Healthcare for Pregnant Women in Nicaragua

At Clinica Verde, we’re lucky to have talented professionals and students serve in internship positions. Below, a couple of posts by current intern Adrienne Clermont, a research associate at John Hopkins Bloomberg School of Public Health.

As a public health professional who is getting ready to change careers and start medical school next year, I wanted to gain some clinical experience and learn more about the practice of being a doctor. Because my specialty is international health, I wanted my first clinical experience to be in a developing country – and I could think of no better place than Clinica Verde to see how holistic primary and preventive care can be done well in a very low-income setting. I am excited to be here for three weeks and to share some of my experiences here in writing!

Working as a public health researcher dealing with maternal and child health in low-income countries, I’m familiar with the major challenges faced by Nicaragua and other similar countries. However, my work has always been done from afar – reviewing spreadsheets of data on my computer in the U.S., or holding training workshops in the capital cities of various countries. Spending time in Boaco with the staff of Clinica Verde has brought many of these issues to life in front of my eyes. Rather than analyzing statistics on Nicaragua’s fertility, mortality, and morbidity rates, I’ve had the chance to see pregnant women and families with children who come to the clinic for care. Rather than reading research studies on the effectiveness of antenatal care visits in reducing pregnancy complications, I’ve had a chance to sit in on those visits while shadowing the clinic’s gynecologist.

Clinica Verde’s staff have been helpful and welcoming, and seeing the work of the doctors, nurses, and administrators here has me very excited about the path I am about to start down in training to become a medical professional. I look forward to learning more over the next two weeks of my time here!

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The past couple months have been busy ones at Clinica Verde, so we thought we'd share brief highlights from our Executive Director in Nicaragua Yolanda Paredes-Gaitan. We invite you to reach out to us with questions and ideas. We love to hear from you!

• Our partnership continues to develop with the Ministry of Health of Nicaragua to redesign two of their health posts (puestos de salud) and train government staff in sustainable design and our compassionate care approach. We're currently dealing with infrastructure challenges in the rural sites. The local engineers in Boaco have been very helpful and quick to respond! Our architects at Amanda Martocchio Architects have created a thoughtful and exciting plan that we can't wait to share with you as we move forward.

• Our Teen Program at Clinica Verde continues to be a vital center. We had a training workshop for 21 teen peer counselors, conducted a "restorative circle" with the group to empower them in their commitment to the role they play among their peers, and did four talks on topics related to sexual and reproductive health. The group also went hiking together :)

• We continue to develop our work to provide occupational health services to regional businesses in the department of Boaco, which serves a critical need in the area while promising to strengthen our financial sustainability.

• The non-profit Hopeful Ways has agreed to sponsor cataract surgery for 8 of our seniors at the local nursing home where we provide service. Great news!

We'll continue to share news with you – the people who make this work possible.

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We'd also like to share with you our Annual Report from our Founder and Co-Chair at our Annual Meeting of the Board in Granada, Nicaragua – held on Feb. 4, 2017. You are always there with us in our minds :)

Co-Chair Report

I’d like to welcome all of you to the 11th Annual Meeting of the Board of Directors of Clinica Verde. (Thanks for traveling here and taking time from work/family.) As we enter this year, we celebrate 10 years since our founding – 10 years that have shaped the lives of so many people, each of you, and me personally.

In past years, I’ve presented Chair and CEO Reports that detailed the progress and challenges of the prior year. I’m going to narrow my report somewhat this year, as we continue to look to our leadership in Nicaragua to provide insights and updates on the very important work they do on the ground to bring our shared vision to life.

But first, I’m happy to share some highlights that should make each of you very proud:

• Since opening our doors in 2012, we’ve served more than 60,000 patients, providing health education to more than 10,000 community members.

• In the past year, we’ve seen the growth and promise of 2 of our cornerstone programs: Our Prenatal Nutrition Groups and our Teen Program, in which we train teen peer counselors in reproductive health. These programs show promise of truly transforming the health and wellbeing of our patients through education that promotes behavior change. We expect to see continued growth and strengthening of these efforts in the year to come.

• We’ve fortified our partnerships with key organizations in biointensive gardening, leading to the establishment of Clinica Verde as a regional training center for students in both Nicaragua and the U.S.

• We gained our certification as a Health & Hygiene clinic, becoming the only entity in the region certified by the government to provide occupational health services. This position promises to further support our path to financial sustainability.

• We developed our optometry services in partnership with FCO (Fundacion Para el Cuido del Ojo), providing much-needed care both in-clinic and to rural patients during community health visits.

• Through the contribution of some of these efforts, we increased earned revenue at Clinica Verde by 55% year-to-date. We expect to see this trend grow even more robust in the coming year, as we cultivate business clients for health and hygiene services.

• And, the development that we’re all excited about: We realized the goal set at last year’s annual meeting to establish a partnership with the government of Nicaragua and the Ministry of Health in order to begin to fulfill the vision of scale that guided our team from its earliest beginnings.

This is an exciting and very significant undertaking, and the direct investment of the Nicaraguan government in this project makes us elite among the tens of thousands of NGO’s operating in the world today. We have world-class architects designing our puesto prototype, which you’ll see later this morning, and in the coming years we hope to make our case for a low-cost, sustainable solution to rural care that is grounded in human-centered design, education, compassion, and community involvement.

