A pregnant woman waits for a taxi in downtown. Approximately a quarter of all Nicaraguan women experience their first pregnancy by age 17. (Sarah Kramer\/Medill)<\/figcaption><\/figure><\/div><\/div>\nOn a hill overlooking a steep mountain valley dappled with tropical greens and dry scrub brush, wire fences and a small dirt footpath lead to the main road and the town center of Boaco.<\/p>\n
Above all this sits the home of Milagro Solano Lira, 29, and her 4-year-old daughter, Yosmiling. She is a single mother, having separated from Yosmiling\u2019s father three years ago, and works as a lavandera, washing clothes. Her home is just two rooms, built of concrete and corrugated metal, with hardly enough chairs to seat the half-dozen visitors who come to visit on a windy afternoon in February. Outside her modest home is a panoramic view of mountains worthy of a palatial villa. She has no electricity or potable water and keeps chickens. She grows fruit and herbs in a small yard fenced by barbed wire wound around thick branches.<\/p>\n
On the day the visitors came, Yosmiling, a sweet toddler in a pink dress, had a cough and a fever. After work, Lira said, she\u2019ll take her to the clinic where her sister, Yessica Solano, works as a nurse. She has been going to this clinic for two years, and though she has to pay for consults and travel an hour each way on the public bus, she far prefers it to the free public clinics run by the Ministry of Health. It\u2019s faster, she said, and the staff is more attentive. She has to save to pay the 30 c\u00f3rdobas, roughly $1.20, a suggested donation the clinic asks for each consult. Still, she said, the treatment she receives is worth it.<\/p>\n
Welcome to Cl\u00ednica Verde .<\/p>\n
The gold and green building stands against a backdrop of farmland, with the rough, verdant hills of central Nicaragua in the distance. A large sign sits in front of the landscaped breezeway, complete with pharmacy window and a small wooden swing. Double doors lead to a lobby where patients, mostly women and children, wait for their appointments. Cl\u00ednica Verde, however, is trying to be something more than a doctor\u2019s office. Cl\u00ednica Verde is trying to change how we view health care, starting in a small corner of Nicaragua, the second poorest country in Latin America.<\/p>\n
Joselin<\/strong><\/p>\nSusan Dix Lyons, founder of Cl\u00ednica Verde, has always felt a connection with Nicaragua. Her journalist grandfather traveled the country in the 1970s, meeting Pedro and Violeta Chamorro while Pedro was the editor of la Prensa. The Chamorros were outspoken critics of the Somoza family, who ruled Nicaragua with an iron fist for over 40 years. In 1978, Pedro\u2019s assassination by unknown gunman sparked riots in Managua. The following year, the Sandinista National Liberation Front overthrew the Somoza regime and the small country plunged into a decade of revolution and turmoil.<\/p>\n
In 1990, Dix Lyons was a reporter for the Tico Times in Costa Rica. She traveled to Nicaragua to report on the presidential election\u2014the second since the first Somoza, Anatasio, seized power in a coup on New Year\u2019s Day, 1937. Violeta Chamorro, the widow of the assassinated journalist, won narrowly over incumbent Daniel Ortega. Dix Lyons\u2019 connection to Nicaragua and the Nicaraguan people had been reinvigorated.<\/p>\n
Then life took over. Dix Lyons moved back to the U.S. at the end of 1990. She moved to Chicago and then to Tampa, Florida, working her way up the ranks of a local alternative weekly, then back to California in 2001; to raise her sons with her husband, Tim. She went back to graduate school for a master\u2019s degree in art history and in the process became fascinated with sustainable urban design.\u00a0 She also gave birth to a daughter in 2003.<\/p>\n
After graduating in 2005, Dix Lyons said, she was \u201clooking for purpose. In 2006, she returned with a group of volunteers to Nicaragua. The poverty, especially among young women, ignited her passion. She had found her purpose.<\/p>\n
\u201cI met a lot of people who had a clear and significant need,\u201d Dix Lyons said of her return to Nicaragua. She remembered Joselin in particular: a small girl, 9 or 10 years old, with warm brown eyes and wavy, chin-length hair.<\/p>\n
\u201cI looked at Joselin and said, this could be my daughter,\u201d Dix Lyons said. To the journalist and mother of three, it seemed Joselin was suffering because of the \u201cgrave injustice\u201d of being born into poverty. Dix Lyons saw in this little girl the stark reality of a life that was severely limited by external circumstances\u2014the likelihood of a next meal, the need for adequate shelter.<\/p>\n
