Evening team circle under a thatched palapa at the Amigos for Christ compound

FAVNica · Chinandega · 31 Aug–4 Sep 2026 · Hospital Dr. Mauricio Abdalah

Work and live without a tube in your neck

“I was sick and you visited me.”
Matthew 25:36

Hosted by: Amigos for Christ

A fistula is your own vein, in your own arm — so hemodialysis does not have to mean a plastic tube in the neck and the infections that come with it.

Evening circle under the palapa at the Amigos compound, Chinandega. String lights, white chairs, a few still in scrubs — the day’s list behind them.

Chinandega · 2026

They came to make a door in the arm

To our knowledge, the first mission team organized specifically to create and teach AV fistulas in Nicaragua.

For one week at the hinge of August and September, a small visiting team slept at the Amigos for Christ compound in Chinandega and operated at Hospital Dr. Mauricio Abdalah in Chinandega. They came to create arteriovenous fistulas — a joining of artery and vein — so that people who need hemodialysis can be needled in their own vessel, instead of living on a plastic tube in the neck.

Amigos for Christ, based in Buford, Georgia, has a long presence here. The work is done alongside Nicaraguan surgeons, nurses, and hospital staff — juntos, in the ordinary sense: two teams in the same rooms, sharing tables, language, and the day’s list. Evening devotionals gather under the palapa when the schedule allows. That is the shape of the week, not a slogan.

This page is a brigade journal: why kidneys in western Nicaragua fail younger than they should, what a fistula actually is, and how this operating week was built. It is not a census, and not a promise that every arm can be sewn.

Team standing on the cinder-cone summit — On the cinder cone. Heat, ash, and the Pacific-side sky — the same climate that shapes work in the cane fields below.

The land and the kidneys

In the sugarcane and hot outdoor work of Chinandega and León, kidney failure often arrives in young men. That is not the usual U.S. story of chronic kidney disease — older adults, diabetes, hypertension. Here the pattern has another name: Mesoamerican nephropathy, also called chronic kidney disease of non-traditional origin (CKDu).

It is a tubulointerstitial disease. There is often little protein in the urine. Blood pressure may be normal or only mildly high at the start. Many of the men who get it do not have diabetes. The cause is not fully settled. Heat stress and heavy workload have the strongest epidemiologic support; agrochemicals, well water, and other exposures have been studied. Honesty requires the uncertainty.

8.6% CKD in a León household sample, ages 15–59. Suspected CKDu 3.1%. About twice as common in men. Strasma et al., BMC Nephrology 2023 · doi 10.1186/s12882-023-03381-1

~10% / 3.5% Apparently healthy 18–30s in León and Chinandega: about 10% of young men and 3.5% of young women had very rapid kidney-function decline. González-Quiroz / London School of Hygiene & Tropical Medicine

73.9 Nicaragua’s age-standardized kidney-disease death rate per 100,000 in 2019 — highest in the Americas (regional average 15.6). National figure, not a Chinandega census. PAHO, using WHO Global Health Estimates, 2019

These are published studies and named estimates. They are not a count of everyone in Chinandega. Do not read them as “the highest in the world,” and they are not a death toll for this week.

The chair, the road, the bloodstream

When kidneys can no longer clear the blood, hemodialysis is not optional. Several times a week, or they die. That means chairs, machines, travel, missed work — and a reliable way into the bloodstream. Access is the bottleneck.

Public hemodialysis through MINSA is free for the patient. Formal workers covered by INSS typically receive three sessions a week. A private session, about $140, is out of reach for most families.

Cajina-Aguirre et al., Kidney360, 2023

The people in those chairs are not the older diabetic patients many U.S. units are built around. Average age in the MINSA and INSS dialysis populations was about 49.9 years. Three-year survival after starting hemodialysis was reported at 52% in that same overview. A 2020 series that trained native AV fistula surgery in Nicaragua found a mean patient age of 48.6 years; 92% were men, and 66% of the fistulas were radiocephalic.

