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PROMOTING SUSTAINABILITY THROUGH COLLABORATIONWorking for passion: Finding purpose in Nicaragua
by Margie Fincham David Corbett (2006), author of Portfolio Life: The New Path to Work, Purpose, and Passion After 50, advises, “Work for pay or passion, but on your own terms.” Nursing is the major component of my life portfolio, and my latest passionate entry in that portfolio is working as volunteer healthcare manager for Roberto Clemente Rancho Santana Clinic Inc. in Limón, Tola, Rivas, Nicaragua. Roberto Clemente, a baseball Hall of Famer who played for the Pittsburgh Pirates, died in a 1972 plane crash while flying relief supplies to Nicaraguan earthquake victims. Rancho Santana is an oceanfront development that attracts surfers, retirees and other expatriates from all over the world to enjoy the country’s gorgeous tropical Pacific Coast. The clinic, which provides the services of a full-time doctor, nurse and pharmacy, was inspired by the need for primary health care for Rancho Santana employees and their families. Located on land donated by Rancho Santana, the clinic was constructed with funds from the Rotary Club of Pittsburgh, Pennsylvania, USA. Although the clinic is available to expatriates who require health care, its primary purpose is to provide free and low-cost medical care to residents of the isolated villages of the Tola, Rivas, area in southwest Nicaragua. I have been a nurse for 47 years. I began my career as a graduate of the second diploma class at Barnes Hospital in St. Louis, Missouri, USA. In 1990, after my husband’s death, I checked my life portfolio and took a big plunge by applying to graduate school in the distance-learning program at California State University, Dominguez Hills. Inch by inch, I completed an MSN degree in 1998 and earned a Gerontology Clinical Nurse Specialist certificate. Rural nursing has been a large part of my career. It involves all aspects of nursing—hospital, clinic and home care practice—and I participated in the entire spectrum of that care, from birth to death. Perhaps that is what first drew me to volunteer as a nurse at the Roberto Clemente Rancho Santana Clinic in 2005, shortly after it opened. I hadn’t planned to become involved in a nursing role. In 2004, I was solicited to be a founding donor, to help fund construction of the clinic facility. One of my co-workers at the time was from Nicaragua. Her parents and many family members still live there. Each time we talked about her country, my interest grew. After doing some research, I learned that, since 1989, U.S. nurses have been instrumental in founding and supporting various clinics in the country. I also discovered on the clinic’s Web site—http://www.nicaclinic.org/ —that they needed clinical volunteers, and I took another plunge. In May 2005, I left for Managua, Nicaragua, my two suitcases filled with supplies donated by nurse friends. I also brought a light box for X-rays and a four-wheeled walker that had been donated for my friend’s mom in Nicaragua. Airline personnel are very helpful to nurses who carry humanitarian supplies to less-developed countries. Republic of Nicaragua Customs was more of a challenge, as I didn’t have the requisite papers from the Ministry of Health (MINSA). After getting past that hurdle, I departed Managua the next day for Rancho Santana. After a three-hour trip, I arrived at the development’s clubhouse, my home for the next three weeks. The clubhouse is on the Pacific Ocean, less than three miles from the clinic. I had expected to walk to the clinic, but my driver laughed when I told him that. Although the distance isn’t far, it would be similar to hiking up and down the highest hills in San Francisco on dirt roads. Nicaragua is the third poorest country in the Western Hemisphere; Haiti and Jamaica are the first two. The village of Limón is south of Managua in the region of Rivas (analogous to a U.S. state) in the department of Tola (analogous to a U.S. county). Clinic patients from the city of Tola must travel over a dirt road the last 15 miles of their trip. With two creek crossings, the road is frequently impassable following heavy rain. Transportation for the 46 villages served by the clinic is via foot, bicycle, horse or ox cart, four-wheel-drive vehicle, or a Tika bus that traverses the road from Rivas once a day in each direction. During Nicaragua’s rainy winter season—May to November—the muddy roads have ruts up to a car’s axle, and during the summer—the rest of the year—it seems you could lose your car in an unseen pothole if traveling too fast. Needless to say, respiratory illness is rampant, with dust from dirt roads and local farm fields a major cause of disease. My first day at the clinic was my second day in the country. Unfortunately, I was not very fluent in Spanish at that time. Although communicating was challenging at first, physician Julio Flores and nurse Martha “Marta” Cerda Miranda, together with administrative and farmácia workers, welcomed me with hugs and kisses, even before I opened the suitcases containing supplies. During my first visit to Nicaragua, clinic hours were 7:30 a.m. to 5 