\u201cJoselin, in my mind, became a point of inspiration,\u201d Dix Lyons recalled. \u201cI starting thinking about what we could do to make her life a little better, to give her more options: a life of dignity, possibility, hope.\u201d<\/p>\n
This drive is what led Dix Lyons to start working on the idea of Clinica Verde: a place where even the most impoverished could receive not only health care, but true compassion. In 2007, she asked Cristiana Chamorro, the daughter of Violeta and Pedro, to join her in creating Clinica Verde.<\/p>\n
\u201cWe wanted to create a place for health and well-being from the ground up. What would that look like, what would that feel like?\u201d Dix Lyons asked.<\/p>\n
Dix Lyons began raising funds for Clinica Verde in 2007. The following year, the Clinica Verde board of directors met for the first time in Managua, Nicaragua\u2019s capital city. Then the mayor of Boaco, Vivian Orozco, donated the land for the clinic, a lengthy a complex process. Dix Lyons and the board then spent two years designing the clinic, drawing on the expertise of doctors, engineers and architects from both countries.<\/p>\n
Dix Lyons acknowledges that the process was, at times, frustrating, but the lengthy design and building process \u201cgave us the time to establish meaningful relationships; get to know the community better and signal our unflagging commitment to the vision.<\/p>\n
The clinic is a laboratory of sorts, constantly building new programs and partnerships and adapting to challenges. \u201cWe have to be flexible and adaptive,\u201d Dix Lyons said. \u201cWe\u2019re trying to evolve and grow and become better all the time.\u201d<\/p>\n
A prototype<\/strong><\/p>\nThe Nicaraguan Ministry of Health provides health care to all Nicaraguans through a system of health outposts, clinics and hospitals throughout the country. Health posts are small and give generalized medical care. For those who can afford upper-tier medical care, there are private clinics. Everyone else relies on government facilities. Even these, however, are subdivided into clinics for those with insurance, and clinics for those without.<\/p>\n
As in the U.S., insurance can be provided by an employer or bought in a la carte packages, the main difference being that the government is the sole insurance provider in the market. Most Nicaraguans, however, are poor, with 76 percent living on less than $2 per day. In the department of Boaco, where Cl\u00ednica Verde is located, just over 5,000 patients have insurance in an estimated population of 171,000. In addition, an estimated 37 physicians serve every 100,000 Nicaraguans, and there\u2019s roughly one hospital bed for every 10,000. (In the U.S., there are 245 physicians per 100,000 people and 30 beds per 10,000.)<\/p>\n
Compounding these issues, said Rafael Morales, general manager at Cl\u00ednica Verde, is the fact that Nicaraguan society remains segregated by class. Morales, who grew up in Nicaragua but lived in the U.S. for much his adult life, said that the customer service model of care is somewhat different in Nicaragua, especially when economic class comes into play. But Cl\u00ednica Verde, he said, aims to add a special touch: a kind word, a smile, an affirmation of dignity for every patient, no matter what.<\/p>\n
\u201cI feel strongly that being loved, being touched on a personal level, being looked at with compassion and care, is the first step to well being,\u201d Dix Lyons said.<\/p>\n
La cl\u00ednica<\/strong><\/p>\nCl\u00ednica Verde requests that patients make a 30 cordoba ($1.20) donation for a consult\u2014a pittance by U.S. standards, but the equivalent of more than half a day\u2019s wages for most Nicaraguans. If the price is too steep, however, the clinic won\u2019t turn a patient away. Of 44 patient consults on a single day in February, 12 patients paid nothing at all. The requested donation, said Betsy Dankenbring, the clinic\u2019s interim medical coordinator, is a new policy, intended to promote the idea of Cl\u00ednica Verde as an investment for the community. One of Cl\u00ednica Verde\u2019s goals, Morales said, is eventually to become self-sustaining, rather than reliant on the U.S.-based fundraising efforts that currently fund clinic operations.<\/p>\n
