innerCHANGE associates international (iCHai), a limited liability company, works in partnership with businesses, educational and healthcare institutions, governmental and non-governmental organizations, and communities to develop their human resources through understanding, valuing, and leveraging cultural differences.  Within its humanitarian program division, iCHai engages skilled associates and critical partners to manage sustainable and culturally appropriate humanitarian development programs and projects. 

Children, Health, Education, and Supporting Services (CHESS) is one of the major new initiatives of iCHai’s humanitarian program division.  CHESS aims to assist the municipality of Villa El Carmen, Nicaragua, in achieving community empowerment through improved primary school education and health. innerCHANGE associates international works as the coordinating agent among several key partners, including the USAID Alliance Program for Education and Health, Gran Pacifica Nicaragua (an American-owned resort community) and Rotary Clubs and Rotary International.  As president of innerCHANGE and CHESS Project Director, I oversee a team of highly experienced in-country associates to develop and manage activities for 12 targeted communities of Villa El Carmen in the following key program areas: community health education workshops; continuing English language education for teachers; health and safety improvements, library programs, and cultural heritage education projects for the primary schools; and educational programs for pre-school teachers and children.

Direct engagement with the children, families and elders of the participating communities is an essential aspect of our culturally focused project management strategies.  In October 2006, I was conducting a preliminary site visit to one of the 12 target communities of Villa El Carmen, and was introduced to Miriam del Socorro Araica, the grandmother of eight-year old Elkin Enrique Fonseca Zapata.  Elkin had fallen from a tree 14 months prior and had hit a fence post that fractured his larynx and transected his trachea.  Elkin was emergently operated on in Managua, but because the country does not have ENT surgeons with expertise to handle this type of injury, and the family has no healthcare, Elkin was left with a metal tracheotomy device and very little medical care or follow-up treatment.  Miriam Araica, the grandmother, entreated the CHESS project to help her grandson, one of five children (ages 5-12) under her care after their mother died three years ago.  Elkin lives with his grandmother and three of his brothers in a rural setting.  His father is a construction worker at the American Embassy in Managua.    

In January 2007, during the Gran Pacifica annual shareholder’s meeting in Managua, I met with and presented the case to Dr. Edward Barksdale, Associate Professor of Surgery of Children’s Hospital of Pittsburgh.  Dr. Barksdale provided an on-site medical examination of Elkin in his home in Villa El Carmen, and subsequently presented this as a potential humanitarian global health care case to The Children’s Hospital of Pittsburgh, one of two preeminent centers in the United States for Laryngo-Tracheal Injury treatment.  Because of the great need and urgency of this case, Mr. Roger Oxendale, the CEO of Children’s Hospital of Pittsburgh, has authorized bringing Elkin to Pittsburgh for evaluation and medical care resulting in potential surgery.  The Children’s Hospital of Pittsburgh has agreed to cover the hospital and medical care costs of approximately $300,000. 

Elkin is in great need of immediate care.  Because of the precarious nature of the current tracheotomy, Elkin has not been attending school for 18 months since the accident.  The current device has not been cleaned or replaced and the hospitals in Managua do not have the appropriate surgeons or technical expertise to offer this child the necessary surgery to repair and rebuild his fractured voice box with lacerations of the windpipe.  With this injury untreated, Elkin will not be able to speak, will not be able to lead a normal life for a young child and is at continual risk of infection with an open airway in his throat.  It is essential that Elkin receive the best medical care possible to enable him to return to school with his peers during this critical stage of his education and development. 

This is an important time in the evolution of Nicaragua, a country that is working hard to emerge from its negative image of the 1970’s and 1980’s.  This is also an important time in the relationship between the United States and the new president of Nicaragua, Daniel Ortega.  There is a close connection between Nicaragua and Pittsburgh, extending from the time that Roberto Clemente was killed in a plane crash while flying to Managua on a humanitarian mission after the earthquake of the 1970’s.  Providing such critically important health care to a child in serious need of help carries on the tradition of Pittsburgh’s long-standing relationship with the people of this small country in Central America.   

We have obtained commitments from various partners to support this healthcare mission on behalf of Elkin.  The Rotary Club of Pittsburgh has agreed to ensure that all housing and additional expenses are to be paid by their organization.  Gran Pacifica Nicaragua will cover all expenses in Nicaragua in preparation for the trip to the US for the boy and his grandmother.  The American Airlines Ambassador Program has committed to cover the round-trip airfares for the two people between Managua and Pittsburgh.  Children’s Hospital of Pittsburgh will provide for all medical expenses.  JBM Immigration Group will provide legal advice and support, and innerCHANGE associates international will be coordinating the preparations for the trip in Nicaragua and the community-based social support services while the two are here for the medical care. 

Along with the Nicaraguan CHESS team of Ligia Diaz-Roman, the Education Program Manager, and Helio Alfaro, a teacher in Villa El Carmen and Community Outreach Coordinator for Gran Pacifica, innerCHANGE is currently in constant communication with Elkin Fonseca Zapata, his father, his primary school teacher, and his grandmother.  Miriam Socorro Araica, the grandmother, will travel with Elkin to Pittsburgh to provide the essential social and emotional support to aid in his recovery.  The “Elkin Fonseca Zapata Support Project” is a dramatic example of the power of partnerships “working together across cultures” with the shared aim of understanding and valuing education and health.  By bringing Elkin to Children’s Hospital for health care, we will all provide for one of the children of this Nicaraguan community of Villa El Carmen the opportunity to fulfill his potential, reach his dreams, and lead a healthier and happier life.

Janet J. Foerster, M.Ed.
President
innerCHANGE associates international
CHESS Project Director