By Roger McKenzie

[This article first appeared in the UK publication The Morning Star.]

Roger McKenzie is a journalist from the UK who has spent time in Nicaragua. Here he reports on Nicaragua’s free family and community model of healthcare and the role of ‘brigadistas’ in assisting pregnant women and rural populations. He speaks with Dr Mario Lazo Guerrero, a local healthcare director in Estelí.

Estelí, the eighth-largest city of the Central American nation, the de facto capital of the north, is also the country’s main tobacco production region. The land around Estelí is ideal for growing cigar tobacco and the city became a conclave for Cuban cigar makers who left the Caribbean island after the revolution in 1959. Since that time Estelí has become one of the most important cigar producing cities anywhere in the world.

Tobacco and the health problems that arise from it for the workers who produce it and the smokers that use it seemed to me a good place to look at the Nicaraguan health service. I later learned that in fact diabetes and hypertension were currently the main health issues in the area.

I secured an exclusive interview with Dr Mario Lazo Guerrero, the director of the integral system of healthcare at the local hospital. The hospital in Estelí serves an urban population of more than 100,000 and, like much of Nicaragua, a sizeable rural community.

Dr Lazo told me that Nicaragua has been developing a free family and community model of healthcare with an emphasis on prevention since the Sandinistas returned to power in 2007. They have an extensive community network that makes use of volunteer “brigadistas” to reach out into the community, particularly the rural areas.

Lazo and the members of his team that I met mirrored the commitment to the vocation for providing quality healthcare that I have seen in Britain and other parts of the world, but here it was mixed with the fervent support for the Nicaraguan revolution.

Lazo said, “The brigadistas play a central role in the delivery of healthcare in Nicaragua. They reach out into the community and make sure that there are no obstacles to anyone getting healthcare. This is really important when, like Nicaragua, your economy is mainly rural. It is not always easy for people to get what they are entitled to.”

As in most economies, whether capitalist or revolutionary, how women access healthcare is complicated. “The brigadistas are really vital for us in helping us to improve women’s health in Nicaragua,” Lazo told me. This is demonstrated through the priority given by the Nicaraguans to reducing neonatal deaths. The Nicaraguans place a high priority on supporting women through pregnancy and the brigadistas play a major role in this strategy.

Lazo said, “The brigadistas help us to identify mothers not attending pre-natal care. They can dig deep into the community to identify things like where women have problems with getting transport into the municipal health centres from the rural areas. The brigadistas alert us so we can have the necessary conversations to make sure that women get the transport they need, when they need it.”

He went on to say, “Doctors and nurses all consult with brigadistas over health concerns in the sector they are responsible for. This gives us early warning of any problems that might be arising at a very local level. Brigadistas get trained to know what to look for so that they can consult with or alert medically trained people on what they see. This means we can usually have a speedy response to deal with anything serious that might come up.”

Brigadistas help support patients through the healthcare system and more than half are given smartphones to help them to communicate with healthcare professionals. “We have regular Zoom case meetings, which involve brigadistas, so they are completely part of the process,” Lazo told me.

He continued, “Brigadistas are part of the birthing plan of pregnant women, particularly of those at risk. They help develop a plan to get pregnant women to and from hospital. Unlike in the neoliberal years, most women give birth in hospitals. Only 0.2 per cent of women now give birth at home.”

The level of care for pregnant women described by Lazo is astonishing and, in revolutionary Nicaragua, completely free. He explained, “In Nicaragua all women are brought into hospital or a maternity waiting home two weeks before their due date to await birth. This is completely free for all their transport, bed, food and healthcare.”

After the birth women can stay in hospital with their children, “for usually two days after the birth before being transported home,” Lazo said.

The care doesn’t end after the birth of the child. Lazo explained, “The brigadistas help us to maintain control over the vaccination programme that every child is entitled to. They help us to make sure that the plan is maintained because it’s all too easy to believe that the job is done after the birth.”

This strategy for reducing deaths among newborns is proving to be a success. Lazo stated that, “In this area in the first five months of this year there have been 1,032 births, of which 92 were premature. Of this number there were six deaths of which two were genetically malformed and would not have survived.”

In Estelí there are around 1,322 brigadistas, “which is great but we need more as the existing cohort is getting old. We are in a constant process of recruiting new brigadistas. Each brigadista is asked to identify new people to eventually replace them.”