López, Salgado, Vachharajani, Kidney International Reports, 2021

A high-capacity hemodialysis center now exists in Chinandega city: Centro de Hemodiálisis Comandante Germán Pomares Ordóñez (“El Danto”), which opened 23 September 2024 with about 103 chairs. It is a different campus from Hospital Dr. Mauricio Abdalah in Chinandega, where this brigade operated. A chair is one problem. A safe, lasting way into the blood is another.

The catheter: a bridge that exacts a toll

A central venous catheter is a plastic tube, usually in the neck or chest. It can start dialysis the same day. That speed is why it exists, and why it is hard to leave.

The costs are not abstract. The tube is a path from skin into the bloodstream, so infection is the first tax. Catheters clot. They can scar and narrow the central veins — stenosis that may steal the chance of a fistula in that arm later. KDOQI 2019 prefers AV access over a catheter for most hemodialysis patients because of infection risk. Large observational studies also associate catheters with higher death rates than fistulas; that is not the same as proven causation. People who stay on catheters are often sicker or started dialysis in a hurry. The direction of risk is clear. A precise mortality multiplier is not a fact this page will claim.

Lok et al., KDOQI Clinical Practice Guideline for Vascular Access, 2019

Peritoneal dialysis, when the house can hold it

Peritoneal dialysis can be excellent. Fluid goes in and out of the abdomen at home. It can spare the thrice-weekly road. Nicaragua uses it — especially CAPD in the public system. This page will not say it is never used here.

It asks a lot of a house. Sterile technique, a reasonably clean room, a steady chain of boxes of fluid, a way to store them in the heat, enough literacy and training to run exchanges without contaminating the line. In rural Chinandega those things are uneven: well water, crowding, heat, long supply runs. Peritonitis — infection of the abdominal lining — is the failure that people fear, and it is not a small fear. For many agricultural families, in-center hemodialysis with a working fistula is the more durable path. That is a statement about housing and logistics, not a verdict on peritoneal dialysis as a therapy.

The fistula: own tissue, years of needles

A fistula is not a miracle in the cheap sense of the word. It is a small, exact joining of two vessels that already belong to the patient — usually a radiocephalic fistula at the wrist (radial artery to cephalic vein) or an upper-arm fistula if the forearm will not serve.

After it matures, the dialysis needles go into living tissue — the same arm, year after year — instead of a foreign tube that never quite belongs.

Own tissue. Far less infection than a catheter. A chance at years of needle access. It is not ready the day of surgery. A fistula needs weeks to months to mature. A catheter may still be needed as a bridge. Not every arm qualifies: veins too small, arteries too calcified, prior catheters that have already stolen the central veins. The blessing is real. So are the limits.

This team’s purpose is creating AV fistulas — lasting access from the patient’s own vessels — so dialysis can happen without a tube in the neck.

Surgeons with loupes creating an arteriovenous fistula at the wrist; patient face not shown — AV fistula surgery at the wrist. Loupes, fine instruments, a small field. The patient’s face is not shown.

Inside the operation

Map the vessels. Isolate artery and vein. Vessel loops and bulldog clamps. A fine anastomosis — typically 6-0 or 7-0 polypropylene. Loupes. Castroviejo or Potts scissors, microvascular forceps, needle drivers, rubber shods, heparinized saline. Success is a palpable thrill in the vein, the hum you can feel with two fingers.

This is fine vascular work. Experienced general surgeons do it here, together with Nicaraguan colleagues. Nicholas Peter Maxwell and Margaret Eileen Gallagher operate. Thomas James Gallagher assists — extra hands, not the primary fistula surgeon unless asked. Nicaraguan colleagues are in the rooms.

Vessel mapping
Vessel loops
Bulldog clamps
6-0 / 7-0 polypropylene
Surgical loupes
Castroviejo / Potts
Microvascular forceps
Needle drivers, shods
Heparinized saline

Two surgeons wearing loupes operating on an arm; patient face not shown — Two surgeons, loupes on, over an arm. No patient face.

