After civil war destroyed the country’s economy in the 1980s, hospital administrators and influential businessmen now think the country is stable enough to lure foreign visitors looking for cheap surgeries.
The nascent industry here of selling Americans gastric sleeves and artificial knees began at Managua’s Hospital Metropolitano Vivian Pellas about a year ago. The hospital’s medical tourism director, Arlen Perez, walked the bleach-white hallways recently and explained why drawing foreign customers to Nicaragua’s capital is hard work.
“The educated patients won’t take risks,” she said.
Metropolitano opened in 2004 with the backing of the Pellas family — arguably the most influential business titans in all of Nicaragua. Recently, the hospital became the country’s first to get a coveted Joint Commission International certification, which ensures the building and its doctors meet certain safety standards. Without its high-powered family name and that stamp of approval, the medical tourism project might have a hard time getting off the ground.
As it is, Perez says only about 10 patients a month come from the United States and Canada.
“We’re trying to get 50 patients per month,” she said. “We believe that’s a good number for the following two years at least.”
So the hospital is starting out with ads targeting Latinos in the U.S. The basic message is that a hip replacement might cost $25,000 in the states, but “here we do it for $9,000,” Perez said.
Perez and her team are trying to sink their teeth into an industry that’s spreading across the globe. The accounting firm Deloitte predicted more than 1.5 million Americans would travel outside the U.S. for medical care last year. Places like Mexico and Costa Rica have long been popular, but Nicaragua has more or less been off the map.
“The nice thing about the medical tourism is that they’re here for a week or so, and that’s a more profitable situation for me as the owner,” said Mike Quinn, who is encouraging the industry to inch into his business.
Quinn owns a bed and breakfast that doubles as a working farm. Quinn has teamed up with Perez at the Hospital Metropolitano. Some patients go straight from its operating room to Quinn’s hotel.
He recently rented a room to a man with a new knee who couldn’t walk very well at first, “but he could certainly get in that pool and just relax in that gravity free-environment. That felt really good for him,” Quinn said.
Quinn sees enough growth potential in medical tourism here that he’s invested about $3,000 to build a new concrete ramp into to the pool.
A few years ago, this could not have happened. A decade of fighting between the U.S.-backed Contras and the socialist Sandinistas crushed Nicaragua’s economy.
“We’re trying to catch up, but we’re still way behind,” said Carlos Muniz, who heads the Nicaraguan economic development organization FUNIDES.
Muiz said the country still needs better roads, better education, and a stronger judicial system to catch up with neighbors like Costa Rica. But there is promise. According to its Central Bank, foreign investment in Nicaragua grew nearly 30 percent since 2008.
That’s one reason Nelson Estrada sees an opportunity on a mountaintop that overlooks a popular surfing town and a shimmering Pacific Ocean.
“This is one of the most beautiful views that we can have in San Juan del Sur,” Estrada said, with the wind whipping his back. “Wow, a dream.”
Estrada wants to put a $16 million resort-medical center on this mountain, and he has the clout to do it. He comes from the family of three former Nicaraguan presidents, and his sons grew up with a son of the powerful Pellas family.
Estrada said he’s raised most of the money he needs to break ground on the resort, which he is naming Solest. It's a place where foreigners go to get a nose job, and then recover in luxury.
“You’re talking about wrinkles, eyes, the chin, the breast reduction and augmentation,” he said.
According to Estrada’s plan, every surgeon who works here will be trained in the U.S.
But Estrada said he’s looking beyond this project. If it gains traction, other investors may start new projects. If the medical infrastructure is strong, it might open the market for a wave of American Baby Boomer retirees to move here for good.
Estrada says there’s a saying in Spanish that explains this idea.
“One particular bird alone doesn’t make a summer,” he said. “If we were alone — and we expect to be alone for a long time — this is not going to work.”
There’s a model for all this just south of here. From the mountaintop you can almost see Costa Rica, a country that has figured out how political and economic stability has a way of luring Americans with money.