Nicaragua – An Introduction

The 1972 Managua earthquake destroyed the city

The 1972 Nicaragua earthquake occurred at 12:29 am on December 23 near Managua, the capital. It had a magnitude of 6.2, with the epicenter 28km northeast of the city centre. The earthquake caused widespread casualties among Managua’s residents: 6,000 were killed, 20,000 were injured and over 250,000 were left homeless. It destroyed or severely damaged much of the city centre.

Damage Done to Managua After Earthquake

Millions of dollars of aid were donated. President Anastasio Somoza Debayle diverted much of the money for himself and those close to him. Frustration grew into a revolt that became the Nicaraguan Revolution, in which Somoza was overthrown in 1979. A broad coalition of forces led by the Sandinistas overthrew the Somoza dictatorship that had ruled Nicaragua for 43 years. Healthcare reforms and a widely lauded Literacy Crusade, which cut illiteracy from more than 50% to 13% in two years, earned the revolutionary government accolades on the world stage.

Civil war further devastated the country

In 1981, in an attempt to overthrow the Sandinista government, the Reagan administration began illegally financing and training the contras, a mercenary army based in Honduras. The Soviet Union and Cuba funded the Nicaraguan army. Much of the country’s infrastructure was damaged or destroyed. When Congress moved to cut off aid to the Contras (1985), Reagan aide Col. Oliver North concocted a clandestine and ingenious plan to continue funding the Contras terrorists (Iran-Contra Affair). In 1986, the World Court ruled that the US war against Nicaragua was in violation of international law and ordered the US to pay $12bn reparations. The US refused. The contra war led to the death of 60,000 soldiers (half on each side) and 50,000 civilians between 1981 and 1990.

Due to the extent of the damage, corruption and the subsequent revolution and 11 year civil war, much of Managua city centre remained ruined for almost 20 years. Reconstruction only began in the 1990s. This was not co-ordinated and has led to a sprawling mess with no centre.

Nicaragua Managua Houses

Between 1990 and 2007 a neo-liberal government brought significant change

Neo-liberal governments spread across the whole of Latin America at this time. In Nicaragua this included Liberal Arnoldo Alemán, voted one of the world’s 10 most corrupt politicians by the UN Human Rights subcommission. Alemán siphoned off US$100 million from the government.

During the neo-liberal years trade union power was diminished. This then allowed widespread privatisation. Thousands of public sector jobs were lost, the health service was underfunded and suffered from acute shortages.  Until 2007, Nicaraguans in effect ceased to have access to free health care.  Education, trains, telecommunications, electricity and even land was also privatised during this period.

Nicaragua is one of five countries in the world where abortion is illegal with very few exceptions.

Daniel Ortega (Sandinistas) returned to the presidency in 2006, bringing positive reforms.

Nicaragua is the largest country in Central America, covering an area the size of Greece. It borders Honduras to the North and Costa Rica to the South. The Caribbean Sea (Atlantic Ocean) lies to the East and the Pacific Ocean is to the West. A canal linking the two oceans has recently begun construction. Costing US$50bn and developed by a Chinese company, it will be 172 miles long, 750-1700 feet wide and 90 feet deep. This compares with the 100 year old Panama Canal which is currently being upgraded to 50miles long, 180 feet wide and 90 feet deep. When complete in five years, the canal should double the country’s GDP.

Nicaragua Canal

There are 6 million people (45/km2) and half live in the Pacific region. A quarter of the total population live in the capital. Nicaragua is the second poorest country in the Western Hemisphere and half the country lives in poverty. 77% of the population in rural areas have an unsuitable water supply. 33% have no electricity and 59% use wood for cooking.

The new government has made significant improvements to salaries, healthcare and other areas. Health (treatment and prescriptions) and education are now free. Illiteracy has nearly been eliminated; maternal mortality and malnutrition rates have reduced by up to 50%. There has been a huge investment by the government in social programmes such as Zero Hunger.