Awake, on purpose

Most of these operations are done awake. Jared E. Boyd, the anesthesiologist, places a brachial-plexus regional block — axillary, supraclavicular, or similar — and local anesthetic at the field. General anesthesia is avoided when it can be. Kidney failure already taxes the heart, the potassium, the fluid. A quiet, numb arm is often enough. The block also helps with pain after.

Hospital surgical corridor with signs for emergency operating rooms and surgical scrub — The OR corridor at Hospital Dr. Mauricio Abdalah: QUIRÓFANOS EMERGENCIAS, LAVADO QUIRÚRGICO.

The shape of the week

Hospital protocol here is not the U.S. same-day fistula. Patients are admitted the night before and discharged the day after — two nights in a bed, families in the hallway, a slower clock.

Sunday · setup Pre-screening in two consult rooms. OR setup. Instruments to sterilize. Materials to the hospital at 8:00 a.m.
Sunday · after the rooms are ready A climb at Cerro Negro, Reserva Natural Complejo Volcánico Pilas–El Hoyo. Ash underfoot, boards on shoulders, the week still ahead.
Monday–Friday · operating days Leave the compound about 6:30 a.m. after breakfast. Work until the list is done. Evening devotionals under the palapa when possible.
The list, honestly Day-one target was six cases, not eight. Supplies were packed with about 24 operations in mind. This page will not publish a completed case count while the week is still running.

Team sorting surgical instruments and supplies from suitcases in a hospital hallway marked ALMACEN ROPA LIMPIA — Sorting instruments and sterile supplies from suitcases in the hospital hallway — ALMACÉN ROPA LIMPIA — before the first cases.

Team gathered at the Cerro Negro natural reserve sign — The team at Cerro Negro / Reserva Natural Complejo Volcánico Pilas–El Hoyo, after Sunday setup.

Team hiking up volcanic ash carrying volcano boards — Volcano-boarding hike: boards on the shoulder, cinder under the shoes.

The team, juntos

Names from the brigade authorization and the rooms. No invented biographies. Nicaraguan hospital staff work alongside — their names are not all in the traveler list, and they are not a footnote.

Nicholas Peter Maxwell General surgeon. Operates.
Margaret Eileen Gallagher General surgeon. Operates.
Thomas James Gallagher Obstetrics & gynecology. Extra hands; not the primary AVF surgeon unless asked.
Jared E. Boyd Anesthesiologist. Brachial-plexus blocks.
Christa Leah Maxwell Nursing. OR, packs, instruments.
Kendall Clare Adrian Board and flow; Spanish.
Morgan Michele Solomon Nurse. Circulating, cleaning instruments, and logistics.
Colleen Weston Board-certified infectious disease physician. Circulating, cleaning instruments, and logistics.
Crystal Dawn Mitchell Hemodialysis technician. Circulating, cleaning instruments, and logistics.
Andrew Rebock Non-medical. Field work bringing water to Nicaraguan communities.
Maggie Dunne, RN U.S. on-ground coordinator.
Lic. Reyna María Silva Cabrera Local coordinator, Chinandega.
Tessa Sulimirski U.S. Director of Missions, Buford office.

Juntos. The visiting names sit beside Nicaraguan surgeons, circulators, and scrub techs in the same blue corridor. The week only works that way.

Team playing foosball at the compound, some still in scrubs — After the rooms: a foosball table at the compound, some still in scrubs.

The week in pictures

Photographs from the team’s shared album — Chinandega, 31 August–4 September 2026. Hosted by Amigos for Christ. No patient names. Faces of patients are not published here.

A team member’s backpack being inspected by an official on arrival — Arrival: a backpack opened for inspection on the way in with the supplies.

Team standing over yellow-lid bins and cardboard boxes on a sidewalk — Yellow-lid bins and cardboard on the sidewalk — supplies coming off the truck.