The clinic can test blood samples and pap smears, and recently received a colposcope, a machine physicians use to examine the cervix, a key tool in the battle against cervical cancer, the most common form of cancer among Nicaraguan women. Dankenbring said the clinic has the ability to provide the vast majority of common diagnostic tests. The clinic is also expanding into dentistry, with two dental chairs and the first panoramic X-ray machine in Boaco.<\/p>\n
La farmacia<\/strong><\/p>\nTo the left of the lobby entrance, a small pharmacy window provides medication to patients. Some are free, but others are sold at what Morales calls an \u201cethical markup,\u201d That is, the minimum Cl\u00ednica Verde can charge while not losing money. Any medicine Cl\u00ednica Verde receives for free is redistributed without charge, said Dankenbring. Implanon, for example, a contraceptive implant, is available for about $15\u2014far less than the $100 price tag at a private clinic. Childhood vaccinations are free, thanks to a USAID program.<\/p>\n
The question of financial independence can sometimes strain the clinic\u2019s ability to compete with the single-payer model of the government clinics. While Cl\u00ednica Verde runs its pharmacy on very slim margins, Lira said she can\u2019t always afford to pay Cl\u00ednica Verde prices for medications. However, she pointed out, government clinics are often out of certain medicines. When she can\u2019t afford pharmaceuticals, Lira treats her and her daughter\u2019s ailments with herbal folk remedies from her garden.<\/p>\n
El huerto<\/strong><\/p>\nBehind the clinic, roughly three dozen garden beds burst with squash flowers, bean tendrils, bright amaranth blossoms and desiccated sunflowers, ripening chili peppers and rich green kale, with tawny bursts of marigolds providing natural pest protection. The garden, the result of a partnership with sustainable agriculture nonprofit Global Student Embassy, is biointensive.<\/p>\n
Biointensive agriculture focuses on producing as much food as possible in a relatively small area while improving soil quality and minimizing negative impacts. The gardens are organic and serve as teaching tools for the surrounding communities. Global Student Embassy, a California-based environmental education non-profit, and Clinica Verde have also brought small gardens to nearby schools, with the goal of growing produce for the schools\u2019 cafeterias. In March, Clinica Verde announced plans to launch a 10-week prenatal and early childhood nutrition program, using the garden as a teaching tool for nutrition and cooking classes. An estimated 23 percent of children in Nicaragua are undernourished, and need is even greater in rural areas. The clinic hopes to use the biointensive garden and spacious kitchen facilities to combat malnutrition.<\/p>\n
Just outside the kitchen, a small greenhouse provides a safe space for seedlings, while a black tank collects rainwater. A few feet from the tank stands one of Clinica Verde\u2019s most ambitious and challenging moves toward sustainability projects: the transition to solar panels for free energy and a smaller carbon footprint.<\/p>\n
Los paneles solares<\/strong><\/p>\nThe solar panels are the result of another partnership, this time with Portland, Oregon-based Green Empowerment and its local affiliate, Asociaci\u00f3n Fenix. A mutual donor interested in helping Cl\u00ednica Verde lower steep electricity bills supported the partners and project. Caitlyn Peake, Green Empowerment\u2019s regional director for Latin America, said the organizations knew of other solar projects that had been given permission to connect to the Nicaraguan grid, and were encouraged to go ahead with the project to demonstrate commitment. One year later, and the solar panels are up and running, supplying 30 percent of the clinic\u2019s electricity.<\/p>\n
\u201cThey\u2019re basically just producing electricity that they\u2019re using for themselves at any one moment, but what they\u2019re not doing is offsetting electricity they use at night\u201d or during other sunless periods, Peake said.<\/p>\n
Peake is confident that legislative change will soon require Nicaraguan utility companies to allow solar energy systems to connect and send excess power back to the grid. When this happens, Peake estimated, the clinic will be 70 percent powered by solar panels. Despite the sense that tropical climes are best suited to the solar revolution, the experience of Cl\u00ednica Verde shows the need for legal and physical infrastructure to support alternative energies.
