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Dr. Saul Contreras Martinez was born in a small town in Guatemala. His family has a history of achievements and his medical degree is one of them. When he was forced to flee the killing and violence of the wars, he joined other family members already in Toronto. But he soon returned to work in health care in war-torn El Salvador and then settled in Nicaragua. In addition to his already busy work schedule, Saul is now also the Doctors for Global Health In-Country Coordinator in Nicaragua.

Saul's life is based in the large "developing" infill tracts of the sprawling city of Managua, the capital of this impoverished country. Many of the streets are rough and unpaved. The good neighbors watch each other in the day and retreat behind walls and wire at night. Some of the homes double as local business places serving the food, auto repair, building and other needs of the community. Vendors move efficiently through the maze of streets calling out their presence. Dogs, chickens and an occasional pig know how to act in the scheme of this communal but individual life.

“For the past six years Saul has been living his dream of working within a broad definition of health. He is reaching many people in a way that uplifts and transforms their lives permanently.”

In the cooling night, with the workday over, the people can take a breath and dream of a better life for their families. Guards keep watch on businesses and some homes that have material stores. Some guards blow whistles intermittently through the night to broadcast that they are there and awake. The chickens sleep a few hours and then crow and cluck in the dark. With first light, the music cacophonous of Managua begins.

For the past six years, Saul has been able to make his dream a reality. He is working within a broad definition of health, reaching many people in a way that uplifts and transforms their lives permanently. He has set up a nonprofit organization in Nicaragua—a great accomplishment in itself—to assist and accompany increasing numbers of people in urban and rural communities. While he operates clinics that deliver free or low-cost care and medicines, he is mostly working through the training of health promoters. He has written an excellent manual for health promoters that has a comprehensive approach to community and environmental health.

Preschool at the Barrio Edgar Lang Community Center in Managua.

Dr. Saul Contreras Martinez was born in a small town in Guatemala. His family has a history of achievements and his medical degree is one of them. When he was forced to flee the killing and violence of the wars, he joined other family members already in Toronto. But he soon returned to work in health care in war-torn El Salvador and then settled in Nicaragua. In addition to his already busy work schedule, Saul is now also the Doctors for Global Health In-Country Coordinator in Nicaragua.

Saul's life is based in the large "developing" infill tracts of the sprawling city of Managua, the capital of this impoverished country. Many of the streets are rough and unpaved. The good neighbors watch each other in the day and retreat behind walls and wire at night. Some of the homes double as local business places serving the food, auto repair, building and other needs of the community. Vendors move efficiently through the maze of streets calling out their presence. Dogs, chickens and an occasional pig know how to act in the scheme of this communal but individual life.

In the cooling night, with the workday over, the people can take a breath and dream of a better life for their families. Guards keep watch on businesses and some homes that have material stores. Some guards blow whistles intermittently through the night to broadcast that they are there and awake. The chickens sleep a few hours and then crow and cluck in the dark. With first light, the music cacophonous of Managua begins.

For the past six years, Saul has been able to make his dream a reality. He is working within a broad definition of health, reaching many people in a way that uplifts and transforms their lives permanently. He has set up a nonprofit organization in Nicaragua—a great accomplishment in itself—to assist and accompany increasing numbers of people in urban and rural communities. While he operates clinics that deliver free or low-cost care and medicines, he is mostly working through the training of health promoters. He has written an excellent manual for health promoters that has a comprehensive approach to community and environmental health.

The promoters, mostly women selected by their communities, now number approximately 100. They are very well grounded in subjects ranging from community diagnosis, proper referral practices, health education and primary care. Their skills range from malaria treatment to suturing minor wounds. In other words, they serve the frontline needs of their communities. After their extensive training, they continue to meet monthly at the central villages in their Districts to receive continuing education and a re-supply of medications.

Dr. Saul Contreras (far left) and visiting DGH volunteer nurse, Jennifer Perry-Hidalgo, (far right) meeting with health promoters at the Acahual Women's Clinic in Managua.

This supply of medications make up the bulk of their botiquin, or first aid kit, and it is very useful to the poor people of Nicaragua who are otherwise faced with impossibly costly drug prices. Most of the promoters come many kilometers to these meetings and have to walk all or much of the way. They are the superstars of their neighborhoods and each has a personally compelling story. They are well versed in public health and community development. Saul is pleased that some of them are also interacting with other NGOs and expanding their work.

In the last year, the promoters have diagnosed the chief needs of their communities and new projects have been started. Because the health promoters have been well grounded in their approach to community health, they have worked with Saul to help fight one of the main determinants of ill health: poverty. They work on projects to increase economic development for their communities.

DGH's work and mission and that of Saul mesh very well. Saul supervises the DGH projects and assists DGH volunteers as needed in Nicaragua. The relationship began with the development of free or low-cost clinics and pharmacies. DGH is also funding small poultry co-operative projects in very remote rural locations. These co-ops are supervised by the health promoters from the communities who work with groups of neighbors. In general, this is an effort to make raising poultry more efficient and sanitary by keeping chickens from roaming the areas around and in the homes of people in the community. Each group of families will have a post and wire chicken coop with partial sheet metal roofs and a starter supply of a few chickens. A Nicaraguan agronomist is training all of the health promoters and visiting and supervising the construction of the small coops. He is also teaching them special skills, such as how to vaccinate the chickens.

Saul, in his role as coordinator, has likely become the physician with the most advanced knowledge of chicken farming in Nicaragua. Saul knows a lot about many things in the lives of economically poor people of Central America. He is involved with many issues, including legal rights and defense of abused women, job training, and team sponsorship of sports for children and young people, and most recently, sewing machine co-operatives in neighborhoods.

By reinvigorating basic social justice principles, he and DGH are building on the local fabric of cooperation in neighborhoods. The chain of DGH and its supporters, Saul, and Health Promoters is very effective in many localities. This chain provides a diffusion of influence to thousands of people living in poverty to build a future with the spirit of community. DGH and Saul are accompanying people on their road to self-sustaining development.

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