50 | HerbalGram 80 2008 www.herbalgram.org
NATURAL DOCTORS
I N T E R N A T I O N A L
www.herbalgram.org 2008 HerbalGram 80 | 51
Innovative Nonprofit Enables Natural Medicine
Practitioners to Participate in Global Relief Efforts
The Development of NDI
NDI was established with the goal of enabling NDs and other
alternative healthcare providers to participate in international
relief medicine—much as the program Doctors Without Borders
provides for conventional medicine practitioners. NDI has established
a permanent presence on Ometepe and is involved in multiple
sustainable services and programs for the local community,
serving as a model for other volunteer networks interested in global
justice and medical assistance.
The organization was co-founded in 2003 by Tabatha Parker,
ND, Laurent Chaix, ND, and Michael Owen, ND.2 These 3 cofounders
established NDI after discovering that there were few
opportunities for the naturopathic profession to participate in
international relief efforts. The founders were passionately committed
to developing and implementing NDI within the legal framework
of any foreign country hosting an NDI site. Further, they
wanted participants of NDI to live and work closely within the
local community, rather than stay in resort areas or fancy hotels
Introduction
The island of Ometepe within southern
Nicaragua is inhabited by approximately 35,000
people—and it is equipped with one 24-hour
hospital. The island’s hospital, the Moyogalpa
Health Center, contains 25 beds and is attended
by a total of 5 doctors, only one of whom is
available for 24-hour in-patient care. Poverty is
so extreme on the island that citizens often have
trouble affording bus fare to the hospital, where
they are offered free medical services through
Nicaragua’s Ministry of Health.
It is here that a new kind of relief organization,
Natural Doctors International (NDI), developed
its successful pilot program. NDI established
a site in Ometepe in 2005, and for the past
few years the organization has encouraged
naturopathic physicians (NDs) and other
alternative healthcare practitioners and students
to volunteer their services for the island’s
underserved population.1
and have limited outside engagement with citizens, as is the case
with some international relief programs.
The founders chose Nicaragua as the location for the first NDI
site based on their previous travels to the country and the preestablished
contacts they had made in the area. Nicaragua was also
selected due to its extreme poverty and deficits of healthcare.
“Nicaragua is the second poorest country in the Western hemisphere,”
explained Dr. Parker, who continues to live in Nicaragua
and serves as NDI’s executive director (oral communication, May
15, 2008). “There’s a lot of need there.”
According to the World Bank, Haiti is the only country in Latin
America with an economy worse than Nicaragua’s.3 Although
some economic progress has been attained in recent years, including
a reduction in the scale and severity of poverty in Nicaragua, it
is still estimated that 46% of the population lives below the poverty
line. The World Health Organization (WHO) indicates that
communicable diseases such as malaria, tuberculosis, and HIV/
AIDS are prevalent or increasing in some areas of Nicaragua, while
noncommunicable diseases such as cardiovascular disease, cancer,
and diabetes result in high morbidity and mortality.4 Nearly 22%
of children from the most disadvantaged quartile of urban Nicaragua
suffer from malnutrition.
By Courtney Cavaliere
Nicaragua
Ometepe
Top left photo: NDI global health course participants work to clean corn and
beans with Valeriano, a 104-year-old Nicaraguan campesino (farmer). Photo
©2008 Tabatha Parker
Bottom left photo: Dr. Tabatha Parker attends a young girl in the NDI clinic in
Nicaragua. Photo ©2008 Tony Trujillo
52 | HerbalGram 80 2008 www.herbalgram.org
Dr. Parker and her colleagues collaborated with Nicaragua’s
Ministry of Health in developing NDI.1 They set up a 3-year
contract with Nicaragua’s government, which recognizes NDs as
licensed practitioners and allows them to legally work within the
country through NDI.
Volunteering with NDI
NDI offers 1-year volunteer opportunities for state licensed NDs.
