Nicaragua

Written June 30, 2008

This was my third trip to Nicaragua. The place has started to be quite familiar to me, and I am beginning to develop what feels like a good relationship with many of the people there, including President Daniel Ortega and his wife Rosario.

President Ortega has perspectives different than those of many people in the United States, but I have always appreciated the fact that he treats me personally with dignity, and in a friendly, open way. We have developed the capacity to talk privately about our differences, and in the health field, we have common interests and aspirations for the people of Nicaragua.

This trip was actually fulfilling a commitment I had made to President Ortega when I saw him in January this year, at the inauguration of President Colom of Guatemala. During that conversation, we discussed the connection between clean water and air and general health. I committed to bring some people from the Environmental Protection Agency and the HHS Centers for Disease Control and Prevention to consult with the Nicaraguan Government on how to deal with the challenges they face with Lake Nicaragua, a large lake near the city of Granada.

People in the United States might reasonably ask why the United States Secretary of Health and Human Services spends time in Nicaragua worrying about the water. There are several reasons. My primary purpose for being in the region was the safety of products (especially food) imported into the United States. We are changing our strategy to make sure quality is built into the food we consume and a significant amount of our fresh fruit and vegetables is produced in Central America. One of the most significant components of food safety is the quality of water. If we want to have Central American fruit during the winter months, it is important the water they use in Nicaragua and elsewhere in the region to grow the fruit is clean.

Another reason is the success of Nicaragua as an emerging democracy. Our nation cares about the people of Nicaragua, and sees delivering on health and basic social services as important for elected governments to succeed, which further supports the stability of that region.

In the evening, President Ortega and I spent about an hour and a half talking together about the lake and ways we could work together to improve it. The lake has a fascinating history. President Ortega invited some knowledgeable local experts who are working hard to save the lake. I had invited Ben Grumbles, the Assistant Administrator for Water at EPA, to accompany me, and Captain Craig Shepherd from HHS/CDC, the Chief Environmental-Health Officer of the U.S. Public Health Service. We agreed to spend some time the next day actually on the lake to help us devise ways of working together.

Following our meeting, President Ortega drove me in his car to a local hospital, where we talked to patients, doctors and families about the quality of care they were getting and what needed to be done to improve their health system. There are a lot of needs in Nicaraguan hospitals.

Thursday morning we spent time on the lake itself, aboard a steamship. After the tour of the lake, the President and I drove around an island, and then settled into a meeting to outline a process for the U.S. Government to help Nicaragua, technically, in their clean-up. The Nicaraguans are aware of the progress we have made in the United States with our Great Lakes. When I was Administrator of the EPA, I organized the Great Lakes Collaboration, which has developed a master plan to further improve the lakes. We talked some about that process, and agreed to send a technical team to Nicaragua at the end of July.

President Ortega brought Secretary Leavitt and Captain Craig Shepherd on a boat tour of Lake Nicaragua to work on a plan to analyze the condition of Lake Nicaragua.

I met with several other groups while I was in Nicaragua, including people from the business community and a large group of students at the medical school of the National Autonomous University. I enjoy my encounters in other countries with students. They have straightforward questions, and I’ve found they appreciate straightforward answers.

Comments

Secretary Leavitt,
Have you given thought to pushing a better management system for healthcare in general? The international ISO standards, such as the ISO IWA-1, Guidelines for Process Improvements for Health Service Organizaitons or the new Automotive Industry Action Group (AIAG) document, Business Operationg Systems (BOS)for Health Care Organizations would be examples. Actually the Baldirge Award health care criteris would be another. Once a better management system is in place, best practices could be institutionalized in HC organizations and hopefully the best practices would be promoted throughout the USA. Dr. Donald Berwick is supposed to have said it takes about 15 years for new protocols for care to be adopted and by the time some adopt them they are obsolete.
Food for thought.

Posted by: Mickey Christensen | July 16, 2008 at 05:27 PM

Obviously the interest in Nicaragua´s water - products are directly related with United States , i was thinking that maybe some efforts (even little ones) could been made for a more global healthy improvement. Maybe some support for include the States in the Kyoto Protocol in a near future.

thanks for listening....

Posted by: Diseño Web | July 21, 2008 at 04:13 PM