Going global: UNC’s work in Nicaragua

Almost 2,000 miles away, researchers, physicians and residents from N.C. Children’s Hospital are improving health and outcomes for Nicaraguan families. Our collective efforts are helping improve birth outcomes, advance research in pediatric infectious diseases and train local physicians and residents in new techniques and processes.

Going global: UNC’s work in Nicaragua click to enlarge Dr. Augusto Guevara, a neonatologist, working in the neonatal intensive care unit in Leon, Nicaragua. Dr. Guevara spent time training at UNC through our program and regularly hosts pediatric residents from UNC.
Going global: UNC’s work in Nicaragua click to enlarge Dr. Gladys Jarquin, a pediatric infectious disease physician with her medical team in Nicaragua. Dr. Jarquin spent time training at UNC through our program and regularly hosts pediatric residents from UNC.

A little more than 1,600 miles away from the N.C. Children’s hospital, researchers, physicians and medical residents are working to make a difference in health outcomes for children, mothers and families.

UNC’s collaborative efforts in Nicaragua span improvements to data collection and the quality of care, research focused on pediatric infectious diseases including Zika, a clinical exchange program that brings Nicaraguan physicians to Chapel Hill for training and resident programs in pediatrics.

Programs are led by Carl Bose, MD, Professor of Pediatrics in the Division of Neonatal-Perinatal Medicine, Sylvia Becker-Dreps, MD, MPH, Associate Professor of Family Medicine and Associate Director of the Office of International Activities, and Rick Hobbs, MD, Associate Professor of Internal Medicine and Pediatrics.

“We come at improving overall health outcomes from many different directions,” says Dr. Bose. “At the core of our efforts, we’re partnering with the government, local providers and nonprofits to ensure we’re providing what the communities actually need.”

Addressing the need

Infant mortality rates in Nicaragua can be as high as 54/1,000 live births in some areas of the country. Low-cost interventions, including training in neonatal resuscitation and other elements of basic newborn care, have been shown to effectively reduce newborn mortality and improve the overall quality of care.

Dr. Bose’s initial work in Nicaragua was sparked by interest from neonatology fellows at the School of Medicine and the generosity of a donor from the UNC Children’s Board of Visitors, Cecile Noel.

Dr. Bose started the work by partnering with AMOS, a nonprofit dedicated to addressing the problems of poverty, disease and preventable deaths in Nicaragua. Together, they identified two local health centers in which they would implement a teaching program aimed at improving the quality of care and processes of care, particularly for early newborn care. This effort helped the health systems more closely align with what the Nicaraguan Ministry of Health was recommending.

“It was so successful, the local supervisor from the Ministry wants to expand it into more health centers,” Dr. Bose says. “That’s what we’re currently working on.”

Research to improve outcomes

Dr. Becker-Dreps leads a research collaboration around pediatric infectious diseases in Nicaragua, primarily in Leon. The collaboration is supported with a variety of funding sources including the National Institutes of Health and foundation and private contributions.

“Over the past year or more, we have been very involved with understanding more about Zika,” says Dr. Becker-Dreps. “Because UNC is such a collaborative place, I’ve been able to bring in Elizabeth Stringer, MD [associate professor of maternal-fetal medicine at UNC] and Natalie Bowman, MD, MPH [assistant professor of medicine in the division of infectious diseases at UNC] to make sure we’re addressing the issue from all areas.

In addition to Zika research, Dr. Becker-Dreps is also evaluating the effectiveness of Nicaragua’s vaccination programs, and trying to understand why rotavirus vaccines are not as effective in third-world settings.

“The great thing about our research in Nicaragua is that we have such a variety of specialties working together,” Dr. Becker-Dreps says. “We have medical students, residents and physicians in pediatrics, family medicine, cardiology, public health and more all collaborating to address the health challenges in Nicaragua and ultimately improve care.”

Education to advance care 

Dr. Hobbs leads a program that provides educational experiences for pediatrics residents at UNC, as well as exchange opportunity for physicians from Nicaragua to come to North Carolina to train. In the past three years, 10 residents from UNC have participated in the program, and specialists in neonatology and infectious disease have traveled to North Carolina for training. 

“The neonatologist from Nicaragua who participated in our program says that he’s actually saved babies’ lives back home because of what he learned at UNC,” Dr. Hobbs says. “He was able to copy protocols from our hospital and brought them back to his hospital in Nicaragua to help improve safety and outcomes.”

One resident from UNC, Erin E. Hayes, MD, participated in the program in January 2016. She says she thoroughly enjoyed her time in Leon, Nicaragua, and spent the majority of her time in the Neonatal Intensive Care Unit at the hospital there.

“It was wonderful working with the residents there, as the hospital in Leon is a teaching hospital,” Dr. Hayes says. “While in Leon, I also had an opportunity to volunteer in a local orphanage. We played, sang songs, and did arts and crafts projects with the children, who were very excited and appreciative. My time spent there provided great learning experience from both a cultural and medical standpoint.”

Faculty from UNC also regularly travel to Nicaragua with this program to do symposiums on a variety of topics. Earlier this year, Dr. Elizabeth Estrada traveled there to talk about common endocrine issues Nicaraguan children face, and potential approaches to treatment.

“Everything we do with this program fits the CARE model that we champion at UNC Children’s,” Dr. Hobbs says. “We’re providing and improving clinical care, we’re advocating for our residents and vulnerable populations, we’re conducting research and providing educational exchange. It’s been great to see the program grow over the years.”

What’s next?

As the overall work in Nicaragua continues, leaders are working to expand the services and opportunities available for residents and the communities the program serves.

“There is such a great need there, and our work with local leaders and non-profits continues to introduce us to more opportunities,” Dr. Hobbs says. “We couldn’t do the work we do without financial support from organizations like the NIH, foundations and private donors. And, of course, we are extremely grateful to our leadership and commitment to this effort from the Department of Pediatrics, particularly Dr. Kevin Kelly. We’re excited to partner with others to expand the work moving forward.”

For more information about how you can help support UNC’s efforts in Nicaragua, please contact Leslie Nelson

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