These long-term volunteers treat patients through a clinic NDI has
established within the hospital, generally averaging between 15 to
20 free patient consults each day. (Between 50 and 150 people typically
visit the hospital every day.) These volunteers further assist
the hospital staff when needed. They also take part in community
projects, consult with some patients outside the hospital, and occasionally
produce and package herbal therapies for NDI’s pharmacy.
Three NDs have completed long-term rotations on the island, and
a fourth ND is currently volunteering long-term with NDI.
Tania Neubauer, ND, worked with NDI as a long-term volunteer
from January of 2007 through March of 2008. “My practice
was full to bursting—from the minute I arrived, I had to struggle
between trying to help more people, faster, and how many people
I would turn away,” she said (e-mail, May 5, 2008). “I’d see a
lot of what you see in primary care in the United States—lots
of respiratory infections, lots of skin conditions, lots of urinary
tract infections, digestive problems, diabetes, hypertension—and
of course, things that you don’t see quite as commonly here, like
parasites and malnourished children.”
According to Dr. Parker, the organization is attempting to initiate
an additional long-term NDI volunteer opportunity, which
might allow year-long rotations for acupuncturists in the near
future.
NDI also provides short-term volunteer opportunities by hosting
a global service learning course titled “Natural Medicine in
Global Health.” Affectionately referred to as “medical brigades,”
these courses offer a unique combination of cultural immersion
and global health training—both in the clinic and the classroom.
These brigades typically consist of 10 participants, who spend
10 days in Nicaragua. Participants live with Nicaraguan families
during their stay, and they pay these families a fee for room and
board, which provides enormous financial assistance for those
families. Brigade members assist NDI’s long-term ND volunteers
by providing services in the hospital and community clinics and
by assisting in community projects. They participate in farming
activities to gain a better understanding of the lifestyle and environmental
conditions faced by local citizens. They also attend
classes taught by NDI personnel regarding global justice issues,
such as the effects of trade agreements and various international
policies on the citizens of developing nations, the economic,
educational and health disparities between poor and prosperous
countries, etc.
“These brigades are a combination of activism and medical
education,” said Benjamin Woodard, one of the brigade facilitators
and faculty members of NDI, as well as director of StillRiver
Health LLC in Boulder, Colorado (oral communication, April 29,
2008). “They’re exhausting but profoundly inspiring for everyone
involved.” Woodard makes arrangements for the brigades and also
accompanies brigades to Ometepe to teach in NDI’s clinic facilities
and classes.
Former National College of Natural Medicine (NCNM) student
Missy Pannone participated in a brigade in August of 2006 and
was so inspired by her experience that she remained with NDI for
6 more months after the brigade ended. “We in the United States
are blessed with great education and so many resources. More
people in the United States need to do what [Dr. Parker] is doing,”
said Pannone (oral communication, May 1, 2008). “The work she
is doing down there is just awe-inspiring. She is on the front line,
making amazing things happen.”
Since its inception, NDI has hosted 12 medical brigades.
“My practice was full to bursting—
from the minute I arrived, I had to
struggle between trying to help more
people, faster, and how many people
I would turn away.”
Dr. Tabatha Parker conducts a home visit for a patient and her piglet.
Photo ©2008 Pauline Baumann
www.herbalgram.org 2008 HerbalGram 80 | 53
Woodard stated that he has begun booking brigades nearly a year
in advance, due to steadily growing interest in NDI participation.
Several naturopathic schools have organized student groups as
brigades. Alternative and conventional medicine practitioners have
also participated in brigades, and persons with no medical background
are also welcome.
“Everyone comes with something they can offer,” Woodard
stated, explaining that this could include administrative skills,
language skills, medical expertise, etc. “We try to find a place for
anyone who has an interest.”
Funding and Support of NDI
The tuition of the global health course participants helps to
fund NDI’s programs and services.5 Many groups conduct fundraising
to help cover costs, as well as to bring donated herbal and
nutraceutical products to the island. Donated botanical, supplement,
and pharmaceutical products are widely used by NDI volunteers
and staff in their clinical practice.
