularly with outdated medications because of this:

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.  (http://www.health.harvard.edu/fhg/updates/update1103a.shtml)

Jessenia in pharmacy photo by Meghan O'Flagherty

So my complaint is really with pharmaceutical companies dating medication so conservatively.  The above article says you can look at it as the companies giving you the most for your money, but with the top ten pharmaceutical companies making over 48 billion dollars in profits  last year alone, I tend to doubt that they have the health of the people of the world in mind. 

Pharmaceutical companies complain about Third World nations violating the patent laws and copying the company’s research and development work to make cheaper medications for their people.  Their complaint is that with patent violations they cannot make enough money to pay for the research and continue the research…but…Note:  48 billion dollars in profits.   To put that in perspective, expenditures of the entire Nicaraguan government  in 2012 were only 2.6 billion dollars.

So our clinic medicine costs go up, and who always bears the brunt of corporate greed?  The poor.  Who always bears the brunt of rising health care costs?  The poor.  Who will suffer if we have to cut back on our services to cover rising medicine costs?  The poor.  

Enough.       -Kathleen

Radiology at the Clinic

Jorge and patient with nurse Jane in 2001

Dr. Jorge Flores was our first doctor in the Nueva Vida clinic.  In July of 1999 we “inherited” the temporary clinic in Nueva Vida from a man who spent his life working in places that experience natural disasters. When Hurricane Mitch hit Nicaragua, the neighborhood of Nueva Vida was created from its victims who were flooded out of their homes near Lake Managua.  This man had committed to sponsoring and overseeing a clinic for six months, and he had hired Jorge to work half-time.

When we took over the clinic, I thought maybe it would be better to interview multiple candidates for the physician’s job and start fresh.  The Nueva Vida residents heard about that and had a different opinion.  They gathered signatures on a petition to keep Jorge on as the clinic’s physician.  We listened to the community, and boy, are we ever glad that we did! 
 
Jorge worked half-time for us for 10 years from 1999-2009 when he resigned in order to study radiology.  He received his radiology degree and is now back, working full-time with us. Currently he is treating patients from 8-5 Mon-Fri.  When we have an ultrasound machine (then x-ray, then mammogram capabilities, etc.), he will do radiology work during the hours that our other part-time doctors are seeing patients.  He will be our general physician during the hours when the pediatrician and the other general physician are not at the clinic.
 

Jorge and patient 2013

This will feed two birds with one piece of bread.  We will have 8-5 medical coverage by a doctor and we will be able to have a more integrated and holistic approach to our health care.
 
We have submitted two applications to received donated ultrasound machines, and are also looking for funds to buy one either used or new.  We prefer a portable one that will allow for examinations in the patient’s homes when they unable come to the clinic.  Jorge could also take a portable machine to more rural areas and to smaller towns.
 
Currently residents of Ciudad Sandino have to travel 10-25 kilometers to Managua to be put on a waiting list for an ultrasound in the public health care system.  While the ultrasound machine will be useful for all kinds of conditions, one example of how we will use the machine is in pregnancy.
 
Nicaragua has 21 cases of infant mortality per 1,000 live births (these are children who die before their first birthday); 12 cases of neonatal mortality per 1,000 live births (these are children who die before they are 28 days old); and 84 cases of maternal mortality per 100,000 live births (these are mothers who die during or shortly after they give birth).
The United States – which is not at the top of the list in the world due to its increasing poverty – has about 1/4 of these deaths.
 

Having access to ultrasounds will enable us to attempt to lower these statistics… or in lay terms: save the lives of babies and mommies.  -Kathleen

Economics Lessons from a 5 year old

I am in the States visiting family.  We went to the zoo.  On the way my grandson, Elliot, wanted to know why Nicaragua - meaning our house - was so far away.  Uncle Joseph, who is 17 and still lives in Nicaragua, was attempting to help him understand why we lived so far away, and then answer every question thereafter… Elliot is five.

I listened as Uncle Joseph tried to explain to Elliot about poor people.  After many questions came the one… “How can rich people make money from money?”  Jessica, Elliot’s mother, attempted an answer.

Note:  Elliot is a train enthusiast and – again- is five years old. 

“Let’s say Elliot, you buy a train for $100.  Then you sell tickets for $1 to ride the train.  When 100 people buy tickets you have gotten back the money you spent on the train, right?”

“Yeah.”

“So after you have sold 100 tickets all the other tickets you sell after that is how you make money.  You understand?”  (Remember he is five)

“But why can’t poor people make money?”

“Because poor people don’t have any money to buy a train with.  Poor people also have trouble getting jobs.”

“Why?”

