MIRROR, MIRROR ON THE WALL…..
Goetz Kloecker, MD
hree years ago, I was lucky to
join GLMS’ medical mission trip
to Nicaragua, one of the poor-
est countries in our hemisphere.
I wrote in this journal about my
absolute astonishment at how patients and
doctors coped with a desperate lack of modern
This year again, I was happy to join a gifted and big-hearted
group of health care professionals to see how this country, under
socialist rule, has fared. Led by Dr. Cynthia Rigby, we were warmly
greeted at the women’s health clinic, known as Bertha Calderon,
and were proudly shown around to a new wing of the hospital with
new CT scanners and a new pathology lab. My expectations about
the health care services were much more realistic than the first
time around. I was glad to hear breast cancers are now tested for
estrogen receptors, and oral narcotics for cancer patients are now
actually available and not so strictly rationed.
All through the busy corridors, handmade notice boards gave
good medical advice, cheered female heroes of the revolution and
thanked the ruling socialist party for the accomplishments. The
waiting rooms were as packed as three years ago, while a sign on
the wall announced, “Todo Servicio Medico is Gratuido,” (Every
Medical Service is Free).
Bertha Calderon Hospital, just as the University hospital, Manolo
Morales Peralta in the capital city of Managua, are the only special-
ty hospitals where patients with public “insurance” can come for
their cancer care, from all over this central American country of
six million. I was told this will change and more specialists will be
available at the Pacific and the Caribbean coast. Currently, patients
from those areas must travel one to two days to Managua either by
car or horse-drawn carriage.
Rounding again with the young residents on the University’s
leukemia ward, where the average age of the patients was 25, I
wondered where the patients older than 40 were (I was afraid they
were all dead). I was amazed to hear that only two dozen residents
are trained per year in the whole country to become specialists.
That is for all specialties! The absolute majority of medical students
will go int o general practice. Of course, why train specialists, if you
do not have access to specialty tests and treatments? Even simple
blood transfusions are hard to get, I learned, when seeing a young
girl with severe menorrhagia and a hemoglobin of five. Nicaraguans
are reluctant to donate blood - I was told - possibly worried about
ill effects of the donation. Thank you again to the American Red
Cross and all the generous donors that we depend on!
What struck me is how expressly grateful the patient and their
families at the San Francisco and AMOS clinics were: for each
minute of listening, for each advice, for each reassurance, and for
each sample of medicine, including the obligatory deworming pills.
We met the poorest and kindest families in the slums of Managua.
For many years, Louisville’s Hand In Hand Ministries has supported
the education of the children of these families. Drs. Grimaldi, Rigby,
Laufer, Weinstock, Brockman, Neimat, Zaid, our tech wiz Courtney
Nanney and I were split into smaller groups and taken into the
families’ homes, and offered the best Managuan Sunday meals. I
met Adriana and her family. Adriana had just graduated top of her
high school class with the help of Hand in Hand Ministries and is
now planning to become an industrial engineer. Her family showed
us around downtown, which is still scarred from the horrendous
1972 earthquake. This city-shattering event ended a half-century
of brutal Samoza dictatorship, leading to the Socialist Sandinista
takeover of government in 1979. I learned more about these events
at the “Museum of the Revolution” in colonial Leon, the city of
poets, where an old veteran explained the fascinating contrapuntal
history, from 1930 to 1990. Over the last 12 years, three elections
have not lead to any change in the ruling Socialist party, nor is any
The history of Nicaragua, just like Nicaragua’s health care system
and the easy friendliness of Nicaraguans who welcomed our group,
mirrors our own history and political involvement in Latin America.
This experience should make us all take a good hard look at our
health care priorities, our helpfulness towards our poor neighbor,
and our gratitude for things we take for granted.
A special thanks to Ed and Barbara Dunsworth, who continue
with Hand in Hand Ministries and the GLMS Foundation to host
us, and let us get closer to this tropical and beautiful land of vol-
Dr. Kloecker is an associate Professor at the University of Louisville
School of Medicine Division of Medical Oncology and Hematology. He
is director of the Hematology-Medical Oncology Fellowship Program.