\nGreen Empowerment, like Cl\u00ednica Verde, works in conjunction with local nonprofits to create innovative, sustainable projects that improve the lives of the community members.<\/p>\n
Organizations outside of Nicaragua are also starting to take notice of the huge benefit solar energy can bring to developing nations. \u201cBy powering a community, you can definitely improve health outcomes,\u201d said Katharine McCormick author of the recent Natural Resources Defense Council paper, \u201cBridging the Clean Energy Divide.\u201d Solar, she said, also subverts the argument that communities must choose between clean environments and the improved standard of living electricity provides.<\/p>\n
In places where utilities and legislation are ready for solar connections, the renewable resource has great potential to expand access to power in the developing world, said Dick Co, assistant professor of chemistry at Northwestern University and director of outreach at Argonne-Northwestern Solar Energy Research Center, said word. \u201cIt\u2019s really an abundant source of energy that we know how use,\u201d he said, pointing out that the cost of panels has decreased significantly as technology has improved. In addition, the small-scale and localized nature of solar power means that the effects of severe weather events on the power supply are mitigated, McCormick said. When one panel goes, the system can continue to function.<\/p>\n
Asociaci\u00f3n Fenix has been operating in Nicaragua for over a decade. Local partners, Peake said, are critical to the success of any long-lasting project because of the individualized historical and cultural knowledge each brings.<\/p>\n
\u201cI would have never gone in as an American without strong partners,\u201d Dix Lyons said. \u201cI knew they had answers and understanding that I never could.\u201d Also like Clinica Verde, Green Empowerment asks that communities make small investments to establish the community\u2019s commitment.<\/p>\n
Roughly two hours from Boaco, the small, arid village of el B\u00e1lsamo has experienced major changes as a result of the AsoFenix\/Green Empowerment partnership. Prior to the groups\u2019 collaboration, which began in April 2013, residents drew all their water from the nearby river, walking over a mile to gather drinking water, wash clothing and water livestock.<\/p>\n
After seeing AsoFenix\u2019s work in a neighboring village, the community of el Balsamo decided to partner with the nonprofits, contributing local labor and supplies to install a solar-powered pump system to draw clean groundwater up from over 35 feet underground. The water is pumped to a large, bright blue tank that sits on a hilltop overlooking the village. The water powers the village\u2019s first communal running-water bathroom and laundry sinks. El Balsamo residents contributed not only labor and materials, but gave a small financial contribution to cover between 20 or 30 percent of the cost of project. Now families pay a usage fee of 10 cordobas per liter, roughly 37 cents.<\/p>\n
Eusebia Campos Rodriguez, a member of the community council tasked with maintaining the project, said the former water supply, from a small river nearby made children and adults ill and gave them skin infections when they bathed. More than 2.8 million people in Nicaragua lack access to adequate sanitation, according to the nonprofit WaterAid. The families in the village had neither running water nor electricity, and relied on latrines.<\/p>\n
Most communities, Peake said, hear about AsoFenix\u2019s work by word-of-mouth. \u201cThey know what their neighbors have done and invested. They get a better sense of what it would be like to develop it,\u201d she said.<\/p>\n
While all the council members agree clean water has been the greatest contribution to the community, AsoFenix is also empowering the community with improved nutrition. The nonprofit partners helped start 32 small huertos, or backyard gardens, so families can grow fresh produce\u2014mangoes, bananas, herbs, beans, squash and more— a boon for a village without access to refrigeration. The food produced in the garden is then prepared on improved cook stoves, designed as an alternative to the traditional wood-fired stoves that caused respiratory and eye infections for families. These problems were even greater in women and children, who spend the most time at home.<\/p>\n
\u201cIt\u2019s so bright now!\u201d joked Rodrigues, mimicking the women wiping smoke from their eyes after the introduction of the new stoves. The cleaner burning stoves use less wood, diminishing the need to haul heavy firewood, and offer the safety of an enclose frame and chimneys.<\/p>\n
In some ways, el Balsamo is a perfect laboratory for these small scale but deeply impactful projects. Because massive, centralized energy infrastructure isn\u2019t yet in place, developing areas have a chance to start fresh. \u201cThey don\u2019t have to undo decades and decades of investment in dirty energy,\u201d McCormick said. \u201cThey can kind of a start with a clean slate.\u201d<\/p>\n
