THE BILWASKARMA CLINIC

On The Verge of Making A Difference

Far into northeastern Nicaragua, one of the most remote, poor, and undeveloped areas in the Western Hemisphere, indigenous Miskito Indians have been eking out an existence over the past several centuries. They number about 30,000 living in 80 villages scattered along the Rio Coco, the longest river in Central America, which divides Honduras and Nicaragua.

To this day, these delightful, noble people, largely neglected by the government in far-away Managua, struggle to survive, subsisting on crops frequently ravaged by floods, watching their children die of the complications of malnutrition, dysentery, even measles.

In the center of this population the Bilwaskarma Clinic (officially La Policlinica Morava en Bilwaskarma) is valiantly striving to meet the health needs of these people. Staffed entirely by indigenous professionals (two doctors, three nurses, and support personnel), the clinic treats an average of 250 out-patients per month, several inpatients, several deliveries, and sponsors periodic surgical clinics when teams of visiting surgeons come for that purpose. (Bilwaskarma is in red, Managua is green on map to left.)

In addition to providing such primary care, the Clinic functions as a health center. It directs a regional preventive medicine program for the immediate surrounding area of seven villages with a population of about 7,500 people. The program, when fully funded, ideally consists of health leadership training, vaccination, education in the villages, local consultation and on-site treatment of illnesses, potable water projects, and community development.

I’d like to share with you the fascinating seventy-year history behind the Clinic. In 1935 Dr. A. David Thaeler arrived in Bilwaskarma, sent by the Moravian Mission Board to establish a hospital there. He arrived with surgical instruments and nails, he told me. Soon, needing a partner, he wrote a nurse who had been a college acquaintance, and shortly thereafter Margaret Heidenreich arrived, married him, and established Nicaragua’s first nursing school. That school, by the way, continued to produce what the Presidents Somoza, father and son, referred to as Nicaragua’s best nurses; they always requested the care of a Bilwas nurse when ill. The Thaelers built a 30-bed hospital, and served thirty years, into the mid-sixties. The hospital soon became famous throughout Nicaragua as the best source of quality surgical and medical care, and in the ‘40s three different national airlines had daily flights to Bilwaskarma!

During the interim after the Thaelers’ departure, Dr. John Gilliland followed by Dr. Sam Marx directed the work.

Meanwhile, I was finishing a surgical residency in preparation for what turned out to be our six years in Bilwaskarma (1968-74). During our tour of duty, the Moravian Church supported the construction of a new, expanded facility, with up to 60 beds. Likewise, the nursing school expanded significantly.

Joan and I, and our four children, remember that time as the best years of our lives. During the last three years there, I was the only general surgeon in the eastern half of Nicaragua. We enjoyed the help of 59 medical volunteers during that six-year term of service. When we left, Dr. Myrna Cunningham, a Nicaragua physician who interned at the hospital and grew up ten miles up the river, became the medical director. She continued to manage the program up through the Sandinista revolution in 1979.

Soon thereafter, the "Contra War" caused the demise and destruction of the hospital. Miskito Indian Contra-Revolutionaries, armed, trained, and supported by the CIA, aggressively fought Sandinista attempts to impose their revolutionary government on them. In a series of firefights on the hospital grounds, our hospital was leveled, and all health care came to an end.

It was with deep sadness that we walked through the ruins, years later, and visited the remains of our home, with only the tall concrete post supports remaining. Powerful memories!

In the early ‘90s I made several visits to Bilwaskarma out of nostalgia and deep friendship with special individuals. While there, in public meetings in the local church, the people begged us to return and restore their hospital to what it was before. It was painful to have to explain to them that the world of missions had changed, and that any health care facility would have to be generated by them.

Amazingly, in ’96, we were notified that they had constructed a 12-room clinic, and invited us to come see it, (which we did—Wow!). We were honored to join them in the effort to re-establish a health care program in its historic center, Bilwaskarma. This was accomplished through a cooperative effort between the local citizens of the Bilwaskarma region, the Ministry of Health, the Nicaraguan Moravian Church, the North American Moravian Church, and U.S. volunteers.

Among those responsible for the success of the program certain names stand out. Dr. Florence Levy, from the East Coast, trained in Public Health in England, directed the program to its zenith before moving into a leadership position with the Ministry of Health. Dr. Bob Bach, a general and thoracic surgeon from Maine, over the past 28 years has made more than annual medical visits to the area doing surgery, carrying equipment, and making a personal prodigious effort to improve and sustain health care in the entire region. He has also formed Partners in Health, an organization of volunteers and contributors committed to the same goals. Interestingly, his visits began the year our family returned from Bilwaskarma to the U.S. in l974.

The current Medical Director is Dr. Patricia Ballesteros, a Nicaraguan physician from the region, who is a talented and dynamic administrator. She is assisted by a team of U.S. advisors with backgrounds in Public Health, Foreign Service, and missionary medicine.

Currently, the Clinic is more active than ever, staffed with two physicians, three nurses, and is seeing over 300 patients a month. Periodic surgical clinics are conducted by visiting teams.

The major development this year (and this is BIG) is the initiation of a new comprehensive outreach program in preventive medicine. This has the prospect of doing something that has never been accomplished before in this region—MAKING A MEASURABLE DIFFERENCE, for the first time, in such areas as infant mortality, nutrition, community-related health infrastructure, life expectancy, and maternal mortality.

So, 7,500 Miskito Indian people living in the 7 villages surrounding the Clinic are going to be involved in this 5-year program to improve their health, and their physical and emotional wellbeing, through public health education and disease prevention training. Our hopes are that the results will be so impressive that neighboring regions will want to replicate the program. It is due to the support of many that the program has reached this point. All of us who are directly involved are committed to helping the Miskito people achieve a better, healthier future.

Hopefully you can join us in this.