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The Education of Development: Experiences on the Ground in Boaco

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Daniel Olivieri, center, at Clinica Verde.

By Daniel Olivieri

Last Saturday, I was talking to an incoming freshman at Texas Christian University who wanted to know what I was doing in Nicaragua and how I got here.

More importantly, she asked me why I was “in Boaco, of all places”?

I couldn’t help but smile.

To me, Boaco is where everything is happening. Granted, there aren’t any volcanoes nearby. We don’t really have many tourist attractions, and the WiFi connection is spotty at best. What we do have are individuals. We have a community, and I’ve never felt so strongly about that before.

Through interviews and surveys, we’ve seen a smattering of responses: from the disparagingly negative to the cautiously optimistic. As you might have guessed, a country plagued by mosquito-borne illnesses, unclean drinking water, and utility usage rations will expose quite a few niches of care. There are problems with lack of medication. The hospital does struggle to obtain the specialists they need, and, yes, doctors often leave for the more lucrative private sector.

What you might not’ve guessed is that even a city in the middle of Nicaragua is filled with blistering ideas. They have individuals who have solved problems of trust, development, and recidivism in ways I couldn’t have even imagined. And there’s a clinic here that keeps innovating, day in and day out.

I’ve heard locals champion the role that religious actors could possibly play in public health measures. We’ve also heard that the local public health clinic fails to tackle the systemic problems that are really hurting Boaco, such as clean water and sanitation. We’ve also seen people come from over five hours away, and others who couldn’t make it that far due to rain, lack of transportation, or money.

I’d be remiss if I didn’t say that the clinic still faces many of the same problems of any other clinic in Nicaragua. They sometimes struggle with obtaining the newest medication, the best equipment, or operating at a social-cost. They also really can’t do anything with the seeming dearth of meaningful public health efforts by the Government.

But like an innovative clinic, they will press on. Because this is a fight worth fighting for.

Because Boaco counts on them. And they know it.

When I first arrived at Clinica Verde, I heard about the team of individuals that came from all over Nicaragua, and that people were “drawn to the vision,” as the general manager once told me. I shrugged thinking that a vision couldn’t really be a tool, or at least not a significant one.

After all, the clinic had other, more obvious tools; to start, the physical design of the clinic is very impressive, to say the least. When you walk in, you are greeted by an illuminating color scheme that is bright, optimistic, and hopeful. The color changes, darkening, almost as if it were focusing, so that when you walk into the patient room, you’re confident that the clinic can provide the kind of care that the community boasts about.

While we might call them simple things, things like the color, design, and structure of the physical building of Clinica Verde play a major role, I believe, in gaining the trust of the community.

From charlas to a revamped consejeria, Clinica Verde presses on.

Weekly visits to more rural communities surrounding Boaco (some over 2 hours away) build trust with key decision makers in those barrios, who coordinate the free visits, which occur usually in churches, and encourage their parishioners to come. All slowly builds that trust.

Any strategy for tackling recidivism and ownership in development needs to tackle the problem by looking at the scope of the community, and it’s easy to see that Clinica Verde thrives wholeheartedly on an underachieving public health system by earning the trust of the community in varying small but significant, profound ways.

Then you arrive at the clinic.

And then you realize that vision is foundation for the clinic.

Just as one’s comportment plays an immense role in gaining the trust of the community, the fundamental design of your organization and clinic frames the way the clinic runs from the inside out.

People gravitate towards visions that are resolute, optimistic, and focused; that is why people gravitate towards Clinica Verde.

By being different, Clinica Verde challenges the negative perception of public health in Boaco to lay a foundation for healthcare tenets of efficacy and ownership.

And isn’t that why we’re here in the first place?

Author’s Note: Daniel Olivieri is an undergraduate researcher from the University of Notre Dame in Notre Dame, IN, and was awarded a Kellogg Institute Fellowship to work with Clinica Verde this summer in Boaco, Nicaragua. Daniel has completed research projects in Havana, Cuba, and Rocinha, a favela of Rio de Janeiro, Brazil, and aspires to work in improving the logistics of public health systems in developing countries through a biopsychosocial approach. He welcomes any questions, critiques, or comments, and can be reached at dolivier@nd.edu.

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