Co said that solar energy could help equalize not only health outcomes, but even deeper disparities:<\/p>\n
\u201cIt\u2019s not just watts you\u2019re putting out; it\u2019s a domino effect,\u201d Co said. \u201cIf you bring power and electricity to the developing world you can allow children, men and women especially to learn.\u201d<\/p>\n
La salud de las mujeres<\/strong><\/p>\n\u201cWomen are the backbone of society,\u201d Dix Lyons said. \u201cThey care for, teach and support the next generation.\u201d The health of women is a major component of Clinica Verde\u2019s work. Of the over 10,134 patients seen at Cl\u00ednica Verde in 2014, women accounted for 7,174. Nearly 2,000 of these women were between 20 and 34 years old. According to the Guttmacher Institute, roughly half of Nicaraguan women give birth before the age of 20. By providing low- or no cost contraception, pap smears and colposcopies, the clinic promotes good sexual health practices in a deeply Catholic country.<\/p>\n
As part of Cl\u00ednica Verde\u2019s model of not just healing, but uplifting community members, the clinic has partnered with Latin American youth empowerment organization JovenSalud, or TeenSmart, to run an after-school program that teaches teenagers about sexual health, personal safety and communication skills. Both sexes are encouraged to attend, but the goals of the program are undeniably geared toward a society where women often have little or no autonomy.<\/p>\n
The program coaches teens to counsel their peers with the same lessons they learn at the clinic. Yessica Solano, Milagro Lira\u2019s sister, runs the sessions, which might include instructional videos, internet questionnaires, role playing scenarios or frank discussions about contraception. Even the youngest teens will soon start seeing pregnancy in their peer groups.<\/p>\n
One teen counselor, Marcela, said the goal is breaking free of the linked cycles of teen pregnancy, lack of education and domestic violence that plagues Nicaraguan women.<\/p>\n
Dix Lyons understands the struggle of Nicaraguan women acutely, especially for mothers like Lira: \u201cA lot of the households are led by single women who work very hard to scrape by, to have enough food for their children, to have enough money,\u201d Dix Lyons said. \u201cWomen don\u2019t have the opportunities that we have in the States.\u201d Again, it is the profound injustice of circumstance that drives Dix Lyons\u2019 passion to help the people of Boaco.<\/p>\n
She credits Joselin as a source of inspiration for her work with Cl\u00ednica Verde, adding fuel to her deeply felt \u201cmission\u201d to help the world\u2019s most needy. After four years of hard work to get Cl\u00ednica Verde off the ground, Dix Lyons found Joselin
\nagain\u2014a young mother, selling food by the side of the road.<\/p>\n
\u201c I walked away, behind this building, and I just cried.\u201d She remember. \u201cI felt like we weren\u2019t good enough. We weren\u2019t fast enough.\u201d<\/p>\n
Joselin still visits the clinic. \u201cWe\u2019re not going to be able to save everybody,\u201d Dix Lyons said, but is indefatigable in her optimism. \u201cI feel that I\u2019m doing work that I was intended to do.\u201d<\/p>\n
Dix Lyons aims to build a replicable prototype that could bring the same form of compassionate care to communities around the globe, including to the U.S. She admitted she will never be finished with the grand project that is Clinica Verde, the compassionate care model. She wakes up in the middle of the night, sometimes, in her home in California\u2019s Napa Valley, wondering:<\/p>\n
\u201cHow do I make this sure this lasts well beyond me? How do I keep this going?\u201d<\/p>\n
She wants Clinica Verde to have the widest impact possible, to save always more people, to lift them out of poverty, to show them individual kindnesses.<\/p>\n
And how does she respond to the skeptics and the isolationists, to those who don\u2019t share or understand her dedication to Clinica Verde?<\/p>\n
\u201cOne of the first things I always say is, will you come?\u201d<\/p>\n
Photo at top: Yosmiling plays outside her mother’s home with her cousin in Boaco, Nicaragua. Boaco’s hillside setting divides the city into Upper and Lower Boaco. (Sarah Kramer\/Medill)<\/div>\n","protected":false},"excerpt":{"rendered":"
By Sarah Kramer On a hill overlooking a steep mountain valley dappled with tropical greens and dry scrub brush, wire fences and a small dirt footpath lead to the main road and the town center of Boaco. Above all this sits the home of Milagro Solano Lira, 29, and her 4-year-old daughter, Yosmiling. She is […]<\/p>\n","protected":false},"author":60,"featured_media":14440,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[452,28,29,436],"tags":[192],"class_list":["post-14342","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-beyond-chicago","category-general-interest","category-health-and-science","category-spring-2015","tag-promo"],"yoast_head":"\n
