November 22, 2020.

Dear PHL friends,

This year, the COVID-19 pandemic has stressed every single health care system in the world. We have learned to quickly adapt and be on par to the situation. We have recognized how important it is to collaborate, preserve resources, and allocate them to the ones in need.

PHL had a very successful trip to Leon in January 2020. We saw 175 patients and the interventional team, primarily from Chapel Hill, performed 16 successful interventions, including minimally invasive repair of cardiac defects.

Our ambitious plan was to return in July with group dedicated to treat heart rhythm disorders (electrophysiologists) led by Dr. Brumfield, and in October with a surgical group headed by Dr. Ted Koutlas to perform open heart surgery for valve replacement. Of course, the COVID-19 pandemic has put these plans on hold. We learned that our colleagues in Leon were overwhelmed with COVID-19 cases. The COVID-19 unit was created on the ground floor of the HEODRA hospital, and at the peak of the pandemic they had an average of 60 severe cases per day in a unit that typically treat a maximum of 10 patients. Mechanical ventilators and personal protective equipment (PPE) were scarce. Many physicians who I personally knew died in the front lines and many others survived after being severely ill.

Officially, it is difficult to know the statistics of the COVID-19 pandemic in Nicaragua. The website of the Nicaraguan Ministry of Health has been down since early August due to a hacking attack by “Anonymous/Lorian Synaro.” Some NGO’s estimate that the number of cases and mortality is being underestimated by factor of 3. The positivity rate at the peak of the pandemic was around 50%. Fortunately, the number of severe infections and admissions to the COVID-19 unit have decreased substantially. The average number of patients in the unit over the last four weeks is around 4. We attribute this to the awareness of the population of the importance of wearing masks, hand hygiene, and social distancing.

When we contacted physicians, nurses, and health authorities in Leon during the beginning of the pandemic, their more pressing needs were PPE’s and mechanical ventilators. Mechanical ventilators were, and still are, difficult to get. We bought in Managua a total of 688 N95 masks, 30 reusable face shields, 30 pairs of boots, 80 protective suits, and 300 oxygen masks. In addition, we bought 250 cloth masks and face shields for the personnel working in the other units in the hospital. The majority of the PPE’s were delivered for the COVID-19 unit at HEODRA. We also delivered PPEs to Victoria Motta Hospital in Jinotega. We spent $14,531.17 in this endeavor; none of this would be possible without the generosity of our donors.

Category 5 hurricane Eta landed in the northeast coast of Nicaragua two weeks ago. The hurricane destroyed an entire indigenous Miskito village in Wawa Bar and caused significant damage in Puerto Cabezas, the capital city of the Autonomous North Atlantic Region. Two fatalities were reported initially, but the authorities are still counting. Despite the damage, the roads were still in good condition to allow the World Food Program to deliver 8 tons of food. It is so far estimated that 3.8 million people were affected in Central America due to this hurricane. Just as I was preparing this newsletter, an even more powerful category 5 hurricane (Iota)landed in the same area. This hurricane extended more toward the west causing more damage, affecting more communities, and causing more casualties. All of this will result in a humanitarian calamity due to the lack of food, shelter, sanitation and the spread of COVID-19, malaria, diarrhea, and dengue fever.

We would like to send a container as soon as possible. We have collected PPEs here in the USA, as well as some equipment such as one anesthesia machine, one EKG machine, monitors, defibrillators, two treadmills units for stress testing, coolers, and disposable supplies for open heart surgery and the critical care unit. We think that there will be space left in the container to send mosquito nets, insect repellents, water filters, antimalarials, Tylenol, electrolyte solutions, hand sanitizers, clothing, and hygiene supplies.

If the COVID-19 pandemic allows it, we would like to go next year to conduct clinic and perhaps interventions or surgeries. If we go next year, it will be better to avoid a trip close to the Nicaraguan presidential election that will be held in November. Obviously, we take very seriously the safety of our volunteers and we could postpone these plans if needed.

We are also planning to add to our website educational resources for physicians, residents, and nurses. We are planning to create a series of 10-15 minutes clinical lectures. We are working on the technical details, but if you want to contribute with a recorded lecture please let us know, we could translate it or add close captions. We have discussed with the UNAN-Leon medical school dean the need of creating a cardiology fellowship in Nicaragua in the future. It is still a premature idea, but it is the first step forward.

The overall goals of PHL remain the same: to provide specialty and general health care to the citizens of Nicaragua, to educate Nicaraguan and American medical professionals, and to provide needed medical supplies and medications to health care facilities in Nicaragua. PHL receives no government funding. Therefore, our work depends on private donations. Medical equipment, supplies, and shipping are very expensive, and your financial contributions are needed in order for PHL to continue its mission of helping the people of Nicaragua. Please consider contributing. Checks should be made payable to PHL and mailed to the address found in the letterhead. Contributions are tax-deductible. If you are interested in volunteering for a brigade, please contact us to this email;

Many thanks for your interest and support. Be assured that we hope to resume the project when that is a possibility.


Carlos A. Espinoza, MD, FACP, President

Mike Yeung, MD, FACC, Vice president

Jack Rose, MD, FACC, President Emeritus

John Paar, MD, President Emeritus