“A lot of donations come from the students just going out and
talking to people,” said Dr. Parker. “When groups come down, we
never quite know what we’re going to get. We have to be pretty
flexible.”
Companies and individuals have also contributed greatly to
NDI’s mission through donations. Dr. Parker mentioned that the
dietary supplement manufacturer Standard Process (Palmyra, WI),
for instance, once donated $22,000-worth of products. NDI has
also received important donations of homeopathic medicines and
mother tinctures (solutions of botanicals in alcohol and/or distilled
water for use in homeopathic remedies) from various companies
via charitable donation.
“About halfway through my time [volunteering with NDI]
we got a tremendous donation of many gallons of bulk tinctures
from Oregon’s Wild Harvest and Heron Botanicals, which
really improved my ability to practice herbal medicine,” said Dr.
Neubauer. “We also had a very extensive homeopathic pharmacy,
and last year we got a donation of hundreds of homeopathic
mother tinctures, which is great—the clinic will be able to replenish
its stock permanently without being reliant on future purchases
or donations. We could never keep enough vitamins in stock—
there is an immense need.”
The Use of Herbal Medicine by NDI
In addition to donated supplies, NDI also purchases some tinctures,
salves, bulk teas, and other ingredients from 2 organic Nicaraguan
farms—Isnaya and Cecalli. NDI volunteers and staff occasionally
make some of their own medicines, and they use some local
Nicaraguan botanicals as well. According to Woodard, one of the
latest brigades harvested turmeric (Curcuma longa, Zingiberaceae)
The main street in Moyogalpa Ometepe, where the NDI Nicaragua clinic is located. Photo ©2008 Tabatha Parker
from an organic farm as part of its educational experience. This
turmeric was then tinctured for patients’ use, since NDI did not
have the processing equipment available to encapsulate it.
“We use a tremendous amount of herbs,” said Woodard. “This
is a paradigm in which patients often prefer natural medicine to
allopathy. Not once have I had a patient who was uneasy or tentative
about taking herbs.”
Dr. Neubauer, likewise, noted that she prescribed natural medicine
for probably 80% of her patients. “One of the biggest differences
[between working as an ND in the United States and Nicaragua]
is that natural medicine is part of everyday life in Nicaragua,”
she explained. “Most people still grow up knowing some
of the plants around them and how to use them as medicine. It’s
not an exotic, strange thing as it still is in the United States. The
vast majority of people are very interested in natural medicine
and very happy to use it . . . Also, there’s a significant percentage
of people—it seems to be much higher than in the United
States—that only want natural medicine and that never want to
use another pharmaceutical again, so they are completely thrilled
to have access to an ND.”
A graduate student at Virginia Polytechnic Institute and State
University conducted a survey in 2007 of 100 Ometepe inhabitants,
as well as 20 semi-structured interviews, to determine the
community’s perceptions of NDI and its use of naturopathic
medicine.6 The student, Andrew Allen Duncan, found that all
surveyed Nicaraguans considered natural and herbal medicine to
be a legitimate form of therapy, and responses to the interviews
indicated that natural medicine was generally viewed more positively
than conventional pharmaceuticals. Moreover, 99% of all
respondents claimed to believe that natural medicines were a part
of their culture.
According to Woodard, many local Nicaraguans traditionally
use botanical therapies that NDI physicians have incorporated
into their own practice. Locally used medicinal plants include
Cassia grandis (Fabaceae) for anemia; guava (Psidium guajava,
Myrtaceae) for dysentery, diarrhea, and parasites; calendula
(Calendula officinalis, Asteraceae) and Tecoma stans (Bignoniaceae)
for skin disorders; eucalyptus (Eucalyptus globulus, Myrtaceae),
mint (Mentha spp., Lamiaceae), and aloe (Aloe spp., Liliaceae) for
respiratory complaints or skin conditions; and Artemisia vulgaris
(Asteraceae) for parasites or scabies. Dr. Neubauer would sometimes
prescribe a cough syrup made from the local plant juanislama
(Lippia spp., Verbenaceae), and she said that she frequently
used a plant called jiñocuabo (Bursera simaruba, Burseraceae)
to treat urinary tract infections, skin disorders, and respiratory
infections.
