Tim’s Clinic (Consultorio Materno Infantil Tim) is our full-time children’s and women’s health clinic in Estelí, Nicaragua.
Tim’s Clinic was dedicated in 2005 in honor of Tim Anderberg, who died from injuries received in a pedestrian accident, and was the son of one of our most faithful volunteers, Roger Anderberg, MD. Tim, who was 24 years old when he died, loved life and possessed a contagious joy. All who met him experienced his electric personality and warmth, and he had a particular love for children. Tim’s dedication to the well-being of everyone he met during his life serves as a perfect motivation for the work we aim to do with the poor and disconnected of Nicaragua.
At Tim’s Clinic we employ three part-time physicians, an in-country coordinator, a care coordination nurse, pharmacist, lab technician, and clinic assistant. The clinic is dedicated to serving the city of Estelí as well as all of the many outlying areas of the larger Department of Estelí year-round.
In the United States, many of us are accustomed to participating in volunteer outreachs where we provide free healthcare to people in need. At Tim’s Clinic we also aim to provide affordable and comprehensive care to the community, but the model differs for very important reasons from that of the U.S. First, citizens of Nicaragua have disparate choices of healthcare. The government, via regional hospitals and health centers, provides free healthcare, including medications when available. Second, citizens of means can alternately receive care at military, police, or private hospitals, or from physicians with private practices. Finally, many citizens employed by companies of a certain size are entitled to health care, including medications, through a system similar to the common American model of employer provided health insurance. This latter group constitutes a very small sector of the population.
The reality is that the limited government health care budget is understandably spent on immunizations and care of hospitalized patients, so in actuality the cost for an individual who seeks care through a government health center or hospital is typically much higher than what it costs through Tim’s Clinic. For example, for a typical visit (consisting of a consultation with a physician, anti-parasite medication or immunization, antibiotics, and multivitamins), the cost at a government health care center would be the equivalent of $31; for citizens seeking private care, it would cost $54.70; and at Tim’s Clinic, it would cost only $1.90. However all clients of Tim’s Clinic undergo a financial assessment as part of the intake process. If Tim’s Clinic patients cannot pay even this small amount, they are eligible to receive free care.
There are several reasons we have adopted the model of asking for a donation of 50 Cordobas per physician visit. (Cordobas are the Nicaraguan currency; 50 Cordobas is the equivalent of approximately $1.90 US dollars.) First, we do not want to be in competition with the government health system. If patients have access to free government care, and they can be adequately treated there, we want them to use this system. Second, asking nothing can create a kind of paternalism that is not helpful. Third, if care were free, some patients would use the system to receive free medications which they would then sell on the black market. Allowing patients to make a contribution for care gives them dignity while requiring them to invest something in their own care. Our Tim’s Clinic Staff know their community well, and they have a system for determining when it is appropriate to exempt someone from the required payment. We have found this to be the most effective way to avoid duplication of services while also meeting our responsibility to our donors to be good stewards of our resources by limiting the opportunities for abuse of “free care.”