Archive for August, 2008

A big step forward

Last Tuesday, Aug. 19, Boaco Mayor Vivian Orozco signed the papers that finalized the donation of 1 manzana (1.75 acres) of land for Clínica Verde. Mayor Orozco offered the donation last October at our annual meeting of the board in Nicaragua, and we had been persistently navigating the challenge of obtaining title since then, so this was a day of celebration. We had a board meeting in California that night, and toasted this big step forward. 

By Wednesday morning, our project manager in Nicaragua Johny Siman had already contacted engineers to do soil and water absorption tests and met with a local architect. We have a great team working on this, and are ready to get down to work!

We’re so grateful to Mayor Orozco for his generous donation and for supporting our efforts to bring a sustainable health clinic to families in need to this region of the country.

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Introducing Dr. Incer …

 

From left, Boaco Mayor Vivian Orozco, former Minister of Health Margarita Gurdian, Dr. Armando Incer and Rafael Rios.

From left, Boaco Mayor Vivian Orozco, former Minister of Health Margarita Gurdián, Dr. Armando Incer and Rafael Rios.

 

The photo above is from October of 2007, when we held the first annual meeting of the board of directors of  Clínica Verde in Managua, Nicaragua. Third from the left is Dr. Armando Incer, one of our advisors and a key person to the development of our clinic in the community of Boaco. Below, a brief introduction to Dr. Incer:

Tell me about your family and your history in Boaco as physicans.

My family’s roots are in (the city of) Boaco. In Nicaragua, the surname Incer is connected with this city.

My parents have been key to the development of the city, and from them I’ve learned the good things that I hold dear. I learned the importance of believing in God, the importance of family, love of work, the value of integrity. They taught me to love Boaco, and the importance of giving your best to reach your goals.

My father was the first doctor from Boaco to graduate in Nicaragua. He was the family doctor for Boaco families in the ‘60s and ‘70s. Last year he celebrated 50 years of working in this capacity.

My mother is the great woman who has stood behind my father and behind every one of her children.

 What is your vision for Clínica Verde?

I see a modern clinic where rural women and their children can come for health and smiles, being attended by qualified professionals who understand the importance of these patients receiving free, high quality service that allows all users to leave with the certainty that Clínica Verde has provided hope that tomorrow will be a better day.

*  *  *

Habla un poco de tu familia y su historia médica en Boaco.

Las raices de mi familia estan en Boaco. En Nicaragua el apellido Incer se relaciona con esta ciudad.

Mis padres han sido personas claves en el desarrollo de la ciudad. De ellos aprendí las cosas buenas que tengo. Aprendí la importancia de creer en Dios, la importancia de una familia, el amor al trabajo, el valor de la honradez. Me enseñaron a querer a Boaco, y la importancia de dar lo mejor para alcanzar las metas.

Mi padre fue el primer médico Boaqueño graduado en Nicaragua, fue el médico de cabecera de las familias boaqueñas en las decadas del 60 y 70, y el proximo año cumplira 50 años de ejercer esta profesión.

Mi madre ha sido la Gran Mujer que ha estado detrás de mi padre y detrás de cada uno de sus hijos.

Cual es tu visión de Clínica Verde?

Yo imagino una clínica moderna, a la que llegan mujeres campesinas y sus niños en busca de salud y sonrisas, siendo atendidos por personal calificado que sabe la importancia que tiene para sus pacientes recibir servicios gratuitos, pero de calidad que permiten que al final de la jornada todos los usuarios se despidan con la seguridad de que La Clínica Verde les ha dado la esperanza de que desde ya tienen un mañana mejor.

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Why Nicaragua?

People often ask us, “Why Nicaragua?” The answer to that, in truth, begins in the 1970’s. My grandfather, a journalist, traveled to Nicaragua with my grandmother and became friends with members of the press in that country during the Somoza dictatorship, when newspapers were routinely censored and journalists often lived under the threat of death. As chairman of the Freedom of Information Committee of the Inter-American Press Association (and, later, its president), my grandpa worked throughout Latin America to advocate for and uphold the values of a free press. I grew up hearing about these stories as the background to Sunday meals, with copies of Spanish-language newspapers common in my grandparents’ home in small-town Ohio.

My first job out of college was at the Tico Times in San Jose, Costa Rica, an English-language newspaper operated by the wonderful Dyer Family – Richard, and his daughter Dery (who still runs the paper today). During that post-college year, I traveled to Nicaragua for the 1990 presidential election between Daniel Ortega (Nicaragua’s current president) and Violeta Chamorro. Those few days I spent in Nicaragua left a powerful impression on me.

Some 15 years later, my husband and I, now living in California, met Jake Scheideman, the owner of a bike shop in our town who was involved in humanitarian work in the village of Empalme de Boaco, Nicaragua. Jake and his group had – and has – accomplished great things. What began with the dream of creating a baseball field for this dusty, impoverished town, led to the construction of 60 homes for low-income families, a high school, and now a community program for jobs and long-term sustainability. We met Jake and said, “Take us with you.”