p.m. Each day, Flores and Miranda commute via bus to and from Rivas—a one- to two-hour trip each way. From the very beginning, I worked alongside Flores as he saw patients in his office, the consultorio. I took blood pressures; did auscultation of heart, lungs and abdomen; assessed skin lesions; and performed wound care. Thanks to nurse friends at Kaiser Permanente in the United States, we had some gel wound-care supplies for a primiparous C-section patient with an infected wound from her surgery in a Rivas hospital. She was 95 percent healed by the time I left Nicaragua. Flores and the clinic staff are employees of the clinic foundation, located in Baltimore, Maryland, USA. As an employee, Flores felt he couldn’t voice concerns about the condition of the new facility. However, as a founding donor and clinician, I spoke out. The windows and roof leaked, and water covered the floors in a hard rain. The only shelves were in the farmácia, and there was no organization of medications. Wires hung from ceilings and there were no fans. Without air circulation, I couldn’t stand the heat, so I spoke to the building contractor and purchased fans to install in all the rooms before I left. I also began soliciting money from landowners at the Rancho Santana development for storage cabinets and additional shelving. After one week at the clinic, I knew it was the passion for which I had been searching. During each visit—at six-month intervals—Flores and I set goals for making additional improvements to the facility and to organizational and clinical procedures. We now have two electric sterilizers, a washing machine, a new electrocardiogram (EKG) machine and, most recently, a new automatic external defibrillator (AED) that I obtained with a donation. On one visit last year, the power in Nicaragua was out for four to 24 hours almost every day. When there is no power, there is no water. I initiated fund raising for an aboveground water tank that was proudly displayed at my most recent visit. My current facility project is an alternative-energy, battery-backup system to provide consistent power for clinic hours, now extended from 7:30 a.m. to 10:30 p.m. This year, the foundation took a leap of faith and hired a Nicaraguan administrator with nonprofit experience. The directors also decided to hire me as healthcare manager. My responsibilities include raising funds, soliciting supplies and managing requests from other volunteers and supply donors. As payment, the foundation pays my transportation to and from Nicaragua. The administrator recently applied for and received not-for-profit status for the clinic from the government, enabling us to acquire supplies from the American Nicaragua Foundation without taxation or duty and also to request Nicaraguan donations. The clinic needs an additional building to house a laboratory and provide rooms for minor surgery, dental practice and optometry. Many patients need dental and optometry service, and volunteer organizations could provide services on a regular basis if there was enough room to store equipment and facilitate procedures. Currently, because of insufficient space, the clinic cannot accept donations of used equipment from hospitals or other organizations. After two trips, I learned that the clinic is unable to use 50 percent of the supplies that are generously donated, as equipment usually cannot be repaired in Nicaragua and batteries are not readily available. Disposable items that rotate quickly are always needed. The farmácia has two areas of need: purchased drugs and donated drugs. Patients who work pay for their medications. Children, elders and nonworking individuals receive donated drugs. Medications cannot be accepted if past their expiration date. Nicaraguan people are kind, clean, caring individuals. They exhibit patience and bravery and are grateful for every aspect of health care given them. I could tell stories for hours about some of the trauma cases seen and treated at the clinic. Or I could talk about the baby born outside the clinic after hours. The villagers sent for me to help. This was the second of four births at the clinic; the other three moms had made it inside the building during clinic hours. There have also been two stillborns, to moms without previous health care from the clinic or the local midwife. My life portfolio grows daily as I think about ways I can contribute to the Roberto Clemente Rancho Santana Clinic. Primary care in a developing country is rare. I am privileged to be a part of a rural primary health care project in one of those countries, and I am grateful for the advanced professional training and experiences that led me to this part of my life. Solo el amor prevalece—only love prevails. RNL For more information or to make a donation to Roberto Clemente Rancho Santana Clinic Inc., visit http://www.nicaclinic.org/. When making a donation, please indicate that you learned about the clinic through this article in Reflections on Nursing Leadership.—Margie Fincham, RN, MSN, GCNS, a resident of West Sacramento, California, USA, is healthcare manager for Roberto Clemente Rancho Santana Clinic, Inc. in Limón, Tola, Rivas, Nicaragua. Reference |