“One challenge we often encounter is incorporating folk use of
botanicals sustainably into clinical use,” said Woodard. “We have
54 | HerbalGram 80 2008 www.herbalgram.org
Patient receiving Reiki and bodywork from team NDI. Photo ©2008 Tabatha Parker
to ensure that the herbs, their use, and delivery all truly work.
When herbal medicine is one of your first lines, you better have
faith in it!”
In addition to their widespread acceptability and general
sustainability, herbal medicines are also typically a first choice
among NDI physicians because they are considered more effective
than many available pharmaceuticals. Woodard explained
that drug resistance is a huge problem of “social justice medicine.”
Whereas citizens of economically developed countries generally
have access to a multitude of pharmaceuticals, communities in
developing countries usually only have access to a few. These few
pharmaceuticals are then overused for a variety of conditions,
and patients are often placed on previously ineffective treatment
protocols when alternatives are not available.
“We now are seeing more than 80% resistance to amoxicillin,
a first-line broad-spectrum antibiotic, in uncomplicated urinary
tract infections, simply because of overuse,” Woodared explained,
noting that this and other drugs cease to be effective, as patients’
bodies grow accustomed to the medications.
Dr. Parker noted that many patients in developing
countries also present with multiple complaints during
consults. “One of the great things about herbal medicine
is that you can really tailor and customize a treatment
for someone,” she said. “It allows us to be more
flexible in our treatments.”
Challenges of Providing Medical Aid in a
Developing Country
Working in a foreign culture and developing country
does present various challenges. Woodard pointed
out that Nicaraguan citizens often have deeply-seated
cultural beliefs that must be taken into account when
prescribing treatments. For instance, many Nicaraguans
believe in the concept of aire—the belief that
illness can result from abrupt temperature changes.
Dr. Parker explained that a Nicaraguan who has
returned from working in the hot fields will often not
cool off by taking a cold shower (it is believed that this
abrupt temperature change could result in sickness),
but he or she might instead drink hot coffee. Similarly,
certain medicines are considered “hot” and “cold.”
Pills, for instance, are considered “hot.” A person with
symptoms of a cold might therefore scoff at the idea
of taking a pill as a treatment, as humoral medicine
theory suggests that a pill could cause their symptoms
to worsen. For this reason, teas and tinctures are
sometimes considered better treatment options than
conventional pharmaceuticals.
“You have to be respectful of that and learn how
to speak their language,” said Dr. Parker. “Having
this conversation and being open is very important,
because otherwise you could be giving all of this advice
that isn’t going to be followed.”
Witnessing the poverty and suffering of patients is
also a huge challenge for volunteers of NDI. For this
reason, members of brigades attend group processing
sessions, which are designed to help participants
understand and cope with what they observe in the
clinic and in the community.
“Nicaragua is the second
poorest country in the
Western hemisphere …
There’s a lot of need
there.”
www.herbalgram.org 2008 HerbalGram 80 | 55
Typical home on the island of Ometepe in Nicaragua.
Photo ©2008 Tabatha Parker
Walking barefoot puts young children at risk for ground parasites, as with these two young
children in Ometepe, Nicaragua. Photo ©2008 Tabatha Parker
56 | HerbalGram 80 2008 www.herbalgram.org
“Bearing witness to this much suffering is really a lot to handle,”
explained Woodard. “We try to provide as much emotional
support as we can.”