The 2020 Covid pandemic was a massive challenge for Nicaragua, as it was for the rest of the world. But, for a country trying to build a healthcare system that did not depend on how much money you had in your pocket, this was an additional challenge.

There were no lockdowns during the pandemic in Nicaragua. The economy remained open. There was no official mask wearing policy, save for people with respiratory conditions or people providing care to patients. In hospitals and healthcare centres most people wore masks and handwashing and alcohol hand sanitisers were available throughout the country.

Nicaragua had one of the lowest death rates per 100,000 population in the world. The World Health Organisation and Oxford University both reported a rate of just 189, compared with 276 for the UK and 374 for the US.

It’s taken for granted that the US and their allies and their employees in the capitalist press will dispute whatever the Nicaraguan authorities say, but what can’t be denied is the critical role played by the brigadistas in reaching out into the community to make sure everyone received the COVID vaccine.

When you don’t travel to Nicaragua and see for yourself how people are attempting to construct their revolution, it’s easy to take the comfortable route of believing reports from what many people consider to be reputable news sources.

My advice is to go and see for yourself what this amazing country is trying to do to make sure that everyone has access to healthcare regardless of their ability to afford it. Revolutionary change takes time, but surely one of the main measures is the priority that a nation places on everyone being able to get the best possible quality of healthcare.

Nicaragua certainly puts people first and tries to involve the whole population in providing the best possible care.

The brigadistas play a central part in the process.

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Briefs
By Nan McCurdy

Nicaragua’s Message to the United Nations
At the 78th United Nations General Assembly meeting in New York, Nicaragua’s message, expressed by Foreign Minister Denis Moncada, was a denunciation of imperialism and colonialism. Moncada urged the gathered nations to defend the planet from severe global threats. Delivering a message from President Daniel Ortega and Vice-President Rosario Murillo, Moncada said, “We are living the moments of extinction of the imperialist, colonialist model, of the plundering and genocide caused by greed that have struck nature and our world.” And, he said, “Nicaragua continues to battle for true liberty, for light and truth.”

Moncada said that Nicaragua demanded before the UN General Assembly that the 1986 ruling of the World Court against the United States be enforced and that the US be made to pay, at least in part, the costs of the destruction, aggression, pain and suffering of Nicaraguans in the war imposed by the US on Nicaragua in the 80s in what was called the counterrevolution. He added that, “Entire countries have been destroyed in the brutal scorched earth policy which seeks to satisfy the bestial appetites of the imperialists of the Earth.” Nicaragua expressed its solidarity with Cuba, Venezuela, Honduras, Bolivia, Palestine, Puerto Rico, China, and the Democratic People’s Republic of Korea, who are also victims of imperialism. (JP+, La Primerisima, 26 Sept. 2023)

Infant Mortality Cut in Half
The Sandinista Government has managed to reduce infant mortality by 56.5%, from 29 deaths per 1,000 live births in 2006 to 12 deaths per 1,000 live births in 2022. To achieve this goal, the Ministry of Health has implemented many actions such as attending ten times more births in hospitals and health centers. In 2006, 9,000 women were cared for in maternity wait homes prior to giving birth while in 2022 that number had increased to 71,925, eight times more. Fifty maternity wait homes existed in 2006; in 2022 there are 181 maternity wait homes. Meanwhile, more than one million families have been visited house to house through the follow-up program for children with low birth weight. See Photos: HERE (La Primerisima, 26 Sept. 2023)

19,000 Families Have Homes Thanks to CABEI
The Central American Bank for Economic Integration (CABEI) presented a report on advances of the Casas para el Pueblo Low-Cost Housing Program. The report states that “CABEI allocated US$64 million between 2012 and 2022, building 18,973 homes, 60% of which are households led by women.” It added that, “Currently the Bank has approved US$172 million in additional financing to build 18,660 homes over a five-year period, benefiting 93,300 inhabitants in seven departments and the Southern Caribbean Autonomous Region.” This program seeks to reduce the housing deficit in Nicaragua through the building of low-cost housing for at risk populations in rural and urban areas. (Nicaragua News, 21 Sept. 2023)

