Guess Who Came to Dinner?

doctorsMarina was diagnosed with Hashimoto’s Disease over two years ago. Her journey through this condition led her to a public healthcare surgeon in Managua, who removed her diseased thyroid in two operations a year apart. Gloria, her daughter, brought the diseased thyroid home in a plastic cup for all to see before taking it to a private clinic for a biopsy report.

I shook my head in disbelief.

What kind of pubic health system allows patients to bring a diseased body part home, then asks them to pay a private clinic for a biopsy report?

For Ron’s birthday, we decided to make a North American meal for 15 of our Nicaraguan friends and neighbors. Marina said, “My surgeon and his family are vacationing at my house for a week. Can they come, too?”

“Of course,” I replied. Again, I shook my head in disbelief.

Why would a surgeon want to spend his vacation in a humble abode of a patient instead of a fancy hotel? “Aren’t all doctors rich?” I asked Marina.

What I learned about the public healthcare system in Nicaragua will surprise you.


In 2006, doctors in Nicaragua earned an average of $144 a month, 40% less than their counterparts in other Central American countries. “To protest this situation, the 3,000 member strong Médicos Pro Salario doctors’ union initiated a strike in the nation’s 32 public hospitals and 150 health centers on November 14, 2005, demanding a 140% pay increase.” Health Sector Strike in Nicaragua Enters Sixth Month.

Six months later, the doctors were granted a 16.25% increase in salary, bringing their average monthly salary up to $200-$300. Currently, according to a report completed by PATH, medical specialists ( Marina’s surgeon) receive $732-$786 per month.  The Nicaraguan Health System Report is a lengthy, yet interesting report.


Per month!!! Again, I shook my head in disbelief. But, it was beginning to make sense to me why Marina’s surgeon asked to vacation in her humble abode.

IMG_8518Watching the interaction this week between the doctor’s family and Marina’s family gives me a new perspective on a doctor/patient relationship. Both families are happy with what they have and share their knowledge, their homes, and their lives with each other.

Early one morning, Ron helped Marina butcher a pig. Ron got an anatomy 101 lesson, as the doctor patiently described the functions of the pig’s organs. “I dissected many pigs in my training,” the doctor told Ron.

The doctor’s mother helped Marina make chicharones ( fried pork skins) over an open fire.
Not once did I hear Marina or her family apologize for the lack of a propane stove. The doctor’s two young sons bathed in the lake and played ball with Marina’s grandchildren. Not once did I hear them complain about the lack of a bathroom or indoor plumbing.

The day the doctor’s family arrived, Marina’s family was frantically trying to complete the new addition, borrow some beds for the doctor’s family, and hand-wash the sheets to place on the beds. It didn’t appear to bother anyone, and in fact, the doctor’s family pitched in to help.

IMG_8547Yesterday, the doctor and his family, along with Marina and her family, squeezed into the doctor’s car, and drove to the other side of the island for some sightseeing. Before they left, the doctor made a makeshift door to the addition by propping an old piece of tin roofing up by a plastic chair.

What a treat for Marina’s family. It was her first time to visit Santo Domingo in ten years.
She couldn’t wait to tell us about her adventure to the other side of the island.

IMG_8549This morning, the doctor’s family is weeding Marina’s flowerbeds and chopping firewood for her. Tomorrow, the doctor and his family must return to Managua. He told us that this was his first vacation in four years and his first time to visit Ometepe Island. Looking into his eyes, I noticed a twinkle that wasn’t there at the beginning of his vacation.

It has been an eye-opener for me to watch the interactions between a patient and her doctor. Indeed…good doctors treat the disease, but great doctors treat the patient who has the disease. Marina’s excellent surgeon can come to dinner anytime!

37 thoughts on “Guess Who Came to Dinner?

  1. Pingback: A Few Days in Nicaragua | The Panama Adventure

  2. That was a great story about Marina’s doctor. I’m shocked and somewhat disappointed that a surgeon only earns the same salary as a neighbor who does English phone banking in Managua.

    For all the bad things people say about medical care here I’ve seen some pretty good results. My gardener had the same malady as Marina and they talked often to ease his fears; he’s fine now. His mother has stomach cancer and had to have her stomach removed in May, then started chemotherapy the same time as Simone. They both seem to be progressing as the same rate though my neighbor’s treatments are about $25,000 cheaper. These two are in my thoughts always.

    Mr. Pundit, you had an Obamacare doctor? How long was the line? What was it like, and how did the doctor compare with a regular doctor? I haven’t had a chance to use my Obamacare yet and hope I stay healthy until I can get Medicare in a few years.

    • Brian, what kind of treatment did your gardener have? The same as Marina’s? I’m glad to hear that he is improving and I know Marina was very helpful in alleviating his fears.
      So, his mother received chemotherapy at a public hospital in Nicaragua? Simone receives her treatments at Vivian Pellas, which is a private hospital, and it does cost a lot more. But, her insurance covers most of the treatments, and she is having positive results in a modern hospital with new equipment and techniques. That being said, I, too, would prefer Vivian Pellas, over a public health hospital because I wouldn’t have to bring my own bedding or food, and I would have English speaking doctors. Of course, it all depends on what one can afford in Nicaragua.