Woodard described one of his own experiences on the island,
in which he was introduced to a woman with Parkinson’s disease
who had not eaten for 4 days due to the seeming hopelessness of
her condition. Another patient was diagnosed with kidney stones
but could not afford a trip to the mainland for necessary treatment.
NDI’s Community Projects
Because health is connected with so many environmental,
economic, educational and other factors, NDI has implemented
and is leading several community projects in addition to its medical
services.7 For instance, NDI has been developing a program to
educate local farmers about safety measures to use when harvesting
tobacco. Over 15 women and children were admitted to
the hospital with nicotine poisoning in 2007 from picking wet
tobacco, an illness known as “green tobacco sickness” that can
resemble intoxication from organophosphate pesticides.
As one of her community projects, Dr. Neubauer worked with a
group of community health workers (CHWs) on Ometepe: “The
best way to multiply your work is to train CHWs to take care of
their communities. The CHWs in many cases are more culturally
appropriate and better aware of what the most important needs
are than any visiting foreign doctor can ever be, no matter how
long the doctor stays in the community. The CHWs on Ometepe
were particularly interested in natural medicine.” Woodard noted
that many CHWs and traditional healers of Ometepe are women
and that midwives, in particular, typically hold much of the
botanical medicinal knowledge within the community.
Dr. Neubauer explained that the education of CHWs is particularly
important since local communities have begun to lose this
knowledge. “Nicaragua, like many places in the world, is experiencing
a cultural rupture—many elder healers are not training
anyone new to take on their work because it is too hard to make a
living taking care of your impoverished neighbors in exchange for
a few eggs or vegetables. On the island where I lived, almost every
family had members abroad sending money home from their job
as a dishwasher, construction worker, etc. Which does the world
need more—an intact healing tradition or another dishwasher?”
Duncan’s 2007 survey results also indicate that herbal traditions
in Ometepe have been declining in
recent years.6 Although the vast majority
of respondents claimed that herbal
medicine was part of their culture, some
interviewees qualified that herbal use
was primarily a part of their cultural
past. Some explained that the influx
of pharmaceuticals into Nicaragua and
their use by local doctors has helped to
facilitate this decline in herbal knowledge
and practice. Twenty-one survey
respondents claimed that pharmaceuticals
had replaced the use of natural
medicine, although many more (67)
indicated that this had not yet occurred.
NDI’s education of CHW’s, in addition
to the organization’s own naturopathic
services, could assist in reviving or reinforcing
widespread use and popularity of
natural medicine in Ometepe.
Dr. Parker noted that NDI also sponsored
a baseball team on the island
as another community project, at the
suggestion of local community members.
According to Dr. Parker, this receptivity
to community input and constant
interaction within the community, in
addition to NDI’s medical assistance,
has encouraged citizens of Ometepe to
embrace the organization.
“About halfway through my time [volunteering with NDI] we got a tremendous
donation of many gallons of bulk tinctures from Oregon’s Wild Harvest and Heron
Botanicals, which really improved my ability to practice herbal medicine.”
Dr. Parker examines a foot of a diabetic patient.
Photo ©2008 Amy Johnson
“We’ve been really welcomed by the community, and part of the
reason, I believe, is that we really work with the community and
deal with the needs that they bring up,” said Dr. Parker. “We really
try to bring the community into being active participants in the
growth of NDI.”
All respondents to Duncan’s survey who had previously received
treatment from NDI claimed to consider NDI staff as part of the
community.6 The vast majority claimed that NDI often or always
includes the community in making decisions and defining local
problems, and they further professed a belief that NDI would
be open to suggestions or criticisms. Almost every respondent of
the survey indicated that foreign assistance is necessary to good
healthcare in their community. Duncan concluded—based upon
NDI’s services, its sensitivity to global justice issues, and its overwhelming
support within the Nicaraguan community—that NDI
represents a model organization for providing such aid.
