About Us


The mission of Project Health for León is to promote the improvement of medical care for the people of Nicaragua through education of health professionals, the acquisition of appropriate medical technology, and, when necessary, by direct patient consultation and medical and surgical care, both in Nicaragua and in the United States.


Project Health for León is a group of health care providers whose principal goal is to improve the quality of medical care provided to the poor of Nicaragua through education of doctors and nurses, the provision of appropriate medical technology and resources, and direct patient consultation and care, where such is not available currently in Nicaragua.

Project Health for León had its beginning in January, 1985, when Dr. John Paar, a Raleigh, North Carolina, Cardiologist, first visited the Hospital Escuela Oscar Danilo Rosales A. in León, Nicaragua, to give lectures in cardiology, following an invitation by Dr. Gustavo Sequeira of  León.

Dr. Paar had first visited Nicaragua in 1984 with Witness for Peace and became acquainted with the desperate state of health affairs in that country.  Following the 1985 visit many health professionals from various disciplines came to León to present conferences and see patients. In addition, some Nicaraguan patients were brought to Raleigh, North Carolina for specialty care.

Since that time many U.S. physicians and surgeons, nurses, and technicians have participated in Project Health for León missions in various fields of medicine, including initially in general and specialty surgeons, orthopedists, pediatricians, and others. The orthopedists formed an autonomous group, COAN, which continues to be active, not only in León but in other areas of Nicaragua, and general surgeons have also recently formed a separate group. Project Health for León now is mainly concerned with cardiovascular disease and with bidirectional medical education, meaning that we educate learners from the U.S., as well as Nicaraguan health professionals and students in both countries.

Dr. John Paar


Project Health for León was started in part to improve the standard of living for Nicaraguans suffering from illnesses such as  rheumatic fever. Rheumatic fever is the result of untreated strep throat and is common in the Central American nation. Antibodies that try to kill the invading bacteria that causes the fever also attack similar proteins found in heart valves.

For example, Ruth Garcia Gardado (one of the patients pictured below) suffered from rheumatic fever and  could not afford the expensive valve-replacement surgery. Project Health for Leon was able to provide the surgery.



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; cespinoza75@live.com

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

Recent Trips

“Please see the Annual Newsletter on this website.”

Project Health for Leon made a very successful trip to Leon in January 2020.  We saw about 175 patients in the clinic at hospital HEODRA, including 40 or so pediatric patients in conjunction with Dra. Nubia Berrios.  An interventional team, primarily from Chapel Hill, performed 16 successful interventions, including valvuloplasties, ASD/PDA closures, and coarctation stenting.

Future Trips

“Please see the Annual Newsletter on this website.”

We don’t think anyone knows when global travel will safely resume, although we hope that it will be a possibility by the summer or fall of 2021.