Posted by Rose Martersteck


A sunny afternoon in Agua Fría became the site of a medical emergency as a group of four people arrived bearing an improvised stretcher. Comprised of a sturdy tree branch with an affixed hammock, the stretcher required two men to balance the pole on their shoulders with the patient suspended in the hammock between them. The patient in question was a woman who had abdominal surgery the week prior and subsequently suffered ripped stitches. Managing both the uneven trail and swinging motion of the improvised stretcher, the group arrived to where the Nuevas Esperanzas team waited.

In rural communities, emergency medical access involves more than a quick call to an ambulance. Residents’ commute to a hospital requires a trip by horseback or stretcher down a steep rocky path before arriving at a road. As ambulances cannot reach most communities on the volcano, an emergency requires hiring a private vehicle. The cost is very expensive: a private car costs between C$400-C$800 one-way, equivalent to $15-$30. Once in the car, another hour or two is needed to arrive at the hospital. In situations from broken bones to heart attacks, every moment counts.

People living in communities where roads are rocky to nonexistent know well the risks involved. Don Rene, a resident of Agua Fría, commented that they have lived a long time with the danger. After carrying someone in a hammock for hours, your shoulder burns from the swinging motion and your torso becomes inflamed. The patient suffers an anxious, bumpy ride to the city, and a long journey back. Fortunately, that day the Nuevas Esperanzas team was present to offer a ride to León. On days without such lucky timing, residents must spend critical resources to obtain medical care. A trip to a health center can vary from an hour to several hours, depending on availability of horses, cars, or buses, and the quality of the roads. There are public hospitals and clinics where Nicaraguans can access free care; the problem is getting there.

Access to medical care is also limited for routine visits. Maternal and newborn care is difficult to provide when the roads are inadequate, and elders needing treatment for arthritis or other troubles face a long journey to town. In Nicaragua, only about half of the population seeks or receives medical care when sick. Among ill urban dwellers, 55% utilize health services, while in rural areas only 45% receive health consultations.

Malnourishment is a critical and extensive problem. Not only are residents susceptible to the common range of injuries, they are also exposed to environmental hazards that impact health. In the dry season, clouds of dust envelop homes on gusty days. Dust irritates respiratory passages and can impact those with asthma. One resident in Agua Fría expressed concern for pesticides or other chemicals that are airborne with the dirt. When the wind picks up, there are not many options to avoid the dust beyond turning away and waiting for the rainy season.

While working on projects from rainwater tanks to model farms, Nuevas Esperanzas has improved roads in communities in order to transport necessary materials. There are many reasons why roads are crucial improvements for many communities. Prosperous harvests can provide critical income for families, but profits are limited by how much horses can carry. Improved infrastructure makes profits from harvests possible, and alleviates the difficulties of finding medical care. Though residents are still highly vulnerable to medical emergencies without a vehicle, passable roads are an important start. As Don Rene commented, the danger of limited immediate access to medical care is something those in cities rarely have to know.