That meeting took me further down the road that led to Clínica Verde. After my husband Tim, a physician, and I traveled with Jake’s group we decided to lead efforts to help the local hospital in Boaco. With the generous support of the Adventist Development and Relief Agency – and donations from friends and family – in November of 2006 we delivered a shipping container of medical equipment and supplies valued at over $500,000 to the hospital in Boaco.

      

 

 

 

 

 

 

 

 

 

We felt good about helping out (and sent another container the following year), but that experience also led us to believe that we could – and should – do more. We realized that sending equipment and medications, while helpful, would never lead to systemic change in that community. If we truly wanted to change lives, we would have to be willing to make a deeper commitment. So we enlisted the help of the Minister of Health, who connected us to key people working in the field of health in Boaco, put together a bi-national board of people qualified to get a big idea off the ground, and founded Clínica Verde.

Our vision is for a clinic that is not only environmentally – but socially – sustainable. It will be operated and managed by Nicaraguan health care workers with oversight by our American doctors and board of directors. We will provide not just outpatient clinical care for families in need, but also education on nutrition, general health and hygiene, and economic agency. You can check out digital images, floor plans and elevations on the Vision page of our web site.

In all of this, we’re grateful for the work of Jake Scheideman and his group, Developing Communities, for introducing us to the department of Boaco and showing by example that big ideas can be accomplished. We’re especially thankful for getting to know Peter Stanley, the man responsible for overseeing the construction of the homes and school for Developing Communities in Nicaragua. Peter is now Vice Chairman of Clínica Verde and key to our success.

So, why Nicaragua? Our lives led us to this path, but there is clearly a great need. Nicaragua is the second poorest nation in the Western Hemisphere. It has one of the highest rates of adolescent fertility in Latin America, with almost half of all pregnancies occurring in women between the ages of 15 and 19. One in 5 children is chronically malnourished; in rural areas, that number is often 50% higher. Diarrhea and upper respiratory infections are the two most prevalent diseases in children under 5, linked to low access to safe water. In the department of Boaco and Matagalpa, where Clinica Verde will serve, there are more than 85,000 women of fertile age and more than 73,000 children age 5 and under. We think we’re starting in the right place.

               

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Funding Models

Anyone who’s even marginally involved with nonprofit work knows that an extraordinary amount of time and effort goes into fund-raising. Meeting and cultivating prospective donors, researching and approaching foundations, mobilizing friends and family and, of course, trying to figure out how to best employ social networking with the advent of Web 2.0. As a start-up, this reality especially applies. The funders we approach are more akin to venture capitalists – people who are willing to take a chance on an untested idea because they believe in the vision and thinking behind its model of success.

I love people like this not just because they’re willing to invest in Clínica Verde, but because they tend to be creative, bold in their thinking, and ambitious in their commitment to social change. They’re interesting, fun to be around and – a big bonus for me – generous with their time and experience. They also understand that sustainability in the nonprofit world no longer rests on the capacity to generate financial capital through tireless fund-raising. Make no mistake, we have an urgent need to raise funds to construct our clinic prototype and prepare for operation, but long-term our goals include a funding model with additional streams of income.

One of the most successful models in the field of healthcare is Aravind in India. Founded in 1976 by a physician who decided he wanted to end needless blindness, Aravind’s eye care system is now touted as the largest and most productive facility of its kind in the world. It is also financially self-sustaining. Aravind practices what is referred to as “compassionate capitalism,” essentially a tiered system in which those who can afford to pay do while the very poor receive free care. All clinical care maintains the same high standard of quality. In practice, Aravind says that it supports two-thirds of its patients, while the remaining third in effect subsidizes that care. The money generated covers operating costs in addition to financing expansion. In May, Nobel Peace Prize laureate Muhammad Yunus opened the first Grameen eye hospital in Bangladesh modeled after Aravind’s system.

As Aravind Executive Director Thulasiraj Ravilla tells the story, it was a failure of fund-raising that actually forced Aravind to become sustainable. Concluding that donors were giving more out of “pity than passion,” Aravind’s founders sought an alternate route. Through a combination of what is described as “innovation plus standardization” Aravind developed a model in which much of the care is performed by specially-trained students who support the clinics’ physicians – 4 to 5 trained students per doctor. These specialized workers receive a much lower salary than the physicians. Physicians, meanwhile, are able to focus on their unique capacities – performing surgeries, for example.

Aravind’s high efficiency fuels their margin.  They report that while most private practitioners will perform 20 to 30 procedures per month, Aravind performs 20-30 per day. All while maintaining a reputation for top-notch care. 

You can hear it from Thulasiraj himself in a podcast from Social Innovation Conversations, produced by the Center for Social Innovation at the Stanford School for Business. By the way, Social Innovation Conversations is a really great series that highlights the work of people on the forefront of creating social and environmental change around the world. 

We at Clínica Verde are exploring how we might apply such a model to our clinic prototype in Nicaragua, while remaining true to our goal of serving the poorest of the poor. Sustainability is one of our core values, and it extends to every aspect of our project.

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