Medical Service/Hospitals in Nicaragua

My question is about ambulance/ hospitals/emergency services in Nicaragua. Have any of you had occasion to use nighttime emergency service or had extended stays in a Nicaraguan hospital? I am asking because I remember the case of Huehuete Bob who died a couple years back of a heart attack. Do they have doctors on call at night or just medical attendants? Are there private hospitals with better care or are all public? etc, etc. As many our membership are in our senior years I am very curious to know of your experiences with the Nicaraguan health care system. My own experience is limited to dental work but I would like to know about how it all works not just in places like Granada or Leon but as well in the smaller rural communities and countryside. I would welcome any and all contributions on this subject.

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Emergency Medicine

I am a state certified EMT in the Commonwealth of Virginia and am wanting to relocate with my family to Nicaragua. Unfortunately I have been unable to locate the qualification for an EMT in the country. Does anyone know if they even have EMS? If not who would one have to write to so that the subject can be approached? If anyone knows anything about this please let me know. Thanks so much for you assistance.

Guesses, sugestions

First the suggestion. Posting as a comment in an old thread is not a good place to get noticed. A new forum topic or even in your blog is better.

That said, my guess is that there is no certification required. While there are private ambulances here, the majority of the service is provided by the Red Cross. I would start by talking to them.

Assuming you are looking to do this work because you want to vs. seeing it as a reasonable income source, you are better off to just move here, get established and then go looking for the answer. While I don't know what sort of salary you would be talking about, I believe nurses in the hospitals earn about $200/mo.

If you elect to try to make contact now, there is contact information on the Cruz Roja Nicaragüense ste.

San Juan Del Sur Medical Clinic

I am an Emergency Physician in Philadelphia and have reccently returned from my second trip to SJDS. I plan on making many more and want to begin to gage the interest and the possibility of creating a healthcare clinic for the town that can provide competent, well trained medical care for local and tourists. I am aware of the current clinic in town but have heard that many people would rather make the trip to Managua, past Rivas for just about anything medical. There are many models for such a venture and doing this in a manor that establishes local acceptance as well as tourist confidence is the goal. I hope this is the start of a conversation that will continue into a valuable resource for the community of SJDS.

knee specialist

Hi, for a friend of mine of mine who has a badly injured knee that may require surgery, I'm trying to find an orthopedic specialist/surgeon in Nicaragua, who could also recommend treatment abroad if necessary. Any leads?

A Top NOTCH ORTHOPEDIC SURGEON

is Dr. Guieterrez in Managua, he operated on my ankle and did a fantastic job. I'm sorry, I forgot his first name but he works out of the top hospital in Managua, Hospital Vivian Pellas, and has his own private clinic in Managua near where INTERPOL IS LOCATED BY PLAZA SOL. Best o' Luck.

Doctors

There are some great doctors in Nicaragua many who hang their shingle at VP at least an hour or two a week. We should list them by name in a list like you would do with a dentist. Dr. Jose I. Uriarte works out of VP and is excellent Cardiologist. Dr. Dino Aguilar is excellent is expert and is aware of all the best doctors in their respective fields so you can go to him first. There are no specific Geriatrics practiced but if there was Dr. Eduardo Morales is your man.

I think the issue of concern for gringos should be emergency care like a heart attack. I know several friends who died in Granada alone in the last years. Time is critical to get drugs in you after attack to prevent more damage like they do in the States. Never know if someone would still be alive etc in one place or another. My friend I knew from 7 years old in USA died of a heart attack while in a hospital visiting his sick father-it happens. The father also died the same day!

A defibrillator costs like $600 US and may be an option if you choose to live rural like on Ometepe for example. I took a Nica man to the Japanese 'hosptial' in Granada who broke his leg. I smelled alcohol on the breath of the doctor. Another older wealthy Nica I knew very well needed bypass surgery-his children came from the US to beg him to have the operation done in Miami. He refused-had the surgery in Managua and died at home 7 days later.

Accidents and strokes happen but Heart attacks are the main sudden killers and not thought of or discussed enough.

Health Care in Nica.

Hola BE,

We've had this discussion before.

As compared to Kaiser Permanente in California, hospital facilities here in Leon, are sub-standard, to say the least.

A senior or anyone else wanting to live in Leon, has to do his/her homework, such as:

* What ailments is the person affected with?

* Are there specialists, treatments and medications for specific ailments available in Nicaragua?

* Can medications be imported into Nicaragua to maintain an ongoing treatment for a chronic disease?

* Is it feasible to fly to US in case of crisis or emergency?

