Health Care – Costa Rica and Beyond

Education Plus Nicaragua Needs Help

I’m way behind on posting because we have not had good internet but this post needs to be done in any case. It isn’t about our recent activities, it is about Education Plus Nicaragua which we visited back in May last year.

I didn’t give this organization enough mention in my May 15, 2017 posting. We visited the school and talked at length with a couple of staff members and met some of the kids. The children love going there each day, if for no other reason that they get a decent meal. But most of them appreciate the supplemental education that they get as well.

I received this email today and feel compelled to post it and ask anyone who reads this to consider giving $5, $10, $25, or more one time or on an ongoing basis. I can just about count the monthly contributions that I do regularly on one hand and this is one of them.

“Dear friends and family,

Where to even begin.

Last week, political protests erupted all across Nicaragua, leaving more than 30 dead so far. Protesters are sick of what they view as their corrupt and inept government, and government forces have met peaceful protests with guns and mortars. New laws were announced increasing income taxes, higher taxes on social security payments, and decreased medical coverage. At the same time social security is almost insolvent, its funds having allegedly been used by the main political party, the Sandinistas, to purchase luxury housing and private businesses for themselves. Censorship has kicked up – news channels that are not pro-government have been shut down, and things only seem to be getting worse. “President” Daniel Ortega has announced he will be rescinding the social security reforms, but the number of protesters is still growing, with some police forces disobeying orders and joining the side of the people. Businesses in the capital are on strike today, demanding the release of political prisoners and an end to censorship and violent repression.

While the social security reforms were the main trigger of the protests, this really has been a long time coming. Several other issues have caused the protest, including the government’s inept handling of a recent natural disaster in the Indio Maiz region, and because the people are sick of a public education system that says it averages 25 children per classroom but actually averages 50 or more. Now, a common protest against non-profits such as Education Plus is: “why are you educating that children? That should be the government’s job. If you provide the education, then the government has no incentive to do their job. Therefore, you are actually contributing to the problem.”

Well, in Nicaragua, the endemic corruption is so bad that even if there were more funding for the school system, little would find its way to the children. More fundamentally, the current government does not want its people educated. University students are a main faction of the protesters. The government knows that with education comes greater awareness and a decrease in the sense of powerlessness. Uneducated people are poorer – so the government can buy their votes cheaply in election years by going around giving out sacks of food and cheap building materials to repair homes. Additionally, it is the poor and illiterate who are the easiest to manipulate. We have firsthand accounts of the police going into our community of Pantanal and paying men 200 cord (about 6 USD) to attack peaceful protesters.

This is not the e-mail I wanted to be writing. But big things are going on right now in Nicaragua, and I want to let you all know that with Education Plus, things will be business as usual as much as possible. While public schools are closed for now, our doors will be open. Our employees do not want to stay at home, in fact, they say they feel safer at Casa de los Sueños. We have arranged transportation so they can get to and from work safely. If the power is cut across the country as is rumored (in order to prevent communications of what is going on to the outside world), we will keep our doors open. We will cook with wood and teach in dark but still enthusiastic classrooms. We will remain a safe place for the children to come and be children throughout the crisis.

If we start to argue about “government responsibility”, it is the children who will lose. It falls to us who actually have the economic power to make a difference, to educate the children who will be the future leaders of their country. As Cardinal Obispo Silvio Baez recently told a gathering of university students at the Metropolitan Cathedral, “The students of Nicaragua are its moral reserve.”

To make a donation to help us continue feeding the children during the crisis, please click on the button below:

Click Here to Help us Feed the Children During the Crisis

Thank you for standing with us during these heartbreaking times.

With hope and gratitude,

Monica, Jim, the staff, volunteers and children of Education Plus

Monica Loveley
Executive Director
Education Plus Nicaragua
www.eduplusnicaragua.org
www.facebook.com/eduplusnicaragua”

Women’s Group in Ibarra

Our hostess in Ibarra was Clarita. She is French by birth and a retired nurse. She speaks Spanish quite well and of course French. Her English is about the equivalent of our Spanish…more than minimal but not great.

She and a friend of hers (Justine) who is also French decided to start a women’s group in Clarita’s neighborhood. The first meeting had 11 women (including Clarita and Justine I think) and the second had 5 plus Clarita, Justine, and myself. Although it was disappointing to have such a drop in attendance, at least 2 people were ill and one out of town.