NDI Efforts in Mexico
Although the site in Ometepe is the only currently active NDI
site, the organization hopes to have a second site operational by the
end of 2008 or early 2009. Jacqui McGrath, ND, has been working
with the Mexican Ministry of Health to establish an NDI site
in Bacalar, Mexico. Whereas the NDI site in Nicaragua functions
within Ometepe’s Moyogalpa Health Center, Dr. McGrath plans
to establish an autonomous clinic in a rural location of Bacalar
among some of the area’s poorest citizens, many of whom have
difficulties traveling to currently available health centers.
Dr. McGrath decided to initiate her own NDI site after participating
in the “Natural Medicine in Global Health” course in
Ometepe. “I love NDI’s philosophy of mutual respect and consideration
for the culture and for the government, in addition to
providing long-term health for people and communities,” she said
(oral communication, May 30, 2008). “It’s not just about giving
consults. There is a respect for the governments’ laws and the traditions
of the local people to create projects and programs to help
community health as well as individual health.”
Dr. McGrath has been laying the groundwork for the NDI site
in Mexico for the past few years. She has been working with a local
foundation to get the NDI site registered as a Mexican nonprofit,
and she recently performed a year of social service work in order
to obtain a license to practice medicine in Mexico. During this
time, she has begun to familiarize herself with the needs of the
local community, so that she can develop NDI projects particular
to this region.
The anticipated NDI site in Mexico will follow the same basic
model as the site in Nicaragua, offering courses in global health/
medical brigades and relying to some extent on donated supplies.
The educational component of the site will be complementary to
the classes and teachings given in Nicaragua, although much of the
information will focus on Mexico. Certain differences between the
www.herbalgram.org 2008 HerbalGram 80 | 57
Dr. Tania Neubauer examines this newborn with his mom. Photo ©2008 Tabatha Parker
two locations and cultures, however, may impact the
way that the Mexican site is developed. For instance,
farming is not a common practice in Bacalar, so
brigade participants might spend a day with building
crews or concrete workers to better understand
the local living conditions, instead of the Nicaraguan
NDI experience of working in the fields for a day.
It is also possible that patients in the Mexican NDI
clinic might pay a small fee for consultations, when
they can, since this might be considered more appropriate
within the local culture than the free services
of the Nicaraguan clinic.
Dr. McGrath expressed that she hopes to use a
great deal of herbal medicine in her practice, particularly
since many local patients prefer natural therapies.
However, she said that Bacalar currently seems
to lack some of the herbal resources of Nicaragua.
While the NDI site in Nicaragua is able to rely on 2
local suppliers of quality herbal tinctures and creams
to help supplement the clinic’s donated herbal products,
Dr. McGrath noted that there are currently no
similar suppliers in her area of Mexico. Dr. McGrath
said that she has only just begun to learn about the
area’s medicinal flora, and she hopes to begin communicating with
local herbalists and traditional healers to increase her own knowledge
of local medicinal plants.
Like the site in Ometepe, the site in Mexico will take part in
various community projects. “I would like to work on rescuing the
traditional knowledge in this area,” said Dr. McGrath. “Traditional
Mayan knowledge is still here, but it’s tenuous. There aren’t a lot of
midwives or bonesetters in training.”
Other projects that Dr. McGrath hopes to pursue include a garden
project, an educational program on nutrition, and a project concerning
garbage disposal. She would also like for the site to participate
in local efforts for creating jobs, as poverty is the root cause of many
local health, environmental, and other problems in the area.
Future Goals of NDI
NDI may eventually open additional sites in more countries.
“We’re looking for people who are passionate about doing this and
interested in following this model,” said Dr. Parker. Since countries
have different regulations and licensing requirements for medical
practitioners, the ability to open new NDI sites and the speed at
which such sites could be developed may depend largely on the types
of opportunities available through foreign governments.
Dr. Parker has also been working to obtain non-governmental
organization (NGO) status for NDI with the United Nations.
