Believe it or not, I actually have a job...

I figured that it’s about time I write about the real reason I’m here, which believe it or not isn’t to weigh the pros and cons of hot water, public transportation, or pigs as bacon, not pets. I do have a job and it has proven to be quite an interesting experience, so bare with me and then I promise I’ll get back to the good stuff later, like my first experience with doing laundry in a third-world country.


I started working pretty much the second I got off the plane in Managua. On the same flight as me were 16 undergrad students from Yeshiva and Rutgers who would be staying in Limon and volunteering for FIMRC for the week. Since then it has been non-stop volunteers and will be straight through the end of March. In total, there will be over 40 Americans coming to this town to help provide medical care and public health education.

FIMRC is funded almost exclusively by volunteers. They pay a pretty large sum of money to come here – most of that money goes directly to the clinic and the community (believe me, it’s certainly not coming my way!). So, it’s critical that they enjoy their time here, see value in the work that we’re doing, and go home and tell their friends to get involved with FIMRC. Thus, a good portion of my job is tour guide/babysitter/responder to the 50 million questions they have each day…this is the ultimate test of my patience.

Volunteers go on rounds at the various clinics in the area, as well as the government-run hospital in Rivas. They see some things that would blow your mind…and as a function of my job I’m required to see these things too. On Friday, I scrubbed in and watched a man have his leg amputated (pictures of the shock on my increasingly yellow face to follow). Last week, I saw three c-sections and got vaccinated by a second-year med student – hey, it was free and I ran into a barbed wire fence the day before.

Aside from catering to the volunteers, I’m working with another FIMRC staff member to help establish and grow FIMRC’s program in Nicaragua. Right now, we don’t have our own clinic here, whereas at all other FIMRC sites we do. Here, we partner with the Roberto Clemente Clinic, which is a private clinic funded primarily by Rancho Santana, the “Beverly Hills of Nicaragua” that sits past some giant gates just outside of Limon. Basically, the millionaires at Rancho thought it would be a good idea to 1, have a place they could go get emergency medical care should they trip on the marble floors in their mansions and 2, to contribute something positive to the community aside from their five-minute trips into town where they grace the community members with their presence. Can you sense any distaste for these folks yet?

So, FIMRC has a formal agreement with Roberto Clemente – we provide funding for the clinic and volunteers to execute community outreach and education programs and in turn, the clinic offers us a base from which we can run our program in Limon.

Now the problems. Number one, Roberto Clemente is not technically a free clinic. The clinic charges a “voluntary” fee of $1 per visit. To be clear, nothing “voluntary” in Nicaragua is actually voluntary (we learned this the hard way when there was a “voluntary” tip added to our bill in Granada and the waiter chased us down the street on his bike for not paying the whole thing). So people are absolutely expected to pay. And for most people in Limon, $1 is what they make in an entire week, so this “voluntary” fee means they don’t go to the clinic for care. Instead, they can walk about 1 mile down the road to the government clinic in Las Salinas, where everything is 100 percent free, including all medicines and vaccinations.

And hence the biggest problem of our partnership with Roberto Clemente. FIMRC’s mission is to provide free medical care to children and at RC, we can’t do that. The clinic board is insistent on this fee remaining. They’re afraid that if they don’t have the fee, people from all across Nicaragua will travel to get care at this clinic instead of the government clinics. This is likely true (government clinics are severely lacking in resources), but isn’t that the point?

So to correct this issue, FIMRC’s Yale chapter has raised over $23,000 to build a pediatric ward at RC that would provide FREE medical care to children. Which brings me to problem number 2: the RC board doesn’t want to sell FIMRC the land to build the ward. Instead, they want FIMRC to give them the money and they’ll build the ward and continue to charge for care.

Are you getting the feeling that the board members at RC may not be looking out for the best interests of the community? That’s the understatement of the year. I can’t figure it out yet – why they would treat this clinic like a business instead of a resource for people in need. They view FIMRC wanting to build a pediatric ward as “competition” – when you’re talking about providing free care to save lives this seems pretty ridiculous.

So it’s a pretty tenuous relationship right now and things are starting to come to a head. We attended the clinic’s BORED meeting last week (keep in mind: they meet in an air-conditioned room at the resort with wait staff, cold beverages, and fresh fruit while they talk about how well-connected to the community they are…and then hop on their helicopters to head back to the States). At the meeting, we presented our desire to build the pediatric ward and were pretty much snubbed. So the future of our partnership is up in the air.

In the meantime, I’ve been talking to lots of people in the community about other alternatives. There’s a fishing village north of here where there is absolutely no medical care – if they want to go to a clinic, they walk 4-5 hours one way to get care. The mayor of our district lives in this village and would be highly supportive of a clinic there…as would the owner of the local hotel here, who has property there and offered his design and project management services should we build there instead of Limon. I’m hoping that after I put together all of the resources we have in this community, FIMRC will decide to cut ties with RC and build a clinic in Ostiero, where there’s a huge need and the opportunity for FIMRC to really fulfill its mission.

While I work on saving the world one Nicaraguan pediatric clinic at a time, I’m also in the process of finishing up a massive census of the four communities in the area. This info was pulled together by volunteers over the past year and provides us with a complete list of every person that lives here, a map of where they live, how old they are, and any medical conditions they may have. Once this information is all in order, we’ll be able to implement a more formal system for ensuring they’re all getting care.

So the moral of the story – I do in fact have a job here, it’s proving to be challenging and interesting, and if the volunteers don’t drive me crazy, I may actually be able to make a difference. I’ll let you know how that goes, but first I need to make it through my first experience at a Nicaraguan “fiesta” which I’m off to now. Will write more later – love and miss you all.