Under One Roof: A new approach to health care in Nicaragua - Medill Reports Chicago<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Under One Roof: A new approach to health care in Nicaragua - Medill Reports Chicago\" \/>\n<meta property=\"og:description\" content=\"By Sarah Kramer On a hill overlooking a steep mountain valley dappled with tropical greens and dry scrub brush, wire fences and a small dirt footpath lead to the main road and the town center of Boaco. Above all this sits the home of Milagro Solano Lira, 29, and her 4-year-old daughter, Yosmiling. She is […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/\" \/>\n<meta property=\"og:site_name\" content=\"Medill Reports Chicago\" \/>\n<meta property=\"article:published_time\" content=\"2015-05-07T22:49:42+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2015-05-21T21:43:54+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/yosmiling-resize.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"1100\" \/>\n\t<meta property=\"og:image:height\" content=\"643\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"sarahkramer\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"sarahkramer\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"18 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/\",\"url\":\"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/\",\"name\":\"Under One Roof: A new approach to health care in Nicaragua - Medill Reports Chicago\",\"isPartOf\":{\"@id\":\"https:\/\/news.medill.northwestern.edu\/chicago\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/yosmiling-resize.jpeg\",\"datePublished\":\"2015-05-07T22:49:42+00:00\",\"dateModified\":\"2015-05-21T21:43:54+00:00\",\"author\":{\"@id\":\"https:\/\/news.medill.northwestern.edu\/chicago\/#\/schema\/person\/374a52a22db26fa80eadfc3bbe87474e\"},\"breadcrumb\":{\"@id\":\"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/#primaryimage\",\"url\":\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/yosmiling-resize.jpeg\",\"contentUrl\":\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/yosmiling-resize.jpeg\",\"width\":1100,\"height\":643},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/news.medill.northwestern.edu\/chicago\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Under One Roof: A new approach to health care in Nicaragua\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/news.medill.northwestern.edu\/chicago\/#website\",\"url\":\"https:\/\/news.medill.northwestern.edu\/chicago\/\",\"name\":\"Medill Reports Chicago\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/news.medill.northwestern.edu\/chicago\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/news.medill.northwestern.edu\/chicago\/#\/schema\/person\/374a52a22db26fa80eadfc3bbe87474e\",\"name\":\"sarahkramer\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/news.medill.northwestern.edu\/chicago\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/861e5e2609791890ffa729810e6a713da75328a198a6db04b66065ebe2666f1e?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/861e5e2609791890ffa729810e6a713da75328a198a6db04b66065ebe2666f1e?s=96&d=mm&r=g\",\"caption\":\"sarahkramer\"},\"url\":\"https:\/\/news.medill.northwestern.edu\/chicago\/author\/sarahkramer\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Under One Roof: A new approach to health care in Nicaragua - Medill Reports Chicago","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/","og_locale":"en_US","og_type":"article","og_title":"Under One Roof: A new approach to health care in Nicaragua - Medill Reports Chicago","og_description":"By Sarah Kramer On a hill overlooking a steep mountain valley dappled with tropical greens and dry scrub brush, wire fences and a small dirt footpath lead to the main road and the town center of Boaco. Above all this sits the home of Milagro Solano Lira, 29, and her 4-year-old daughter, Yosmiling. She is […]","og_url":"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/","og_site_name":"Medill Reports Chicago","article_published_time":"2015-05-07T22:49:42+00:00","article_modified_time":"2015-05-21T21:43:54+00:00","og_image":[{"width":1100,"height":643,"url":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/yosmiling-resize.jpeg","type":"image\/jpeg"}],"author":"sarahkramer","twitter_card":"summary_large_image","twitter_misc":{"Written by":"sarahkramer","Est. reading time":"18 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/","url":"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/","name":"Under One Roof: A new approach to health care in Nicaragua - Medill Reports