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Issue 16
Ramblings, thoughts and occasional sense from the Eastern Caribbean >>
Events and news from around the region >>
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Lesser known corners of the Caribbean, where to go>>
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Offshore insights from a Manhattan realty guru>>
Living, working, relocating and investing in the Caribbean. Information on retiring, real estate, Caribbean lifestyles, job opportunities, Caribbean culture, classifieds and the Caribbean Marketplace.

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by Lori Estrada

Indeed, foreign residents, expatriates and tourists are finding that the quality of health care in Nicaragua far exceeds expectations.

You can find excellent personalized care as well as highly-trained, English-speaking doctors and state-of-the-art facilities. Most people are truly amazed at the diversity and level of quality care you can find if you know where to look.

High-quality care is not only accessible in country, but reasonably priced as well, with a wide range of coverage options for foreigners that can cover everything from maternity costs to international MedEvac insurance (which costs about $250 a year) to ensure that in case of an emergency (such as the need for open heart surgery) you'll be airlifted by jet to Houston or Miami from Nicaragua.

Even out-of-pocket health expenses are uncommonly affordable by international standards.


People from the United States are always amazed at how quickly they can get in to see a specialist, especially one who’s friendly and genuinely concerned for your health.”

A client of mine, visiting for a week confided in me the night before he was to leave that he had been ill for 6 months and was not getting any better – in fact, he was feeling worse as he now had other complications from the medicine he had been taking in high doses for the past months. He then related that he had been seeing a specialist (that had come highly recommended) twice a month.

Aside from not helping him, he waited all morning to be seen for a $180, 5 minute consultation and felt that his Doctor did not care or even listen to him. I suggested he see someone here (a specialist that speaks English) the next morning.

He argued that he had to be at the airport by 10:00 am and there was no way that was possible.

I assured him that if I got him a 9:00 am appointment he would be seen on time – he took the appointment, was seen on time and spent 30 quality minutes with this Doctor who had a different diagnosis and prescribed another type of medication. My client was amazed!

He left the Doctors office, stopped at the pharmacy, purchased his new medicine and was at the airport at 10:00 sharp! Two days later he called me to say that he felt like a new man!

One year later I still hear from him telling me that the next time I see his Doctor, to please thank him again!!! He feels wonderful!


It is easy to be a happy practicing physician in Nicaragua. I have done so for almost 11 years now. The low cost of health care is easily understood as we don’t have hours of paperwork to fill out and insurance headaches to justify ordering routine exams that our patients require.

It is a pleasure to practice medicine here! If, for example I order and MRI for a patient, they will usually be back in my office in 2 hours (including travel time) with the films in their hands.

Here are some prices of common medical exams:

Ultrasound: $15.00
X-ray: $15.00
Mammogram: $26.00
MRI: $300
CAT scan: $120.00
Bone Density full body: $90.00
EKG: $15.00

I have practiced here almost 11 years and I am still amazed at the low cost high quality care in the hospitals here!

An expat living here told me the story of her hospital stay this year. At 9:00 pm she started to have pain in her abdomen and chest. By midnight she was in agony and went to the emergency room at Metropolitano.

Her husband pulled up to the door where she was met by nurses that assisted her into a wheelchair and took her straight to a bed where doctors began attending her! They did not ask her for insurance cards or how she would take care of her bill but began treating her immediately!

Having a heart condition and high blood pressure (which was very dangerously elevated now from her severe pain and distress) and abdominal pain, a cardiologist and gastroenterologist were both summoned.

After an EKG, blood work, ultrasound and x-ray they determined she was passing a kidney stone and was admitted to the hospital (in a private room) for 4 night and 5 days to help control her pain and dissolve the stone.


The specialists checked in on her three times a day. She told me that she never had treatment like that in a hospital before in her life!

When I asked what her total medical bill was she said,” You’ll never believe this- $1,800.00 for everything – hospital stay, emergency room, doctor consultations, lab work and prescriptions. Amazing!!!.”

Her story is not unlike countless others I have heard – medical care here is personal, affordable and wonderful.

Yesterday, I visited a friend in the Metropolitano hospital who moved to Nicaragua last year. She had just given birth to her first baby. She told me her whole story of complications she had and how she had to deliverer her son by c-section. I was amazed at how wonderful she looked.

She told me that during her entire prenatal care, delivery and hospital stay that her medical care was top notch and she felt as though she was being “spoiled rotten”! I was not surprised to hear that.



Many of the doctors in Nicaragua receive their medical degrees from the United States before taking positions here. It’s usually not until foreigners visit a doctor’s office or hospital before they realize the quality of the care they can receive.

While you can’t just open the Yellow Pages, hospitals such as Vivian Pellas Metropolitano Hospital in Managua can offer highly competent care in just about any medical field.

Since opening as a private hospital in 2004, Vivian Pellas Metropolitan has built a medical staff of some of the top specialists in the country. It is also the only hospital in Nicaragua in the process of being internationally accredited by the U.S.-based Joint Commission International Accreditation, in recognition of top standards for quality and service within the medical industry.