Those who attended were probably 40’s-70’s but I’m guessing. The meeting started with some very gentle movement exercises like rotating our arms or legs while standing. We spent about 5 minutes doing this.

This night’s topic which was diabetes. Diabetes is the number one killer in Ecuador and looking at people as we walk around town, it isn’t surprising that 1 in 4 have it. (In the States it is just under 10% by one CDC statistic I saw.)

The typical diet is heavy on starch and fruit. At breakfast, our Ecuadorian neighbor made for us ($2.50 each) included Perico (scrambled eggs with finely chopped green onion and tomato), rice, French fries, or hominy, a plate of chopped apples, papaya, and bananas, a large glass of fresh juice, and hot chocolate. Every day we had to tell her to give us less food because the servings were too large.

Lunches typically are a bowl of soup, a meat (usually stewed), rice, French fries, fried plantains, and a small salad with a large glass of juice. I don’t know how different dinners are but servings are always large.

We watched a video on diabetes in Ecuador (in Spanish of course). During the discussion afterwards, the two older ladies didn’t say much but the other two had a lot of input. I could understand some of the discussion and much of the video. We also tasted a pudding type dessert made of pureed avocados, bananas, and I don’t recall what else. It was sweet and pleasant tasting. At the end of the meeting we had hot tea made of cinnamon which was very tasty. The entire meeting was 2 hours.

The fact that anyone shows up is a wonder. One of the women gets up at 3:30 every morning to make food for her family before she goes to work for 10-12 hours! The other two younger ones work as well. Not sure about the 2 older ladies but I am sure that they have to take care of their homes and cook.

I really admire what Clarita and Justine are doing. A real grassroots effort to make significant changes for the local Ecuadorians. It is a small group but if even 3 or 4 women start making changes and teach their children/grandchildren to make changes, it will have a huge impact.

The group is not solely devoted to nutrition. They are planning to plant flowers and I saw two small avocado trees that they have already planted. Clarita’s husband, Alfonso, is a forensic pathologist and is going to talk about violence in the home in an upcoming meeting. I wish the group all the best!

Medications and Pharmacies

Typical pharmacy in Latin America. A few are twice this size and rarely much larger.

In all of the countries that we have been in so far (Costa Rica, Nicaragua, Panama, Colombia, and Ecuador), the pharmacies are similar. They are usually much smaller than a 7-11 store in the USA; often you just walk a step or two from the sidewalk to a counter. They tend to have medicines in a series of deep drawers behind the counter. The staff doesn’t wear any type of name tag or badge so I don’t know if they are “pharmacists” or not. They do tend to be pretty knowledgeable and able to recommend products for colds, coughs, bug bites, etc.

In Panama, Ecuador, and I think Costa Rica and Nicaragua as well, they are called farmacias but in Colombia they are usually called drogerias.

I know in Nicaragua, I could buy generic Xanax and Ambien with no problem, and no prescription. In fact, the generic Xanax was on the top shelf of the glass counter. No limits on how much I could buy either. And very cheap, under $0.30 each if I remember correctly.

When I talked to the doctor who came to see Dan when he was under the weather in Popayan, he said that the only things that require a prescription in Colombia are antibiotics. I am glad that they require a prescription but it is amazing that you can buy anything else any time you want.

The farmacias tend to have a small selection of supplements, dental items, personal care items, etc. It will be interesting to see the differences in the future countries.

You don’t generally see items in bulk. They are usually sold by a blister pack sheet, even something as common as acetaminophen is sold by a sheet of about 10 or 12 tablets. Selection is much smaller and options different from the US. For example, if you want a cream to stop itching from mosquito bites, you can’t get a benadryl type cream. And what you can get in one country you may not be able to get in another.

I take a large dose of Vitamin D3 every day so I like to get 5,000 unit gel caps but you are lucky if you can find 2,000 units caps and if you do, they are expensive where as in the US they are pretty cheap.

Face Masks

Mouth guard worn by a few wait staff or vendors

While not really common, it is not odd to see a person on the street with a surgical mask over their mouth (seldom over their nose as well). I have tried to find out the reasons although I confess I haven’t talked directly to someone wearing the mask since I didn’t want to offend a stranger.

