Running head: HEALTHCARE IN NICARAGUA 1

Healthcare in Nicaragua: Steps to becoing a !irst "orld healthcare s#ste

Sarah $artine%
Libert# High School
E&er# #ear '$($I) 'aptist $edical and (ental $ission International) goes to Nicaragua and
helps people li&ing in rural &illages and pro&ides the "ith health care* Treating o&er a thousand
patients "ithin !our da#s) it is hard to gi&e people the +ualit# edical attention the# need* Unli,e soe
Aericans "ho ha&e the lu-ur# o! accessing health care "hene&er the# want) the people o! Nicaragua
!ace an# obstacles pre&enting the !ro getting the health care the# need* Slo"l# the# are ipro&ing
their nation.s health care) it is /ust a atter o! "hat steps the# need to ta,e in order to o&ercoe those
obstacles* In order !or Nicaragua to ha&e a coparable healthcare s#ste to !irst "orld countries the#
!irst need to stabili%e their go&ernent) then a,e +ualit# healthcare) and lastl# a,e the healthcare
accessible and a!!ordable to e&er#one*
The go&ernent is the ain proble "hen it coes to healthcare !or the people o! Nicaragua*
In the 1012.s and 32.s the Soo%a !ail# dictated Nicaragua until it "as o&erthro"n b# the Sandinistas
also ,no"n as the 4SLN) Sandinista National Liberation 4ront) in 1030* (uring the Soo%a era there
"as healthcare a&ailable !or the people) but it "as not easil# accessible !or e&er#one* To obtain
healthcare) a person had to pa# cash up5!ront and people "ho had a certain aount o! one# "ould
sta# in an open "ard) probabl# "ith other patients) and ight not get treatent* I! a person had a little
ore one#) the# "ould be put in a ore pri&ate roo and ight get !aster treatent6 people "ho had
an aple aount o! one# "ould get their o"n roo and "ould get treatent right a"a# 7Slater)
1080) p*191:*
A!ter the Sandinistas had o&erthro"n the Soo%as) the# established a re&olutionar# go&ernent
in its place* ;ith the ne" go&ernent) public healthcare "as a&ailable to e&er#one !or !ree "hich ade
the deand !or edical care o&er"heling 7Slater) 1080) p*198:* Scared that the Sandinistas "ere /ust
HEALTH CARE IN NICARAGUA
another dictatorship) a rebellious group ,no"n as the <Contras= "ere gi&en ilitar# and !inancial aid
!ro the US go&ernent to o&erthro" the 7Ho"Stu!!) >21?:) e!!ecti&el# beginning the Contra ;ar*
A!ter an# #ears o! rebelling and resisting the Sandinistas) the# "ere o&erthro"n "hich le!t Nicaragua
in po&ert# "ith an unstable go&ernent* Soon later the 4SLN "as re5elected into po"er "here it
reains toda#6 still le!t "ith an unstable go&ernent) soe guerilla groups continue to rebel and create
destruction and !ear in innocent &illages all throughout Nicaragua*
Ha&ing a stable go&ernent is the !irst step Nicaragua needs to ta,e in order to ha&e a
coparable healthcare s#ste to !irst "orld countries* @n one hand) people ight argue that the
Soo%a dictatorship "as not a stable go&ernent !or Nicaragua* (uring the dictatorship all three
Soo%as had onl# their best interest in ind) not the countr#.s6 the# !ocused on achie&ing and
aintaining coplete go&ernent) econoic) and ilitar# control* Aareba 7100>: stated) <Soo%a
began consolidating his po"er and increasing his o"n "ealth at the e-pense o! the national treasur#
and the nation.s poor= 7p*?:6 this sho"s that "hen the Soo%as re&eled in po"er Nicaragua su!!ered in
po&ert#* This is the reason Nicaragua struggled "ith healthcare) the go&ernent lost sight o! the greater
good6 the Soo%as did not !ocus on "hat Nicaragua needed) the# onl# !ocused on "hat the# needed
and "anted !or thesel&es*
@n the other hand) ho"e&er) it can be obser&ed at that an# go&ernent in place is better than no
go&ernent at all* @nce the 4SLN "as in po"er) it partiall# helped the treendous aount o! people
li&ing in po&ert# to get /obs again and to start constructing the < .ne" Nicaragua. = Aareba 7100>:
"rote) <The Sandinistas instituted !ar5reaching) inno&ati&e re!ors in education and healthcare* The
econo# "as redesigned and reoriented to"ard re&olutionar# ends) "hile it sought to aintain the
cooperation o! the traditional iddle sectors= 7p*1:* This "as the start to building a ne" !oundation !or
Nicaragua and leading its people to a better "a# o! li&ing* Ho"e&er) "hen the !irst !ree elections cae)
the Sandinista go&ernent "as de!eated lea&ing guerrilla "ar!are throughout Nicaragua 7Aareba)
HEALTH CARE IN NICARAGUA
100>) p*1:* ;ithout a central go&ernent) no bigger plan is in place6 there is no one to place ta-es to
le&# !or healthcare "hich lea&es chaos* Guerrillas are not elected) the# do not care about the asses o!