Tourists and Nicaraguans no longer have to leave the country and travel to Costa Rica or Miami, Florida for first class private hospital care. In fact, once word gets out about Managua’s new Hospital Metropolitano Vivian Pellas, foreigners without health insurance will probably start traveling to Nicaragua for affordable, world-class medical treatment.

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Inaugurated May 31, 2004, the $23-million Hospital Metropolitano Vivian Pellas is being billed as the most modern, state-of-the-art private hospital in all of Central America.

The hospital, open 24 hours a day, employs more than 300 of Nicaragua’s leading medical specialists (most of whom speak English) in gynecology, cardiology, orthopedics, pediatric, internal medicine, surgery, neurology, urology, anesthesiology and ophthalmology, among other areas.

The hospital also has a modern emergency room, pain clinic, maternity ward, pharmacy and first class laboratory that can run all the same tests as a U.S. hospital, for a fraction of the cost ($3.50 - $22). A private room in the hospital is $110/day billed in 12 hour blocks. Operating room services with general anesthesia are $200 for 2 hours and 4 hours in recovery. A CBC blood test is $8.40 – prices we have not seen in the US for many, many years!

Hospital Metropolitano Vivian Pellas is home to the country’s only specialized burn unit for children, which operates cost-free with an annual budget of $1 million from private-sector funds. “There is nothing better about being human than giving to others”, says Vivian Pellas, the wife of Nicaraguan business tycoon Carlos Pellas, and the Hospital’s namesake.

Unlike overcrowded hospitals in the United States, Metropolitano Vivian Pellas is very accessible for walk-in appointments, although calling ahead for an appointment is recommended. For the first several months after the grand opening, Vivian Pellas had the strange feel of a hospital waiting to happen, clean modern facilities, crisply dressed nurses, stethoscope-toting doctors and virtually no patients. Business has since picked up.


Hospital care at Metropolitano Vivian Pellas is easy on the wallet, compared to similar care in other parts of the world.

Hospitalization costs only $98 a day (plus a $300 deposit), and procedures that are unaffordable for patients without health insurance in the United States are economically feasible here. Vivian Pellas also offers “executive check-ups” for men and women, including full lab work (cholesterol, liver, stool cultures, urinalysis, etc), abdominal ultrasounds and electrocardiograms starting at $170 (men under 40) and $200 (women under 40, including gynecological exam), to $310 (men over 40) and $400 (women over 40 including gynecological exam and mammography).

Unique to Metropolitano is its health plan, the Club de Salud, or Health Club. There are two levels of private health care plans providing affordable health insurance for locals and foreigners with no paperwork nightmares. Compared to most international health insurance plans – it is a true bargain.

The hospitals premium program is the Gold Plan. It is the most comprehensive. Under this plan a person over 40 would pay less than $665 a year for coverage and would receive up to 100% off in emergency room care, 50% discount on medical consultations, 65-80% discount on medical exams, 80% on charges for hospitalization, 50% discount on surgeries and 35% for medicine from the hospital pharmacy, 50% discounts on childbirth and many other services.

Under the Silver Plan, a person over 40 would pay $168 a year for coverage entitling them to discounts up to 70% off hospital charges, diagnostic exams surgeries, hospitalization and intensive care, up to 50% for physical therapy and rehabilitation services, 30% off at the hospital pharmacy, 20% off doctor consultations and 30% off childbirth, among other services.

There are additional discounts for family members enrolled in the same plan. Under the Gold Plan, costs for the plan range from $20 a month (for under 18) to $60 a month for those over 65 where the Silver plan ranges from $5 to $15 per month. The Health Club is one of the few that will insure the over 65, thus very attractive for the many retirees that spend the winter months in Nicaragua.

In addition to the Gold and Silver Plans, Vivian Pellas offers special discounted packages for some types of general surgery, orthopedic surgery, plastic surgery and maternity. The Maternity Packages ($515 for a normal delivery and $790 for cesarean) includes all delivery costs and hospitalization in a private room allowing monthly payments leading up to the birth.


For the international traveler that wants a broader coverage, I feel that the Danish company, IHI (International Health Insurance) is the most comprehensive plan. It allows the options of flying back to your home country (travel for the spouse and hotel is included in coverage) if surgery is needed. Patients can feel comfortable to choose the hospital and physician they wish to treat them under this plan. For more information, see .

In addition to Vivian Pellas, there are three other hospitals I would feel comfortable going to for treatment in Managua: Salud Integral, Hospital Bautista and the Military Hospital. Hospital Salud Integral in Managua also has state-of-the art 24 hour emergency services, with operating rooms, intensive care, clinical laboratory, and endoscopy. Private consultations range from $21-$25 dollars, and they have four types of rooms to choose from for hospitalization, ranging from $40 to $100/ night.

Hospital Bautista in Managua is a 75-year-old private hospital that was the best hospital in Nicaragua until the newer clinics opened in recent years. But Bautista is still a very competent and affordable clinic, with a level of personal care that ought to shame U.S. hospitals. An affiliate of the Baptist Health Systems of South Florida, Bautista offers all the same services of Vivian Pellas, but with a less-shiny coat of paint.