I’m told that the reasons for wearing the mask may vary from having a cold to avoiding the dirty air. Neither of these explain why the nose isn’t covered…they can’t all be mouth breathers. And the effectiveness of these inexpensive masks, especially as worn as they are, is probably limited, especially for air pollutants.

On a different but related subject, I see a few vendors, restaurant wait staff, or servers wearing a clear plastic guard that loops over their ears. The purpose is to avoid the person breathing on or coughing on the food. The device is fairly unobtrusive and probably has some efficacy although I would think making it a little bigger would make it much more effective.

In any case, I appreciated the business’s efforts at keeping my food safer.

This last picture (sorry I don’t have a better image) shows the cook in a local chain restaurant with a face mask, below his mouth. Maybe he is covering a goatee?

Dental Work in Colombia

Dental work in Colombia is very cheap. It is hard to get actual prices and even those could vary based on individual needs. Implants and braces are commonly advertised in the larger cities.

Even though labor is cheap here, I have seen many, many people with lower paying jobs like restaurant wait staff and store clerks with braces on so the braces must be extremely cheap. We spoke to two students when we were on the cable car who both had braces. They said that they cost 150000 Colombian pesos or about $500 for their work and that it must be paid in full up front. That is a lot of money for many people in this country so I am a bit surprised that it costs that much but it is in keeping with the odd price I have seen posted.

Looking on the internet I see mixed reviews of the dental work. Many people rave about the work while others report poor quality. I do know that the parents of the owner of my former workplace go to Guatemala to get their dental work done. They are happy with the results and spend less, including travel expenses, than they would in the US.

I tend to gravitate towards the higher end dentists because of bite issues. So while I had an excellent cleaning for $50 in Panama, I hope to not need any major work while we are traveling. I prefer to stick with my more expensive dentist who I can see whenever I am back in Durango rather than someone I only see while passing through a country.

Healthcare in Panama

Invoices from Clinic visit. Note the charge for the “consultation”, $5 to see the doctor.

We’ve had more occasion to check out the Panamanian healthcare system in our travels than we would have preferred. First Dan had allergies or a virus and saw a local doctor who was raised in the USA but got her medical training in Panama. I saw her to see if she had any different suggestions for the chronic insomnia that I have (some help).

Then last week when we went to Bocas Del Toro on the Caribbean coast I got “amoeba”. The water in Bocas is notorious but from what I can tell, the incubation period for amoeba is 1-2 weeks so I can’t blame it on Bocas. Amoeba seems to be the underlying problem causing dysentery. Gross bloody mucus stools, intense cramping. It came on quickly and I went to the Bocas clinic the next morning.

The clinic is in a large old building. Staff was professional but not overly friendly. The wait for care wasn’t long. I saw a doctor with a face mask on who asked me about symptoms and allergies. She ordered basic blood work, two IV antibiotics, and medications to take home.

It is obvious that sanitation is not a very high priority in this area. While we didn’t encounter mosquitoes in spite of some standing water in some ditches and the doctor wearing the mask, the rest was cursory. Not a single restroom was fully functioning with paper, soap, and flushing toilets. There was some combination of those things in the various restrooms but the only soap was in the treatment room.

The prep of my arm prior to the blood draw or IV insertion was a very quick swipe with a piece of cotton that had alcohol on it. It must have been adequate though.

I went home with two oral antibiotics, antacid, and probiotics. I was shocked (and grateful) that the doctor ordered the probiotics. The IV antibiotics started working within a couple of hours and I am now back to normal.

The entire cost of my test and treatment? $37 which included the medications. I would have gladly paid more to have more sanitary conditions but I know many of the locals couldn’t have afforded that.

Aside from these “adventures”, Dan has seen a skin doctor and will see her again this coming week. The office visit was $40 and the skin biopsies will be about $150 each. I plan to see a dentist locally in the next week or two for cleaning. My understanding is that the dentist himself/herself does the cleaning and that the cost is in the neighborhood of $50.

And in case you are wondering, I really have no idea how I got the amoeba. We have been really careful and use the reverse osmosis water to drink, brush our teeth, rinse many of the dishes, wash veggies/fruits. I had gotten a little lax and drank water in a restaurant in David but so did Dan and he didn’t get sick. We have gotten stricter again, just to be sure.