people in Nicaragua) the# onl# care about thesel&es* ;hen there is chaos) there is no tie !or people
to thin, about lu-uries the# "ant there is onl# tie to panic) !ear) and hope that things get better*
(uring the !irst !ree elections the Sandinistas "ere de!eated b# Bioleta 'arrios de Chaarro)
an# sa" this &ictor# as a &alidation !ro the long5tie support "ith the Contras and li,ed the idea
that the Sandinistas "ere* Ho"e&er) !ree elections continued and the Sandinistas still contribute to a
role in Nicaraguan politics 7Sandinistas are) >21?:*
@nce there is a central go&ernent in place) the ne-t step that Nicaragua needs to address is
de&eloping good +ualit# healthcare !or the people* This "ill not onl# help decrease ortalit# rates but
it "ill also increase eplo#ent rates* The National Health S#ste in Nicaragua assures that all
edical school graduates "ill ha&e a /ob in a public sector "ithin a counit# 7'ra&ean C $ora)
1083) p*983:* Ha&ing ore /obs a&ailable could potentiall# gi&e people ore options in their li&es and
,eep the a"a# !ro gang related li!est#les) "hich could pro&ide securit# and trust "ithin
counities so people a# be ore "illing to go out and see, the edical care the# need*
'rune C 'ossert 7>220: stated) <Trust and participation in greater nubers o! groups ha&e been
lin,ed to decreased ortalit#***Dipro&edE ph#sical sel!5reported health status***decreased &iolence and
higher incoe*= This is good !or counities in Nicaragua because ha&ing trust can lead to building
and sustaining ore hospitals "ithin the countr# "ithout ha&ing to "orr# about the being destro#ed
b# Contras* Ha&ing hospitals and healthcare !acilities !or the countr# "ould pro&ide iuni%ations !or
people) help increase li!e e-pectanc#) pro&ide clean "ater) and re5h#dration stations 7Angel5Urdinola)
Corte% C Tanabe) >228) p*8:*
Ha&ing ore healthcare !acilities ight inspire people to learn ore about healthcare to ensure
their !ailies are getting the care the# need* Iron5de!icienc# aneia is an issue in #oung adolescents)
HEALTH CARE IN NICARAGUA
<The percentage o! children aged 1>5F0 onths "ith aneia in Nicaragua is >8*9 percent) and the
pre&alence is higher in rural areas than in urban areas= 7Angel5Urdinola et al) >228) p*13:* The ore
parents are educated about aneia the ore the# can pre&ent it !ro happening in their children* $an#
deaths in children can be pre&ented b# nutrition) good care) and edical treatent*
It is easier) ho"e&er) !or people li&ing in bigger cities and to"ns to ha&e access to education
about healthcare and actuall# recei&ing edical treatent* <Incoplete &accinations can re!lect !la"ed
ser&ice deli&er# and ine!!icient logistical s#stes) as "ell as a lac, o! health ser&ices and budget
allocation especiall# in reote areas= 7Angel5Urdinola et al) >228) p*12:* It is not &er# e!!icient to ha&e
healthcare i! people are not able to e&en access it6 people "ould not "ant to see, edical care i! it
eant ha&ing to tra&el long distances especiall# i! the# are not properl# educated about it* This leads to
the ne-t issue Nicaragua needs to assess: accessibilit# to healthcare*
Nicaragua is co&ered in dense rain !orest) "hich a,es it hard !or the people li&ing in rural
&illages to access healthcare the# need especiall# i! the# li&e !ar a"a# !ro large cities* (estabili%ation
!ro the "ar also a,es it di!!icult !or people in rural &illages to go to the cities in order to attain the
edical care the# need 7Slater) 1080) p*198:*
(eolishing hospitals and other healthcare !acilities) the Contras also ,illed healthcare
personnel such as ph#sicians and nurses* <Si-t#5!i&e health !acilities) including !our large clinics and
one hospital) D"ereE reported to ha&e been copletel# or partiall# destro#ed= 7Slater) 1080) p*1F2:* The
Contras destro#ed these healthcare !acilities because it is their "a# o! rebelling against the Sandinista
go&ernent6 this ta,es a"a# one# !ro the healthcare s#ste because the# ,eep ha&ing to rebuild
those !acilities /ust to be torn do"n again*