According to Dr. Parker, NGO status would give NDI access to large
organizations involved in global policy work, which she argued is
important since few natural medicine organizations and associations
are presently involved in this arena. The WHO has stated that more
NGOs, as well as national and international professional organizations,
should take on the mission of expanding the appropriate role of
and access to traditional natural medicine in developing countries.8
While the organization continues to expand its reach through new
sites and networking opportunities, its mission has been spreading
even more rapidly through the enhanced knowledge and perspectives
of volunteers and brigade participants. According to Dr. Parker, the
living conditions and poverty that students and volunteers witness
during their time with NDI may be difficult to observe, but the experience
as a whole can be extremely uplifting and motivating.
“The developing world is an extreme,” she said. “It can be very
empowering if you learn how to incorporate your experience there in
a positive way.” She stressed that participants are encouraged to integrate
their experiences with NDI into their own lives and communities
at home.
“I’m more committed than ever to being a doctor working for
global justice,” said Dr. Neubauer of her own experience with NDI.
“More doctors need to be speaking out about the health effects of
international policies that are condemning many people to lives
of poverty and suffering . . . Doctors have a unique and respected
voice—we should be using some of the authority vested in our
profession to push for the big changes at the global level, in addition
to ‘being the change we wish to see’ in our daily practice with our
patients.”
References
1. Parker T. Going global: Natural Doctors International. Naturopathy
Digest. January 2006.
2. Alumni Career Spotlight: Tabatha Parker, ND. Association of Accredited
Naturopathic Medical Colleges Web site. Available at: http://www.aanmc.
org/careers/alumni-leaders-in-the-field/tabatha-parker.php. Accessed April
21, 2008.
3. Nicaragua Country Brief. The World Bank Web site. Available at: http://
web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES /LACEXT/
NICARAGUAEXTN /0,,contentMDK:20214837~pagePK:141137~piP
K:141127~theSitePK:258689,00.html. Accessed August 11, 2008.
4. Nicaragua Country Cooperation Strategy at a Glance. World Health
Organization Web site. Available at: http://www.who.int/countryfocus/
cooperation_strategy/ccsbrief_nic_en.pdf. Accessed August 11, 2008.
5. Clinical Service. Natural Doctors International Web site. Available at:
www.ndimed.org. Accessed April 21, 2008.
6. Duncan AA. A participatory evaluation of a development NGO in Nicaragua
[thesis]. Blacksburg, VA: Virginia Polytechnic Institute and State
University; 2007.
7. Projects. Natural Doctors International Web site. Available at: www.
ndimed.org. Accessed April 21, 2008.
8. World Health Organization Traditional Medicine Strategy, 2002-2005.
Geneva: World Health Organization, 2002.
58 | HerbalGram 80 2008 www.herbalgram.org
View from Finca Magdelena on the island of Ometepe. Photo ©2008 Tabatha Parker
In April of 2007, I flew from Portland, Oregon, down to
Nicaragua to find out how the young dynamo Dr. Tabatha
Parker and her colleagues were able to set up a successful,
free alternative medicine clinic for the Nicaraguan people
in a remarkably short amount of time. I had been in clinical
practice for 20 years and found it hard enough to stay
afloat financially with paying patients—how could one
offer naturopathic medical services at no cost and still eat?
Now that my children were grown, I too had aspirations to
turn my attention to the world and all its ills. I had flown
down to volunteer with Natural Doctors International
(NDI), as well as to learn from these young doctors. And
learn I did—way more than I had anticipated.
I learned about global medicine, social justice,
structured poverty, and much more. I was impressed by
the knowledge of Dr. Parker, and of her recent National
College of Natural Medicine graduate intern Dr. Tania
Neubauer, regarding the international political issues that
continue to keep multitudes of people in impoverished
circumstances. They knew the presidents, the years, the
trade agreements, and the foreign policies that contributed
to the plight of the Nicaraguans and many others. I grew
to fully realize the deep goal of NDI and the difference
between NDI and those organizations doing “medical
tourism” (i.e., sending doctors to hand out band-aids, stay
at the nicest hotel in town, and then fly home, after which
the drugs they brought with them quickly run out, the
underlying issues are left largely unaddressed, and the
diagnosed conditions receive no follow-up treatment or
management).
