Ambassador: Jasmine Grenier
1. Which aspects of Pandemic Preparedness is most pertinent to your country and why?
Nicaragua holds aspects of medical care that are proper to a developing country and some that are proper to a developed country. Indeed, its disease burden and highest causes of mortality are becoming highly due to heart disease and cancer. However, in the rural and indigenous communities, infectious diseases remain a high mortality burden. As over 40% of the population of Nicaragua is rural and as only 6.3% of the population of Nicaragua posses medical insurance, it is needless to say that this would be a major problem in a pandemic situation.
There are some inequities in the access to health services. These are due to many aspects, such as simple geography (rural regions are often hard to reach by medical care professionals or vice versa: cities are often hard to reach for people living in rural areas), socioeconomic status (most indigenous or people living in rural areas cannot afford medical treatment), gender, ethnicity (minorities –the indigenous –are often discriminated against, increasing the difficulty this risk group already has at getting medical care).
As examples of infectious diseases still very prevalent in rural and indigenous communities, tuberculosis and malaria (Plasmodium falciparum –the deadly species of malaria) are major disease burdens in these areas. This is not to mention the effects of environmental degradation (Nicaragua is the most deforested country in the Americas) on the disease burden. Indeed, deforestation breeds for the implementation of vectors to urban and rural communities.
As such, I believe the most pertinent aspect in Pandemic Preparedness in Nicaragua would be the availability of medical care to the populations and risk groups that need it.
2. How would you as the WHO Ambassador of your country address this issue?
Nicaragua has programs and projects set in place to better the situation, as to be adequately prepared to protect its population in the case of a pandemic.
First, National Development Plan 2004-2015 seeks to reduce social fragmentation and inequities in Nicaragua. This would idealistically allow all communities, ethnicities and social groups to access equal medical care.
The General Health Law which is a set of guidelines promoting and enforcing quality in the management and delivery of health services, with an outlook on maximizing benefits and user satisfaction with lower costs and risks. This General Health Law includes licensing and accreditation of health establishments and regulation of health professionals as well as establishment of bioethical tribunals.
The Comprehensive Health Care Model (MAIS) law is “the set of principles, standards, provisions, systems, plans, programs, interventions, and instruments for the promotion, protection, recovery, and rehabilitation of health, centered on the individual, the family, and the community, with actions targeting the environment, and coordinated with synergy, in order to effectively contribute to improving the standard of living of the Nicaraguan population.”1
The National Health Plan 2004-2015 encompasses this by recognizing the social inequities in medical care and the need to surpass them. It supports and implements other measures to provide care for all communities.
As a delegate, I would certainly advocate for and defend these methods which are highly targeted to the problems and concerns of the medical relief situation of the country and which have been designed to be highly effective.
3. How has your country addressed Pandemics in the past? What would you have done differently?
As the H1N1 did not cause that much damage in Nicaragua, I would have to say that the more recent, most important pandemic being dealt with now, is the emergence of an important HIV/AIDS pandemic
In the last four years, the country has seen a steady increase in HIV infection cases. The same problems that govern general pandemic preparedness of course apply here. The lack of trained healthcare workers and supply of medical care is a major issue in dealing with the HIV/AIDS pandemic. Moreover, the government is unable to supply infected individuals with anti-retroviral medication, and its costs (around 1000 US$ per year per person) make it almost impossible for infected individuals to get the treatment they need to keep their viral load in check.
Of course, inadequate treatment which yield high viral loads in infected individuals, make these individuals much more “contagious”, promoting the pandemic inside and outside high risk groups (men who have sex with men, sex workers and injection drug users)
However, the health officials in Nicaragua are aware of these difficulties and have made a point out of implementing projects and protocols to prevent transmission and to help infected individuals cope with their disease. For one, protocols for preventing mother-to-child transmission have been in place since the year 2000. Projects aiming at community mobilization against HIV/AIDS, delivery of antiretroviral drugs made available by the government to patients unable to collect them themselves, testing and treatment sites nation-wide and specific national and international funds donated to these various endeavours have made Nicaragua’s response to the rising HIV/AIDS pandemic aggressive and effective.
As this pandemic is, of course, not yet resolved, it is difficult to assess missteps and outcomes. These will come at a later date; in the meantime, we keep tracking the infection rates.
4. Which countries do you see yourself becoming allies or rivals with? Why?
International cooperation in the form of donations or loans is a primary help for the health sector in Nicaragua. These various countries and organizations make strong allies for Nicaragua, as they are constantly helping and supporting the country’s medical care infrastructure and the various programs which seek to improve it. A non-exhaustive list of potential allies for Nicaragua includes Austria, Canada, Finland, France, Germany, Ireland, Italy, Japan, the Netherlands, Norway, Sweden, Spain, the United Kingdom of Great Britain and Northern Ireland and USA. International organizations supporting Nicaragua and in turn supported by Nicaragua include The Red Cross and GAVI.