;hile soe personnel are erel# caught in the iddle o! "ar others "ere pointed out as targets
and ,illed 7Gar!ield) 4rieden C Berund)1083:* Not onl# has the "ar cost an# li&es but it has also
cost the countr# a lot o! one#* It is hard !or the go&ernent to !und the healthcare s#ste because so
HEALTH CARE IN NICARAGUA
uch one# is going to"ard the "ar 7Slater) 1080) p*1F2:*
;ith the Sandinistas in go&ernent) di!!erent regions throughout the countr# ha&e been created6
"ithin each region there is a health post !or priar# care* Located in urban areas are edical !acilities
!or ore ad&anced treatents* Gatients "ho need hospital care go to the unicipal hospitals located in
cities) and the ost ad&anced care patients go to regional hospitals in the biggest cities ost li,el# in
$anagua or LeHn 7Slater) 1080) p*1915193:*
Although public healthcare is !ree to e&er#one) pri&ate healthcare costs one#* General
hospitals in Nicaragua do not pro&ide certain tests) such as blood tests or antibiotic sensiti&it# tests li,e
the pri&ate healthcare !acilities do* This liits rural peasants and !ar "or,ers to a!!ord tests because
the# do not a,e as uch pa#6 specialists li,e urologists and ornithologists cannot be !ound in public
health sectors but can easil# be accessible in pri&ate ones 7Slater) 1080) p*190:*
Angel5Urdinola et al 7>228: stated that) <(ue to liited access to social insurance and social
securit#) ost o! the pri&ate e-penditures on health in Nicaragua are paid out5o!5poc,et* $edicines are
b# !ar the ain health5related e-penditure) especiall# aong the poor= 7p*3:* Geographicall# it is hard
!or people to a,e trips to get to hospitals) and once the# get there an# o! the still do not ha&e the
!inancial eans to pa# !or healthcare*
Geople in rural &illages are !aced "ith t"o issues "hen it coes to accessing healthcare)
actuall# getting to a healthcare !acilit# and once the# get there ha&ing the !inancial eans to pa# !or it*
Although) the healthcare s#ste in Nicaragua is not the ost e!!icient) it is still use!ul and greatl#
appreciated* Angel5Urdinola et al 7>228: states) <Used b# 9? percent o! the population) health centers
are the ost coon t#pe o! edical !acilit# used in Nicaragua !ollo"ed b# pri&ate clinics 711
percent:) public and pri&ate hospitals 71? percent:) the INSS DNicaragua Social Securit# InstituteE 711
percent:) health posts 70 percent:) and other !acilities 78 percent:= 7p*>1:*
HEALTH CARE IN NICARAGUA
Nicaragua has coe a long "a# since the Contra ;ar and still has a long "a# to go "hen it
coes to de&eloping a healthcare s#ste coparable to those o! !irst5"orld countries* The# !irst need
to create a stable central go&ernent on "hich to build a !oundation6 this "ould eliinate guerrilla
"ar!are creating chaos throughout the countr#* @nce the# ha&e accoplished sustaining a stable
go&ernent) the# need to pro&ide good healthcare to the people* Ha&ing trust in the healthcare s#ste
a,es people ore con!ident in see,ing edical attention 7'rune et al) >220:* Ho"e&er) healthcare
!acilities "ould not be &er# success!ul i! the# "ere not &er# a&ailable to people geographicall# and
!inanciall#* Geople "ho ha&e health insurance are F1I ore li,el# to see, edical care) Angel5
Urdinola et al 7>228: also clais) <4or e&er# additional ,iloeter a"a# !ro a DhealthcareE !acilit#) the
probabilit# o! an indi&idual see,ing a consultation decreases b# 2*> percent= 7p*>?:* All these issues
Nicaragua !aces are ideal to o&ercoe) o&er tie "ith increased e-perience and ipro&eent the#
could ha&e a coparable healthcare s#ste to those o! !irst5"orld countries* I! Nicaragua does not ta,e
these atters seriousl# and a,e an e!!ort to change) their countr# "ill continue to be terrori%ed b#
guerrilla "ar!are lea&ing the to su!!er in po&ert#*
HEALTH CARE IN NICARAGUA
References
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Aareba) Laura $*) MNicaragua: 'e!ore and A!ter the Re&olutionM 7100>:* Honors Theses" Gaper
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HEALTH CARE IN NICARAGUA