“Well, you know how Nattie has to go to work in her car?”  

“Yeah.”

“Poor people don’t even have cars.”  (We were talking about Nicaragua.)

Silence for a bit.

“Why don’t the rich people give them rides in their cars?”

Why not, indeed.  -Kathleen

Our website got a facelift!

Our old serviceable but clunky website

OUR WEBSITE HAS A COMPLETELY NEW LOOK!!!!!  Go look at it when you have a chance (jhc-cdca.org).
 
Our old website, designed 10 years ago, served its purpose but was difficult to update and so was very out-of-date.  

This new program that we are using is easy to update and easy to add new photos making it possible to update even if we only have a little time.

Sarah’s brother, Bill Junkin who is a physics professor at Eckerd College in Florida, helped us create this new look.
Becca has spent days looking for photos in our archives to illustrate the work and Sarah took photos, text, and Bill’s program to create the new look.
 

Website's new look & updated content

All information about our projects is newly written.  There are staff photos and short descriptions about them.  We have updated needs lists for the clinic.  Everything is more trim and succinct.   We have added about 100 photos from some wonderful volunteer photographers who generously gave us permission to use their photos!  So…

What are you waiting for?  I said, “When you have a chance…”  Forget that!  Go look now!  jhc-cdca.org  -Kathleen

One Mother Saving Another

 Abnormal.  Those were the results of the pap smear that María Isidra Calderón got in November.

Maria Isidra with newborn grandson Cesar

“I was scared, I thought I had cancer that couldn’t be treated,” she says, holding her newborn grandson César Joseph who’s just come home from his first well-child check.

After she got the results, the Nueva Vida Clinic’s health promoter Jessenia paid María Isidra a visit. “Jessenia told me that all of us who had abnormal results would be going to a clinic in Managua, and we all went together.  I was nervous, but the doctor explained everything to me.  And thanks to God, I’m okay now.”  María Isidra was one the first women to participate in the Nueva Vida Clinic’s new cancer prevention and detection program.

Cervical cancer is the most common cancer in Nicaraguan women – two women are diagnosed in the country each day – and Nicaragua has more cervical cancer than any other country in Latin America except Haiti. 

Health promoter Jessenia during home visit

No woman should die of cervical cancer.  If it’s caught early, it’s easily treatable.  It’s caught early by going for regular pap smears that are read quickly and with timely follow-up for abnormal results.  Unfortunately, most Nicaraguan women don’t go for regular exams.  By the time they suspect something is wrong, they can wait months for pap results, and follow up for abnormal results might be scheduled months down the road. Cervical cancer kills more women in Nicaragua than any other cancer. 

That’s why we’ve started the Women’s Cancer Prevention and Early Detection Program at the Nueva Vida Clinic. Here’s what the program does: 

•  Educates women about breast cancer and cervical cancer 
• Teaches women how to do breast self-exams 
•  Takes 30 women each month to the Ortiz Gurdián Foundation for mammograms 
• Encourages women to come to the Clinic to have pap smears 
•  Sends the paps to a private lab for quick turn-around (under 2 weeks) 
•  Women with abnormal results are accompanied by the health promoter to the to remove precancerous lesions, perform directed biopsies and for regular follow-up appointments 
•  Since November, the Clinic has taken 96 pap smears of which 8 have come back with abnormal results. Seven have been given a clean bill of health and scheduled for regular follow up exams; one has been scheduled for a hysterectomy. 
•  Since March, 34 women have had mammograms, one had abnormal results and is scheduled for minor surgery this month.

Maria Isidra with daughters Ana & Marielis & grandson Cesar

Everywhere in the world, mothers put their children’s health above their own. They’ll take time off work to take their kids to the doctor, but their own complaints go untreated. María Isidra was no different. Her youngest daughter Marielis has epilepsy and needed constant supervision…she now gets her medication regularly from the Nueva Vida Clinic’s chronic illness program, and her epilepsy is under control.  María Isidra’s oldest daughter Ana Carolina is 19 and gave birth to her first son César last month. She now participates in the Clinic’s New Mothers Program.

Luckily for María Isidra’s family, she took the time to look after her own health – she’s been to four follow-up appointments and each time has been given a clean bill of health. “I’m happy,” she says rocking little César.  “Now I can look after my family.”

One Mother Saving Another…this Mother's Day give a gift in honor of your mother to the Nueva Vida Clinic’s new Women’sCancer Program.  Donate $25 to the program in honor of your mother and we’ll send her a beautiful e-card.  (Please email your name and her name & email address to becca@jhc-cdca.org)  

Happy Mother’s Day!

-Becca