National Property Titling Program Advances
The Office of the Attorney General (PGR) reported on the Family Stability Titling Program that the government is implementing throughout the country. The report states that 37,000 property titles were delivered to families between January and August of this year for a total of 652,162 delivered since 2007, benefiting 3,063,794 people. The report also states that 25 Indigenous and Afro-descendant territories were demarcated, covering 38,426 square kilometers in 315 communities of the two Caribbean Autonomous Regions. (Nicaragua News, 25 Sept. 2023)

Massive Catholic Procession in León to Celebrate the Virgin of La Merced
Thousands of Catholics participated in the procession of the Virgin of La Merced, patroness of the city of Leon on September 24. Led by the Bishop of León, Sócrates René Sándigo, the procession departed from the Church of La Merced and, as every year, went through the main streets of the city. Every September, Leon celebrates the festivities in honor of the Virgin of La Merced or Our Lady of Mercy. Her feast is celebrated on September 24. The history of the celebration of this feast goes back to León Viejo where, in 1528, the first monastery was built in Nicaragua and named La Merced after the Virgin of Mercy. See photos: https://radiolaprimerisima.com/masiva-procesion-catolica-en-leon-para-celebrar-a-la-virgen-de-la-merced/
(Radio La Primerisima, 24 Sept. 2023)

Evangelicals Celebrate the Translation of the Bible into Spanish
This weekend, all through the country, evangelical Christians celebrated the 454th anniversary of the translation of the Bible into Spanish with a series of activities. For example, on Saturday afternoon in Managua, the celebrations took place in La Biblia square, where more than 200 pastors, from different ministries and denominations, preached the word of God to hundreds of people. See photos: https://radiolaprimerisima.com/celebran-el-454-aniversario-de-la-traduccion-al-castellano-de-la-biblia/ (Radio La Primerisima, 24 Sept. 2023)

Since 2007, 156 Fire Stations Have Been Built
The country’s 188th fire station will be inaugurated on September 26 in Nueva Guinea and a truck with a capacity to store 500 gallons of water, a cistern with a capacity of 2,000 gallons, a 4-by-4 truck to evacuate people, and a rescue truck were sent from Managua to serve the area. In 2007, Nicaragua had 32 fire stations. From that date to the present, 156 more stations have been built. The Nueva Guinea Station will include the firefighters, an office of immigration procedures and the delegation of the Ministry of the Interior. The station will have a total of 16 firefighters who were trained to extinguish fires, provide pre-hospital emergency care, as well as fire prevention tasks. More than 70,000 people will be served by the station. (Radio La Primerisima, 22 Sept. 2023)

Extraordinary Results of Orthopedic Fair in Bluefields
The Ministry of Health reported that 4,129 health care services were provided to some 2,000 people from the municipalities of Corn Island, Laguna de Perlas, Kukra Hill, Desembocadura del Río Grande, El Tortuguero and Bluefields, in the South Caribbean Autonomous Region during the orthopedic fair held on September 22 and 23 at the Dr. Ernesto Sequeira Blanco Regional Teaching Hospital in the city of Bluefields. (Radio La Primerisima, 24 Sept. 2023)

Important Investment in Nora Astorga Radiotherapy Center
This week, the government will inaugurate several infrastructure projects; among them is the remodeling of the equipment and sterilization center of the Nora Astorga National Radiotherapy Center, located in Managua. These improvements will strengthen the services provided to more than 55,000 people who receive treatment for various types of cancer at this health unit every year.  (Radio La Primerisima, 20 Sept. 2023)

Potable Water Service Improved for 15,000 People in Estelí
The Nicaraguan Water company has built a major new well with its respective pumping equipment and installed 2,600 meters of water pipes, improving drinking water service for 15,000 people in eight neighborhoods of Estelí. (Radio La Primerisima, 21 Sept. 2023)

Construction of Pacific Coast Highway Begins
The Ministry of Transportation and Infrastructure (MTI) announced the start of construction on Stage III of the new Pacific Coast Highway from Pochomil to Masachapa, providing greater connectivity between León, Managua, and Carazo departments, directly benefitting 375,000 people. Financing is through the General Budget with support from the Central American Bank for Economic Integration (BCIE) and is part of Phase X of the Nicaragua road maintenance and expansion program that has a cost of US$383 million. (Nicaragua News, 26 Sept. 2023)