NDI was operating on a whole different level—just like
alternative medicine—establishing a permanent presence
within the community and dealing directly with the
underlying causes of ailments, including the environment,
the poverty, and the politics, to do more than just treat
the symptoms. As the creation of better health requires
better quality water, foods, wages, and workload, NDI also
is sponsoring water, agriculture, sustainability, and living
wage efforts.
The heat body-slammed us as I exited the airport with
Dr. Parker, and it never lightened from then on. We took a
taxi to the ferry and a ferry to the island of Ometepe, and
we walked from there in search of a hotel. The hospital on
the island is small and basic. NDI operates independently
in one wing alongside the conventional medical services
that include small obstetrical, pediatric, and in-patient
suites. NDI’s waiting room was filled with women
fanning themselves or wiping sweat from their faces with
handkerchiefs. The elderly often exhibit complaints related
to lifetimes of fairly brutal labor out in the fields under the
blazing sun, such as various forms of arthritis and aches
and pains. Fungal infections related to the unrelenting
heat and humidity are common, as are cystitis and renal
stones from lack of access to clean water and adequate
hydration. Numerous children were scattered about, and
babes in arm, and the occasional neighborhood chicken
wandered in the open door to be quickly shooed out
again. Fans run in the tiny consult rooms, though they
certainly don’t make them comfortable, and patients
file in and out all day long. Treatments include donated
nutritional and herbal supplements, a few herbal tinctures
that the doctors make themselves, as well as practical
dietary and hygienic support and advice. As medicine
supplies are extremely limited, individual supplement and
herb bottles are opened and only half dispensed, with
the intent of saving the remainder for the next patient.
Patients are asked to bring back empty plastic bottles
and containers for re-use and as a preventive measure
against littering. As not everyone can afford the 10 cents
to take the public bus to the hospital, the doctors also
make rounds in outlying villages and provide patients
with bus fare for follow-up visits when needed. Malaria
is a public health issue in this region, so NDI also works
with governmental agencies, farmers, and villagers on
environmental issues that impact the spread of malaria.
The funding to provide these services is garnished
largely from “brigades.” Students of alternative medicine
rotate through the clinic paying a fee to NDI for their
accommodations and training. Naturopathic, chiropractic,
acupuncture and Tai Sophia Institute’s herbal medicine
master’s degree students may travel as student brigades
to Nicaragua, their tuition sustaining NDI and providing
for its basic operating expenses. In addition to clinical
experience, NDI provides classwork and facilitates
discussions on global health politics, environment factors,
and structural poverty that contribute to people’s health
and healthcare resources. Students stay in private homes
and work alongside the community in the agricultural
fields to fully comprehend peoples’ lives, resources, work,
and the living conditions that contribute to their health
issues.
Future NDI sites expect to continue this method of
funding to be able to offer free services to additional
communities around the world. Although hosting brigades
is successful and is keeping the Nicaraguan clinic afloat,
finances are a continual challenge and struggle (as is the
case for most nonprofit organizations). The all-volunteer
board throws in its own money, is actively engaged in
grant-seeking, and is presently developing other fundraising
venues. Tax-deductible donations can be mailed
to Natural Doctors International, 1168 Butler Creek Road,
Ashland, OR 97520.
Dr. Jillian Stansbury is a naturopathic physician and
chair of the botanical medicine department at the National
College of Natural Medicine in Portland, Oregon. She serves
on NDI’s Board of Directors.
Funding NDI as Free Clinics for Underserved Populations
By Jillian Stansbury, ND
www.herbalgram.org 2008 HerbalGram 80 | 59