View from a balcony over dry grass and terracotta roofs at the compound — From the balcony: dry grass, terracotta roofs, and the trees beyond the compound in Chinandega.

A coffee mug held against a sunrise over Chinandega hills — Coffee at first light, looking out over the Chinandega hills from the compound roof.

Team eating together at tables with red cloths in a Chinandega dining hall — Lunch together — scrubs and street clothes at the same table, red cloths, plates of rice.

Three visiting clinicians in white coats standing in a hospital workroom — Three of the visiting clinicians in white coats, between cases, in a hospital workroom.

Team members in lab coats in a hospital corridor under a green SALIDA sign — In the corridor — a peace sign, lab coats, and the green SALIDA sign at Hospital Dr. Mauricio Abdalah.

Team sorting sterile supplies from open suitcases in a hospital hallway — Suitcases open on the floor — sterile packs and instruments being sorted in the hospital hallway.

Team around a red crate of drapes and trays before the next operating room — A red crate of drapes and trays; the team counting packs before the next room.

Team in scrubs seated in white chairs during a briefing, duffels on the floor — Between cases: scrubs, shoe covers, white chairs, and duffels still on the floor.

Perforated gray tray filled with clamps, scissors, and hemostats — A perforated tray of clamps, scissors, and hemostats, marked with colored bands, ready to sterilize.

A team member in a mask laying out instruments on a teal sterile drape — Instruments on a teal drape: basins, forceps, a syringe — the table before the incision.

Team sitting on a hospital hallway floor cleaning instruments on blue wrap — On the hallway floor: instruments spread on blue wrap, sinks along the wall, the day’s tools being cleaned.

Team standing at night in front of a building marked CONSULTA EXTERNA — Night at the CONSULTA EXTERNA door: scrubs, a borrowed coat, the week still in the middle.

Team gathered at the colorful Cerro Negro letters and natural reserve sign — The team at the Cerro Negro letters, Reserva Natural Complejo Volcánico Pilas–El Hoyo, after Sunday setup.

Three hikers climbing a steep volcanic ash trail, seen from behind — Single file up the ash — yellow pack, walking stick, the crater wall falling away.

Team in green jackets with wooden volcano boards on black ash — Green jackets, wooden boards, black ash: getting ready to ride Cerro Negro.

Team hiking a volcanic field carrying volcano boards, green cones behind — Boards on the shoulder, cinder under the shoes, the green cones of Pilas–El Hoyo behind.

Looking up a black volcanic ridge with hikers and a board against a bright sky — Looking up the black ridge — a board on someone’s back, the sun just over the lip.

Two team members on a cinder slope watching the sun over a wide plain — On the cinder slope at sundown — two of the team, the Pacific-side sky opening out.

Three team members standing on volcanic ash with a green cone behind them — Three of the team on the ash, the green cone behind them, the climb done.

In the news

On 31 August 2026, Nicaraguan media shared welcome news: a medical brigade from Georgia, United States, working together with Nicaraguan health professionals at Hospital Dr. Mauricio Abdalah in Chinandega. Co-President Rosario Murillo announced the visit. Canal 6 and Radio La Primerísima both covered the week.

Amigos for Christ, based in Buford, Georgia, has hosted medical brigades in Chinandega for years. This week the visiting team and Nicaraguan colleagues are creating arteriovenous fistulas — so people on hemodialysis can live and work without a tube in the neck.

Canal 6 · 31 Aug 2026

Specialists from Georgia strengthen surgical care in Chinandega

Co-President Rosario Murillo announced a specialized brigade from Georgia working with Nicaraguan health professionals at Hospital Mauricio Abdalah in Chinandega.

Read Canal 6 → Radio La Primerísima · 31 Aug 2026

Amigos for Christ brigade at Hospital Mauricio Abdalah

Specialists of the “Amigos for Christ” brigade, 31 August–4 September, Hospital Doctor Mauricio Abdalah, Chinandega. Thirty-two patients named for catheter placement.

Read La Primerísima →