As for the VA Hospital, if there's one in Honduras, I don't think it would treat any veteran just because he or she is a veteran, unless he/she has a service connected problem. There are also VA Health Plans, but last time I read them, I had to be under the maximum income+assets threshold of $80,000.00. annually to qualify.

Al

Substandard

My understanding is that all medical care in Nicaragua is rated substandard by the state department.

i have been down here 20+yrs.

and i dont do anything with the embassy..but get my passport renewed..had a operation in integral salud hospitol..the dr. went to med school in new york..was board certified in the states in urology..had excelent service..the big diference i saw between an american hospital and down here was the price..and i think..i was treated better at my stay in the hospital down here..u guys got to remember....if u want to live like ure in the states or canada..stay there..if u want to enjoy ureself and have a great life..with out all the up North b.s...comon down and enjoy..and quit worring

And the State Department should know all about

what constitutes sub-standard.... They had lots of experience trying to work their way up to that level of service...

Some of the medical services in Nicaragua are quite excellent. Some of my friends and some clients had excellent results in Nicaragua. One of my friends was given a 2% chance of survival going into surgery. He'll tell you that he would likely not be alive if he had the operation anywhere else.

Certainly the great medical service is not available in every health center or in every hospital across Nicaragua. But not every hospital in the US is equal to the Mayo Clinic or the cancer hospital in Buffalo. All in all, the medical service is average. Some as everywhere else. The infrastructure is for the most part pretty poor. However, the buildings, beds and broken floor tiles don't treat the patients. Doctors and nurses do and they certainly are not substandard by any means in my opinion.

travel vaccinations

Question: Any private clinics in Managua where I can get yellow fever vaccination?

The first thing you have to

The first thing you have to remember about Huehuete Bob is that he lived in a fairly remote area. There was no service out there (as in most rural or isolated areas), and the road at the time was about as bad as can be. The trip took triple the time a trip of that distance should take. As for hospitals, that's a tough one. Unless you are in Managua, you don't have many choices. In a place like Matagalpa, for example, there are small private hospitals as well as emergency centers, but oddly enough, the public hospital is probably better equipped to deal with actual emergencies such as heart attacks. For one thing, they have doctors on staff or on call, while the private hospitals rely on your personal doctor. Another side you need to consider is the lack of equipment that we took for granted in the US or Canada. My father-in-law needed an MRI, but none existed in Matagalpa. He had to go to Esteli for the nearest unit.

As I said, Managua is a different story, but even there, some things are simply not available. For example, as of a year ago, a CT Scan was not available anywhere in Nicaragua. My wife has a history of pulmonary emboli (blood clots in the lungs). We took her to Vivian Pellas with chest pain one day, and they couldn't perform the proper examinations (required a CT scan). However, what makes things even scarier is that in a place like Vivian Pellas, they will try to make it sound like they know what they are doing, even if they have no clue, just so they can charge for the extra services. In my wife's case, they took standard chest x-rays, knowing that if she did have another embolism, they wouldn't see it. I had a big fight with them over that one, as I refused to pay for the x-rays (the costs weren't high, but just the idea of paying for a service that you know was not needed). Fortunately, my lawyer was with me.

It would seem to me that the real challenge would be to find out what diagnostic services each hospital is capable of providing, and what each one's emergency/trauma services capabilities are. Unfortunately, it seems like you really can't tell until you need it. It would be very interesting indeed (not to mention very helpful) to compile a list of capabilities of the various hospitals. Keep us posted with any good info you pick up.

dont know much about the

emergency part..but had laser surgery done at salud intergra in managua..had a dr.trained in the usa..that spoke excellent english..the service and the prices were great..i was in the private part..stayed about 3 days in the hospiol..for a little more than the price of an air line ticket to Pittsburgh..

My Wife And

I both have had a lot of medical work done in Costa Rica. We were very satisfied. While CR is NOT Nicaragua, the economic incentive to go in that direction for well-trained, English-speaking doctors has to be very strong. That's where the money is.

If I knew I had something that required in-depth treatment, I would head back to the US. I have good insurance, grabbing a plane to MIA just makes good sense. My Total Options Medicare Advantage plan covers up to $25K of emergency work done in a foreign country, but I have to put out the money and be re-imbursed.

Unfortunately, a heart attack is not going to wait for the next plane, and that's true of some other serious emergencies.

Beyond that, I have already brought down a range of antibiotics, and a quantity of the one eye drop I need to control ocular pressure from a detached retina I suffered some years back. This particular medication is new, expensive, works better -and still not available in Nicaragua. As a side note, I had a very successful repair by a CR surgeon with feet both in CR and the US. A subsequent operation in the US blocked the duct that allows the fluid to drain, hence my condition. I could probably get it repaired, but if I did attempt the procedure, I would go back to the original surgeon in CR.