      • Yes, he had the same operation as Marina. His neck looked like the stitching on a football and I feared massive scarring but is not noticeable now. He’s had no after effects and is guiding 3 volcano hikes this week.

        His mother was at a public hospital in Managua. Her family says the facilities aren’t much to look at yet still produced admirable results with her and her son. Another friend, a long time resident from Canada, had prostate surgery in a public hospital 2 years ago and has had no problems since.

        I’m impressed enough that I am letting my Pellas subscription lapse. I haven’t been sick in over 30 years and can afford my own meals should I need hospitalization. While I would prefer all the comforts of Pellas I understand many of the same doctors also service Militar and the prices are less than the Pellas discounts. For anything outside my budget I now have confidence in the public system.

        There are some nightmare stories here, one being a previous owner of Chido’s Pizza. On the other hand my sister’s husband has been through a living hell for 13 years while treated by UCLA and USC Medical and Cedars-Sinai. all stemming from a cut on his arm, and still nowhere close to good health. I’d hazard a guess his bills are approaching my lifetime earnings.

        Sandra, I was having a little fun with Pedasi Pundit’s comment. In my previous U.S life I worked very hard for the passage of ACA and extremely proud of the results. I was one of the first Oregon residents to sign up and will lose that when I change my US residency to Florida in the near future, though I believe Florida will now be a part of the federal system.

  3. What a rewarding experience for everyone, Debbie. The doctor and wife have come from humbling backgrounds and are empathetic with those with less. Sweet story of a loving group of people.

      • No, Lynne. I didn’t make the cake. Here’s the cake story. Julio, Marina’s son, is our yard man. He rakes and machetes our property. His father, Don Jose, passed away last October. He pulled me aside and told me he wanted to have our local cake baker make Ron a cake for his birthday and asked if I could pay him in advance of payday. He wanted it to be a surprise for Ron. Then, very tenderly, he said, “Ron is like my father, now.” It brought tears to my eyes! By the way, that cake cost Julio a week’s salary. I love this family!

    • Lynne, after the doctor’s family left yesterday, Marina stopped at our house to chat. She said she was exhausted, but very happy that she could share her home with her surgeon. Then, she told me that they are a very poor family because they have no land to raise pigs or grow beans, only a house surrounded by a big wall. She gave me yet another new perspective on what Nicaraguans think “poor” means.

    • I felt like a peeping Tom this week. Tee Hee. Yet, it was so unlike anything I had seen before, and being the curious person I am, I had to watch their daily interactions. What a pleasant surprise for me. And what a shock to see how much public healthcare doctors make in Nicaragua!
      My former gynecologist from TN is a U.S. Congressman, now. Although we had an “intimate” doctor/patient relationship, can you imagine him coming to my house for a vacation and helping me butcher a pig??? Oh, I can’t stop laughing.

      • Yes, you are right..
        I will ask the doctora ‘over’ the clinic in Jama what she makes per month.. She’s an amazing asset to our community, and I told her that last week. (I’m now getting strange spikes in my normally-low-to-norm blood pressure…)

        next week i will be offline, helping my friends in mindo – another story to share soon… don’t worry; not helping with physical tasks chores but one of the support of a good friend.

        i’m glad the chiky pains packed up and left you in peace!

  4. Really an amazing and humbling story that touched me. Just wow, can’t imagine how they survive on that income but they do. We can certainly do without many comforts in our modern world and get back to basics of living, loving, and compassion for fellow human beings. Thank you!

    • Barbara, thank you for taking the time to respond to my post. When Marina’s surgeon contacted her to tell her he was coming to Ometepe Island with his family for a vacation, Marina asked several small hostel owners near her house how much they charged for a room. She was shocked to learn that the rooms would cost $25 per night. She kept saying, “Muy caro! Muy caro.” (very expensive)
      So, she graciously invited the doctor’s family to stay with them.
      At first, I was puzzled. To me, $25 a night for a doctor is nothing. But, after researching the average salaries of public healthcare workers in Nicaragua, I understood.
      Back to the basics here, for sure.

  5. Incredible story and how lovely to meet Marina’s friend and physician. We had an encounter with a pulmonologist in Ecuador who actually stopped by our apartment on his own initiative to check on my husband. He then drove us around Manta (Sunday night during a power outage) to locate a functioning nebulizer and refused our offer of reimbursement. During our conversation we learned he was a professor at Manta’s medical school and that his monthly salary from that source (he operated a clinic also) was only $100. Anita

  6. A world that is long gone here in the states,,where ego reigns and compassion wanes.
    Lovely story , God bless each and every one ,a heartwarming story full of grace and talent!
    I look forward to my adventures in a whole new world .
    Light ,

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