Chicago","isPartOf":{"@id":"https:\/\/news.medill.northwestern.edu\/chicago\/#website"},"primaryImageOfPage":{"@id":"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/#primaryimage"},"image":{"@id":"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/#primaryimage"},"thumbnailUrl":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/yosmiling-resize.jpeg","datePublished":"2015-05-07T22:49:42+00:00","dateModified":"2015-05-21T21:43:54+00:00","author":{"@id":"https:\/\/news.medill.northwestern.edu\/chicago\/#\/schema\/person\/374a52a22db26fa80eadfc3bbe87474e"},"breadcrumb":{"@id":"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/#primaryimage","url":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/yosmiling-resize.jpeg","contentUrl":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/yosmiling-resize.jpeg","width":1100,"height":643},{"@type":"BreadcrumbList","@id":"https:\/\/news.medill.northwestern.edu\/chicago\/under-one-roof-a-new-approach-to-health-care-in-nicaragua\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/news.medill.northwestern.edu\/chicago\/"},{"@type":"ListItem","position":2,"name":"Under One Roof: A new approach to health care in Nicaragua"}]},{"@type":"WebSite","@id":"https:\/\/news.medill.northwestern.edu\/chicago\/#website","url":"https:\/\/news.medill.northwestern.edu\/chicago\/","name":"Medill Reports Chicago","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/news.medill.northwestern.edu\/chicago\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/news.medill.northwestern.edu\/chicago\/#\/schema\/person\/374a52a22db26fa80eadfc3bbe87474e","name":"sarahkramer","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/news.medill.northwestern.edu\/chicago\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/861e5e2609791890ffa729810e6a713da75328a198a6db04b66065ebe2666f1e?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/861e5e2609791890ffa729810e6a713da75328a198a6db04b66065ebe2666f1e?s=96&d=mm&r=g","caption":"sarahkramer"},"url":"https:\/\/news.medill.northwestern.edu\/chicago\/author\/sarahkramer\/"}]}},"_links":{"self":[{"href":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-json\/wp\/v2\/posts\/14342","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-json\/wp\/v2\/users\/60"}],"replies":[{"embeddable":true,"href":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-json\/wp\/v2\/comments?post=14342"}],"version-history":[{"count":0,"href":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-json\/wp\/v2\/posts\/14342\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-json\/wp\/v2\/media\/14440"}],"wp:attachment":[{"href":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-json\/wp\/v2\/media?parent=14342"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-json\/wp\/v2\/categories?post=14342"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/news.medill.northwestern.edu\/chicago\/wp-json\/wp\/v2\/tags?post=14342"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
![\"SLIDESHOW-2\"](\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-21-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-5\"](\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-51-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-6\"](\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-6-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-7\"](\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-7-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-8\"](\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-8-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-10\"](\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-10-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-11\"](\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-11-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-12\"](\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-12-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-13\"](\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-13-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-14\"](\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-14-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-15\"](\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-15-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-16\"](\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-16-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-17\"](\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-17-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-19\"](\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-19-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-20\"](\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-20-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-21\"](\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-211-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-17\"](\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-171-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-18\"](\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-181-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-3\"](\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-3-150x150.jpg\")
<\/a><\/div><\/div><\/div>![\"SLIDESHOW-4\"](\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/05\/SLIDESHOW-4-150x150.jpg\")
<\/a><\/div><\/div><\/div>