One assumes that antibiotics are available in Nicaragua, but NOT all are, and the cutting edge items are simply not there. For example, Zyvox (generic Linezolid), an oral alternative to Vancomycin, is not. This medication would allow you to self treat serious infections, like sepsis, infections that are resistant to many conventional antibiotics, hard to treat, and could kill you quickly.

Pellas

has made some changes. Likely a lot different (on the plus side) from your last experience over a year ago. Not sure if it matches what everyone needs. They are now accredited by the Joint Commission international, which has some real significance. I think they now have a CT machine...not 100% sure though. Going after the medical tourism business which means they need to have quality care to get more business.

My non-emergency stuff there has been very good and 3 or 4 people I know who who had emergency care there (one heart, one stomach and two broken bones) are very satisfied. I am told there are a couple of others in MGA that are good as well. Outside of those in MGA I think it is emergency care and really routine stuff that I would trust to the existing system if I had an option.

There has been a lot of discussion on here about how good the quality of care down here is with the majority saying very good to excellent...and lots say a lot better than the States. For my two cents it is good and Pellas is certainly emergency qualified, but if I knew I had something major wrong, or needed in depth diagnostics, and needed treatment that was not emergency, I would head back to the States. There is a big difference between good and being able to provide the extras that can make a difference in 10% of the cases...and you just may be in that 10%.ZZT

Thanks Charlie-

Your idea of expanding the medical services review and collating them re various hospitals, etc. would indeed be helpful for all of us. Perhaps Nicanor or someone knows of a national registry on medical services that would help us out here. Or perhaps Mr. Tiffer knows someone in the medical profession that could aid our search re finding out what medical services are available and where. I remember meeting a Nicaraguan fellow who had become an American and served in the US military till retirement. When I met him he was on his way from Nicaragua to a US base in Honduras to get medical treatment on a heart ailment. He did tell me that as a vet I would also be able to utilize the services at that base should I ever need to. Course that would be a long way to go if one had a medical emergency. I did have occasion to utilize medical facilities in Acapulco one night when I somehow dislocated my shoulder while sleeping. I was told no ambulances would come and get me and that I was better off going to a private hospital rather than the public one. So off I went at 3:30 in the morning and when I arrived at said private hospital there was only an attendant there. He gave me a shot of some sort of strong pain killer and told me I would have to come back during the day to see the specialist. So I wonder what happens when there are serious medical emergencies in Nicaragua at night-car accidents, stabbings , etc.

If you had to

be a lot easier and quicker to go to Miami for treatment than to Honduras. If needed you could go to the VA hospital there, or whatever. The "base' in Honduras is unlikely to have much in the way of anything you can not get at Pellas or Hosp. Militar in MGA, in fact, likely a lot less. Not sure what insurance you have or will have but medical care here at these two decent hospitals is cheap. By the time you get here, likely at least Pellas will take USA insurance. In fact right now, they have some set up and most polocies have urgent or emergency care provisions that allow for treatment anyplace and they will reimburse.ZZT

FYI - Military Hospital Expansion

The drawings are complete and work could start by the end of the year on the new Military Hospital in Managua. When finished, the new facility will combine with the existing hospital to provide nearly 500 beds to patients on the basis of 75% INSS (Social Security) clients and 25% military personnel. Construction is expected to take between 24 and 30 months. Financing (66 Million Córdoba’s) is through the Central American Bank for Economic Integration (BCIE).

(August 2010 - DSN)

Public Hospitals

Each department in Nicaragua has its own public hospital. Public hospitals will not charge you for emergency services, but you will have to pay for medication and supplies

This link will list Doctors , their specialties , their phone numbers and their command of English-these are all Managua based

Also listed are the names of all the regional hospitals listed by department:

http://photos.state.gov/libraries/nicaragua/63958/docs_spanish/Spanish%2...

This is list of Managua Hospitals and clinics:

HOSPITAL MONTE ESPAÑA, MANAGUA HOSPITAL SALUD INTEGRAL, MANAGUA HOSPITAL METROPOLITANO, MANAGUA CENTRO DE REHABILITACION ALDO CHAVARRIA, MANAGUA CENTRO NACIONAL DERMATOLOGICO, MANAGUA CENTRO CARDIOLOGICO NACIONAL, MANAGUA HOSPITAL FERNANDO VELEZ PAIZ, MANAGUA CENTRO NACIONAL PSIQUIATRICO JOSE D. FLETES, MANAGUA CENTRO NACIONAL RADIOTERAPIA, MANAGUA CENTRO NACIONAL OFTALMOLOGIA, MANAGUA HOSPITAL MANOLO MORALES PERALTA, MANAGUA HOSPITAL INFANTIL MANUEL DE JESUS RIVERA, MANAGUA HOSPITAL ALEMAN NICARAGUENSE, MANAGUA HOSPITAL ROBERTO HUEMBES, MANAGUA HOSPITAL MILITAR ALEJANDRO DAVILA, MANAGUA Carlos Marx Hospital / Tel. 490701 Bautista Hospital / Tel. 497333 / 497118 Villa Fontana Clinic / Tel. 74614 / 672696 Montoya Medical Center / Tel. 281054 Radiology Institute / Tel. 662740 / 666005 Las Palmas Clinic / Tel. 660881 Renovacion Clinic / Tel. 661325 Tiscapa Clinic / Tel. 71300 Davila Bolaños Hospital / Tel. 22764-66 Berta Calderon Hospital / Tel. 601787 /601303 Manolo Morales Hospital / Tel. 70990-92 La Mascota Hospital / Tel. 897700-06 Velez Paiz Hospital / Tel. 650009 Lenin Fonseca Hospital / Tel. 666547-50 Psychiatric Hospital / Tel. 667877-81

Public hospitals in the boonies

Quality varies. We recently took a family member to the hospital in Boaco in the middle of the night and she and the daughter who went in with her were absolutely amazed at the high quality of care received. In the boonies its a crap shoot, but you have no real choice but to go to the nearest public hospital.

''Remember, when seconds count, the police are only minutes away''

Lenin Fonseca

Is the worst hospital you can EVER imagine, I haven't seen anything like it even deep in the Amazon nor in Somalia! I had a good friend of end up there on a small issue never to come out alive! I visited him on many occasions, and it is beyond words what he (and all other patients) had to go through, and the quality of care, both nursing and medical, he received is abysmal. You DO NOT want to end up there. The unfortunate part is if you were ever to be in an accident or require emergency medical care that your local hospital cannot handle you will most likely end up there.

The Salud Integral is probably 8 out 10 by Nicaraguan Standards. I have had no experience with Pellas.

medical care

Private sector doctors of quality can be found here. I am much happier with the Nica doctors I have met than the HMO docotors in NW AZ. (Which is not saying much as their greed and incompetence is what made me decide to take an early retirement and leave the desert).

From the experience of some relatives here, there are also some awful quacks: hip shooters, pill freaks, etc. Go with your gut. Ask an upper middle class Nica for referals.

Regional hospitals do have more emergency capacity due to foreign and government grants. doctors tend to be new and low paid, nursing staff is Latin -style (bring a relative to sit with you 24/7). Food is bad and you may be in the same mosquito filled room with a dengue patient. Private doctors are not allowed to work in public hospitals, so you will be working with a stranger. do not expect sqeaky-clean and do not expect to be hooked up to machines monitoring your vitals. If you get in a major car wreck or whatever anywhere other the MGA, this is where you need to be.

Private hospitals can be better, Again, ask an upper middle class Nica for referal. Do not expect nursing service, squeky clean, etc. a couple months ago i had an emergency in Esteli and chose Pro-familia over the public hospital. I told them what was wrong with me and what treatment I needed and we worked thru it. Doctor was quite good and they had suffient lab to do the tests to convince themselves that I could leave the next morning. Pro-familia is an NGOsuported group with clinics in several towns. granada and leon probably have options for bigger private hospitals.

Rode with a neighbor in a local ambulance. Remember the old MASH tv show? Classic meatwagon with an attendent qualified to decide if you need to be transported. Tee attendant, a neighbor , and me helped load the patient. No medical care enroute. Some ambulances around town look more modern, but fortuneately I havenot had the opportunity for a test spin. the day I was sick I had a neighbor drive me to save the hassle.

Nic doctors are 30-40 years behind on prescriptions--they will tell you nothing about side effects., etc. Look everything up on medlineplus.com before you buy it. Pharmacies have some other bad habits, like letting people buy less than the prescribed number of antibiotic pills.

Local doctors are big on injectable B vitamins. waste of time and effort looking for a nurse to inject. Find some pills.

My opinion: if you have chronic problems you shoudl live near Vivian Pellass ( or by a good private hospital in Leon or Granada, if they exist). Everyone here should have some contingency plan for going abroad for medical care if necessary and posible. You should have a visa card with, let`s say 5 k available on it to get treated and released from a private hospita here.

If you want to be treated like a poor person, get your advice and referrals from a poor person.

"In order to really enjoy a dog, one doesn't merely try to train him to be semi-human. The point...is to open oneself to the possibility of becoming partly a dog" --Edward Hoagland