Nicaragua 2009: Ups and Downs.. July 9, 2009
Posted by jennie on July 9th, 2009
Hello everyone!
In the last few weeks, I’ve really gotten a taste for Nicaraguan Bureaucracy. We have hit some roadblocks, which we are hoping are temporary, along the way to getting the clinic up and running! We had two meetings last week, one with MINSA (Health Ministry) in Rivas (the municipality) and the other with the big guns at MINSA in Managua.
In Rivas we met with Dr. Venegas, whose first words to us were “No somos conejitos de indio”.. In English the equivalent phrase would be “We are not guinea pigs”.. Ah, nice way to start out. So, though we are proposing a center which would primarily be used for prevention activities including education on diet and exercise, we spent a good deal of energy trying to convince the good Dr. that we were not planning on carrying out any crude medical experimentation on the locals. There is, understandably, suspicion against Gringos, who, let’s face it, don’t have the best record in Latin America, but at the same, some of the claims he made were just ridiculous (e.g. there was a clinic here run by Americans, where they were selling medications to the Nicas to “try to get rich”; the people running the clinic apparently made over $25,000.00 doing this activity). First, you gotta sell a lot of medications here to make that kind of money, and second, as if rich Americans would leave high paying jobs at home, come to Nica to fight with the bureaucracy to build a clinic, pay to have the clinic built, so that in the end they could take in a whopping 25K!!! Needless to say our meeting with MINSA in Rivas was more than a bit demoralizing.
Instead of Dr. Venegas approving our center at that meeting (as was in his power to do) he made us an appointment to go to Managua the next morning and meet with HIS boss, Dr. Juana Ortega. More hoops to jump through!! We left the farm at 7am to make it to our meeting in the capital. We had a ’strategy’ meeting in the car on the drive, to organize how we would introduce the project, who would say what, etc. in an attempt to remedy any mistakes made in previous meetings. The head of MINSA Managua, Dr. Ortega, was a very kind and professional woman, who seemed to “get” our program and appreciate that its goal is to be a complement to the (however lacking) medical services that exist here, to use education and support to help improve the health of the local people, not to sell drugs or do medical experimentation. Just when we thought we had finally made some headway, another doctor (Dr. Ortega’s pit bull of a sub director) started ripping apart our plan (which she hadn’t read until that moment despite the fact we’d sent it to her the week prior) and asking us questions about minutia (challenging us as to whether each exam room is to exact building standards is just one example - which is completely ridiculous when you consider the quality of buildings in the area). We left the meeting with more hoops we had to jump through (complete list of required equipment for the center, make some small adjustments to make our plan more clear on certain points, etc.) and a promise that once we have the center completed, we can call for a building inspection.(Oh, but it might “take a year after the inspection to get approved”)
It is quite clear from our experiences here that the gov’t will do whatever it can to slow or halt the process of getting things done. Everything is made more difficult than it has to be; from getting permits, to having an inspection, to sending documents to the right people. Every time you fulfill one requirement they inform you of another one, which you were unaware of before. I know I sound jaded, but it is very frustrating and sad to know that all these blockades are thrown up in the way of people who truly want to help the health situation here. There is such a lack of resources it is baffling as to why the bureaucrats would not want to accept all the help they can get. I believe it is due to a mix of distrust and pride, but it seems senseless nonetheless and the local people suffer.
Unfortunately, the bureaucratic hurdles were not are only setbacks last week. Our doctor, Carmen, who we all love, left for the weekend in Managua, and then abruptly called us to quit. It was not totally unexpected, because we were aware of worsening family issues. Unfortunately, her husband could not accept her working so far from Managua and was becoming increasingly depressed, controlling and threatening.(never mind that he doesn’t have a job and they have 2 kids to feed.. but don’t get me started on the status of Machismo here in Nicaragua). It was very hard for us to see her go since she is a very good doctor and was very committed to the project here. Fortunately, after the abrupt phone conversation, she was able to bring her 2 boys to the finca for lunch this week so we were able to have a proper goodbye!
On a happier note — we had a BBQ on the 4th of July. The party was at Chris’s house (the owner of the finca) and was complete with hamburgers, hotdogs, brownies, beer, and fireworks!! One of the other homeowners here was at the party with his family, including 2 young kids. It was very fun to play in the pool with them and watch the fireflies after sunset.
This week, Alden and I continued to work on education materials development and curriculum development for the group classes that they hope to hold at the center. I really hope that they make it through the certification process so that all this work we’ve done can be of some use! 
But, regardless, It’s been a good learning experience for me and I think my time here has been appreciated by Alden and Federico.
This is my last official week of “work” here with the program. I start 3 days of surf lessons on Sunday, which I am very excited about! Coby, one of my classmates who will be working on a project here as well, arrives Sunday too! I am really looking forward to seeing her and having a girlfriend here. After surfing, I’m hoping to do some horseback riding around the finca, and then spend my last few days relaxing by the pool 
before heading home on 7/20.
List of books I’ve read since arriving here 4 weeks ago:
Nicaragua (a history book)
The Country Under my Skin - Gioconda Bello
Pride and Prejudice - Austen
Saturday - Ian McEwan
The Namesake - Jhumpa Lahiri
The Road -Cormac McCarthy
A Quaker Book of Wisdom
A Tree Grows in Brooklyn - Mary Smith
Geez, I’ve certainly made up for not having time to read during the school year!!!!! No homework at night— yippee!
I hope this post finds you all well. I’m looking forward to my last week here and then looking forward to Summer in Seattle!!
xo.
jennie