Two new $30-million hospitals are scheduled to be built in Managua in the coming years. One of them is a world-class children's hospital. A famous name is building that hospital. They have already started searching for a proper spot.

Some drugs manufactured in Europe that are not yet approved for distribution in the United States are available here. Most of the brand-name medicines you are used to North America or Europe will go by their generic or scientific name here. But most medicines and antibiotics are widely available and usually don't cost more than $10-20 for a prescription. A five day supply of Cipro: a commonly used antibiotic is only $4.50 in Nicaragua. While it is true that you may simply walk into a pharmacy and purchase most drugs without a prescription (not narcotics), please remember that it is always recommended to have a doctor’s prescription as medications may clash with one another and there can be serious side effects.

To assist foreigners in locating viable services, there is a new company called “Nicas” that is a relocation service which includes providing expatriates with a list of recommended doctors and specialists. They can be reached at for any questions you may have. The U.S. Embassy consular services can also provide a comprehensive list of English-speaking doctors, dentists and specialists.

The bottom line is that Nicaragua is a safe country to visit and live in that can offer you a beautiful climate with 300 days a year of perfect sunshine. Come visit Nicaragua: you’ll be pleasantly surprised!

Author: Lori Estrada, an orthopedist, and her husband, Jorge, relocated to the Nicaragua in 1997 with their three young children where they established, own and operate the premier orthopedic clinic in Managua. The Estradas, who are very active in a variety of civic, educational opportunity for youth, and charitable causes have developed a number of community outreach programs that have earned them the 2003 Diploma of Honor and the Medal of Amistad from national fire and police organizations in 2004 and 2006, respectively. The Estradas are developers of the 1000 acre master planned community of Monte Cristo Beach, located on the Nicaraguan Pacific coast. Montecristo is built to impressive world class standards of quality and sophistication, and includes a gamut of amenities from water sports, golf, tennis and horseback riding to a community library, art and salsa lessons.

To Contact Lori:

Caribbean Property MagazineEmail: Lori Estrada
USA Phone: 631-418-8438
In Nicaragua: 505-421-8159

Montecristo Nicaragua
Located on 1000 acres on the breathtaking Pacific coastline the community of Montecristo has four neighborhoods for different styles of living. Home to the community’s lively beach club, along with tennis courts and an equestrian center is Montecristo’s fourth neighborhood Costa Azul, which is most famous for the Montecristo Golf Club, including a beautiful 18-hole championship course, clubhouse, pro shop and an exclusive boutique hotel.

Montecristo has something to offer for everyone, Ventanas del Mar oceanfront condos start at $209,990, while Cumbres lots start as low as $65,000. Cielos ridge lots are offered at $322,000 for over an acre and a half with a large range of choice of position and acreage. And in the Altos Linda Vista neighbourhood there are still lots available at $50,000 for approximately a quarter acre...

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April 2008
Nicaragua is the emerging jewel of Central America having now experienced an 18 year period of political calm and tremendous internal reassessment and growth. There are numerous foreign investors in Nicaragua that, with the support of the new administration, are betting on this country and are responsibly investing in it, with positive and sustainable results. Logically, there`s still a lot more room to grow and a plethora of opportunities to take advantage of... ---> Read More
April 2008
Nicaragua has transformed itself, over the past 18 years, in to one of the fastest growing countries in all of Latin America. The Nicaraguan government has proactively established some of the most advantageous incentive programs to attract and keep foreign investment and business growth in almost all areas and at each market level.
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April 2008
In 1997 my husband, 3 young children and I moved to Nicaragua! We were in critical need of a life and lifestyle that didn`t involve non-stop work, and where Saturday and Sunday`s became two more work days, instead of family days. We visited Nicaragua and felt immediately welcome and at home, plus the people of Nicaragua are so warm and friendly. Nicaragua is indeed the land of personal and professional opportunity. We have never looked back, never been happier as a family, and at 10 years later I can report, that we would not live anywhere else.

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August 2007 /´Crew Wanted´, is a great and comfortable place to start a sailing adventure. Unless you are on a mega-yacht, sailing and comfort don’t tend to go together like love and marriage, or a horse and carriage. And I can now testament to this! The website was where I met my sailing buddies and the start of my eight week adventure sailing around Central America trying to get to the Caribbean. Two Austrian guys and a Dutch girl (plus myself) all in our 30´s, agreed to travel from various parts of the world and meet in Costa Rica.

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June 2007
The tourist permit allows for only a 90 day period. After that, a visitor must renew his or her Visa. According to the immigration law a foreigner here as a tourist must leave the country for at least 72 hours after he or she has been in Costa Rica for 90 days. As far as having to travel outside of Costa Rica, its not that big of a deal and can be fun. Many people travel to David or Bocas del Toro, Panama or Granada, Nicaragua on inexpensive bus tours for a weekend. ---> Read More
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