I’m so honored to be a part of this great achievement with each of you.

Why do this? Why do we want to scale? I ask myself this question frequently, to test both my head and my heart. We want to scale because we continue to hold the belief that families living in poverty need and deserve a better model of healthcare – one that provides compassionate, loving care and health education; that brings dignity and empowerment to the people we have the privilege of serving. We want to scale because it was never our goal to simply build a clinic and provide care for the needy – we sought to transform a community healthcare system that we believed was failing those most in need. We want to scale because we know that what we offer is better than what any of our patients knew before coming to Clinica Verde. We want to scale because our mission to create a new model of care continues to be compelling and urgent.

In our 2008 Business Plan, we set out our vision in these words: “Clínica Verde is founded on the principle that good health should start from the ground up, beginning with sustainable building practices that take a holistic approach to the environment, community and life quality of those served. Clínica Verde’s programs focus on maternal and infant healthcare, including family planning, prenatal care, and education on issues of health, nutrition and spiritual well-being.” Despite the shifts we’ve taken along the way, we’ve held true to that founding vision and this principle: That the impoverished deserve care that’s equal to that of the wealthy, and that responsible design, environment, education and compassion improve well-being, while contributing to a sense of hope and possibility.

In our original Business Plan, we set the goal of finding a way to cover 25% of our costs through earned income. We have exceeded that goal. This year we also reversed the trend of serving a declining number of patients by increasing the number and frequency of rural health visits that our team performs. In addition to helping us expand our impact, this has deepened our understanding of the work ahead redesigning rural health posts and serving our patients in the communities where they live.

Each year since opening Clinica Verde, I’ve put forward 3 goals for the organization. Each year, one of the goals has remained the same: Developing and maintaining our Organizational Culture. It is the essence of our success, and the commitment and passion from our Nicaraguan team on the ground will continue to be the most critical factor in the realization of our vision. You – Rafael, Yolanda, David and Mary – are the leaders of this new model of care. You, who we respect and admire so much, carry the torch, as we provide support and guidance in this very worthy and inspiring cause.

Goal #2 for 2016 was to Increase Financial Sustainability through growth in earned revenue and fundraising. We showed significant growth in earned revenue, but modest growth in fundraising – which continues to be, as it has from day 1, a challenge. This year, we raised $55,000 more in philanthropic dollars than we did in 2015, with the growth coming largely from individual donors.

Goal #3 was to Enhance our Reputation as a Center for Excellence in care and education, which we accomplished through our biointensive training partnership – but we also have much more work to do in this area as we develop a curriculum for training community health workers in our cornerstone programs and approach to care.

As ever, we move forward.

In June of 2015, I said I would be stepping down as CEO in a year. As all of you know, I’m no longer CEO and we’ve started the transition in leadership that I believe will enhance our long-term sustainability as we concentrate more power and authority here in Nicaragua among the people who serve and are served by our shared vision.

It’s not a transition without its challenges. But nearly everything we’ve done has included extraordinary challenges along the way. This has never deterred us, and I trust that our culture of perseverance, courage, steadiness, and creativity will continue to fuel our leaders when we face the challenges of the future.

I’ve devoted the past 10 years of my life to bringing Clinica Verde to life, expecting my family – and some of you – to make big sacrifices right along with me, as I remained fixed on the belief that we would succeed in creating a new and better model for the poorest of the poor.

I am proud of what we’ve created together, and I am proud of the board members and team that have devoted their talents and passion to our shared cause. But it will bring me even greater pride and satisfaction to see the work continue, one day, without me. This has always been a central preoccupation. That we create something so purposeful and inspired together that it lives and prospers far beyond each of us. Because Clinica Verde has never been about me. It’s been about the vision of service and care for the poorest of the poor – a vision that should resonate with those fighting for social equity and the common good everywhere. A vision with a rallying cry as powerful as any in health.

We have a lot of hard work ahead of us. It’s exciting and important work, that I have no doubt we – you – can carry out.

I like to remind people that 9 out of 10 startups fail. Only 10% make it 10 years. We have learned an enormous amount over the course of these years, and we have tried many things along the path to success – some enlightened, some that now appear like spectacular diversions, at best. But throughout the process we succeeded because we supported each other, remained adaptable to change, and never gave up on our vision of health and hope.

At this year’s meeting we’ll continue to plot our course for moving forward, establishing a 3-year strategy for success to guide and animate our organization and our partners. I look forward to serving in 2017 as your Co-Chair with the ever-wonderful and supremely competent Nikhil Bumb.

More than 10 years ago, we imagined a place where the poor would want to go for their health, a place that conferred dignity and love on each individual who entered, where teenage girls could imagine their worth beyond their youth and sex, where vulnerable mothers could find comfort and care, where families would know, beyond a doubt, that they matter. That no amount of poverty or disadvantage should ever serve as a barrier to their dreams of a better future.

Each of you has been a part of this vision that has already touched so many lives – and will touch lives for years to come. I continue to be full of heart and passion for the future of Clinica Verde.

Thank you.