Carla Gart lying down in speedboat.

Carla Gart endures a turbulent two-hour trip to the nearest hospital to give birth to her first child.

After a rough boat ride from a remote coastal community in Nicaragua, Carla Gart reaches medical care to deliver her baby

Carla Gart shuffles slowly across the tile porch of a small coastal health post, her pregnant belly bulging beneath her gray T-shirt, her face grim. Family members flank the tall, 19-year-old woman, clustered by her side with every painful step. One holds an IV bag above Carla’s head, the bag’s tube snaking into her wrist. Others watch as health staff quickly assemble a wooden stretcher and drape it with a blanket to carry the woman through this small village to the boat dock.

Carla’s pregnancy has reached full term, and the baby—her first child—should already be born. But after three days in labor, it’s obvious that something is not right. Here at this remote clinic in Laguna de Perlas on Nicaragua’s Atlantic coast, health staff have no ultrasound machine or other tools to diagnose the problem, nor the capabilities to handle a growing medical crisis. With the murky waters of the lagoon serving as the region’s only highway to the nearest hospital, Carla must endure a lengthy boat ride through choppy seas to get medical care.

Helping hands lower Carla to the stretcher, and four young men carry her down a grassy hill toward the waiting boat. A crowd of two dozen people follows the ensemble onto the dock, watching as Carla is lowered into the small speedboat and the captain starts the motor. For the next two hours, the young mother-to-be will endure the choppy waters and darkening skies of the lagoon until she reaches the nearest city—her closest chance at help.

The challenge of diagnosing illness

A long journey to reach health services, whether by boat or on foot, is not uncommon in Laguna de Perlas. Health workers in poor, rural communities often don’t have the resources they need to diagnose medical issues quickly, on site, and provide the right treatment before a patient’s condition worsens. Patients may have to travel hours just to reach a small health post or, like Carla, go to a regional hospital for more extensive care. From these rural health facilities, tests must be sent to labs in nearby cities, and it could take weeks before doctors receive the results. Additionally, remote communities often have poor infrastructure and limited electricity, adding another challenge to making timely and accurate diagnoses.

PATH is helping develop and introduce technologies that will allow health workers to diagnose illness at the “point of care,” so that even in small health posts patients can receive their results quickly and get the treatment they need. In Nicaragua, where about 35 to 40 percent of the population lacks access to health care, we’re assessing what diagnostic tools are most needed in the country’s most remote areas and how they can be provided for health programs. We’re looking at how a person can get the results of an HIV test in hours, rather than months, or how a health worker can confirm a case of malaria and treat the patient accordingly without guessing at the diagnosis.

“If you’re able to diagnose the illness right away at the point of care, you can treat the person immediately and prevent the transmission of disease,” says Dr. Abraham Mayorga, director of environmental health and epidemiology for the Ministry of Health sector in Nicaragua’s North Atlantic region. The cost to the patient would be much lower, too, without the need for transport, he adds.

“A point-of-care test could really help the patient.”

Working with Dr. Mayorga and others, we’re finding ways to make critical health technologies available to everyone, so that can get the care they need even when the nearest hospital is hours away.

Carla’s baby boy

In the waters of Laguna de Perlas, a nurse and Carla’s mother-in-law accompany her in the boat bound for Bluefields, a small city with the region’s only well-equipped hospital. After a turbulent ride, they reach the city late in the afternoon, and an ambulance soon fetches Carla for a short drive to the hospital.

Less than 24 hours later, the young woman smiles as nurses wheel her from the operating room. She has given birth to a healthy nine-pound baby boy. Despite the obstructed birth, the prognosis is good for both mother and son. But Carla’s journey will continue—another two hours by boat to bring her baby home and, for now, possibly more trips in the future for medical care until the right tools reach the health posts in Nicaragua’s remote regions.

Photo: Miguel Alvarez.