Recognizing the Challenges of Developing Country Medicine: La Dalia, Nicaragua


By: Jennifer Platt

 With a population of over 69,000 people spread throughout numerous mountainous villages, the communities surrounding La Dalia are considerably underserved. There are only thirteen community health centers available to provide medical care to the people in this region. At first, this number sounded like a lot to me. I thought to myself, “THIRTEEN!? WOW! That means each center can take on about 6,000 patients. While not ideal, it certainly is not unreasonable!” This perception was propagated even more when we met with the La Dalian Minister of Health who taught us about how the Nicaraguan healthcare system operated, and what services were available. Services included clinic visits, hospital stays, medications, mental health services, pediatrics, women’s health, physical therapy, imaging, etc. Everything within the healthcare system was free! I was beyond impressed. This sentiment was only furthered by a tour of the La Dalian hospital, which was clean, organized, and run by caring and competent staff.  I was hard pressed to see the flaw in the system of healthcare delivery this developing country had created for itself.  So why was it that the people of La Dalia were so underserved?

Well, when I really broke it down it was quite simple: knowledge and access. The people of La Dalia could not take advantage of the services provided through the Ministry of Health because they either did not know they were available, or they lacked the ability to access them.  The next question is, why is access such an issue?

Geographically, making the trek to and from these villages is a challenge. Not only are the roads steep and treacherous, but three out of four of the villages we visited, a mere fraction of the villages in the La Dahlia region,  were two hours away by bus. TWO HOURS!  Can you imagine how long it would take to make that journey by foot when you are healthy? Let alone sick? And what are these people supposed to do when they are pregnant, or so ill that they are practically immobile? How are they supposed to reach these services?



While I realized that there was nothing I could do to improve the geographic locations of these villages, I am proud to say that the VIMM team worked diligently to get the people of these villages into the healthcare system. How did we manage this? Well, like I said, we could not necessarily help get these people to the health care services, so, we worked out a system to get the healthcare services to them!

The VIMM team was able to create a referral system, through a partnership with the Ministry of Health, which allowed us to identify patients who had chronic conditions such as diabetes, hypertension, epilepsy, and asthma, which needed to be involved in the healthcare system. Once identified, the village location and name of that patient was passed along to the Minister of Health, who made it his personal goal to reach out to these patients, and get them into the healthcare system.  This attempted to reduce the first barrier to care: access. To address the second barrier to care, knowledge, the team was very focused on educating the communities about the services available to them, where they can go, and what they need to do to get themselves involved in the system.

As I reflect back on the work we did over those four days, I am proud of the efforts of my VIMM team. I hope that through partnering with the Ministry of Health, we were able to get some, if not all of the patients we referred into the healthcare system. Yet, above all else, I hope that the education we provided to the communities will make a lasting impression, and help the people of La Dalia take control of their own health and utilize the wonderful healthcare system available to them, so that one day, teams like ours will be no longer

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