They have also improved the image of Managua with illuminated Trees of Life:

 Tree of Life


How FitBit Can Improve Your Diet

My lifestyle was unhealthy

I started using FitBit to both improve my health and to understand the potential of wearable technology. I have a busy life and enjoy eating and drinking! I love croissants, cooked breakfasts, pies, pastry, chips, crisps, cakes, ice cream, chocolate, baklava, wine, beer and cocktails! I used to eat a lot of “ready meals” and Nutella and Häagen-Dazs from the container! Many family and social events revolve around meals. There are always snacks on the ward and I often bring treats for the team. My catchphrases were: “It’s rude not to!” and then “I’m stuffed – never eating again!” I have recently discovered that my ‘individual’ portions are apparently designed for families! No wonder the last few mouthfuls hurt!

Sebastian Caricature

I used FitBit to track my consumption, then limited overall calorie intake

As outlined in Getting Started, I now measure every portion obsessively and enter it into the FitBit app. This gives a guide to calories consumed and remaining in the day. I was pretty good at stopping when I got to my daily calorie limit. And delighted when I discovered that if you walk further, you earn more calories which could allow that extra glass of wine! 😉

I changed my diet in two ways. Firstly, I use the 5 + 2 Diet. This limits intake to 600 kCal a day for two days a week (500 kCal for women). On the other days I could have a normal amount. In order to maximise the rate of weight loss, I selected the FitBit “Harder” option of eating 1,000 kCal less than I burned every day!

FitBit Food Plan

The 600 kCal days can be demanding.

I try to choose days which should are easier. I avoid long days at work, weekends and days with meals out. At first I had so much flab, I didn’t really notice not eating! I usually miss one or two meals a day. The food often involves a lot of salad, some fish and a bit of fruit. I remember removing three lettuce leaves to get to 600kCal! It is amazing how good food can taste on a 600kCal day! The days can be tiring and I have become ratty at times! It is also a challenge to maintain the 10,000 steps on those days.


My behaviour has changed – I now have healthy habits

I have learned to drink water! I used to think there was sufficient water in wine! My FitBit says I need 1,420ml of water a day and I have managed to hit that goal each day.

The experience has been fascinating in many ways! Many foods have a standard portion size that previously seemed ridiculously small! It has been a shock to discover how calorific the foods I really enjoyed are! So now I have cut back a lot on pies, cheese, puddings and bread. I now limit portion size and pour drinks into a measuring jug first! Instead of that goblet I used to like, I now use a much smaller glass! When a bottle is nearly empty, I used to just finish it! Now bottles last for days!

I no longer snack! I can walk past a tin of chocolates and resist cake! It is not painful and I am not being a martyr. The new behaviours have become habits.

When shopping, I choose low calorie options! Restaurants that publish calories are really helpful. It is actually shocking how many calories are in typical meals! I even opted for the Pizza Express Leggera pizza (with a hole in the middle it is only 500 kCal!).

Pizza Express Leggera

This new lifestyle can be challenging

It is difficult to sustain is when tired, under stress and away from home. When run down, I have retreated to snacking for comfort. When at conferences or parties, it is difficult to be too fussy and also hard to know how many calories you are eating.

My new diet has surprised and delighted me!

Overall, it has been a real revelation. I did not believe that measuring my intake and eating less could have such an impact! I have started feeling hunger (occasionally!) which is an entirely new phenomenon for me! Another surprise is that many people in my department are now losing weight! This is without me encouraging anyone! I believe there is huge potential for extending 5:2 to other areas. Click here to learn more about the Quantified Self movement.

How #FitBit Changed My Life!

FitBit has changed my life!

Out of all recognition! I feel different, I look different and my clothes no longer fit! I don’t snack (unless I make a conscious decision to), I drink water and I walk! I have lost 19% of my body weight in 5 months! This blog will give an overview of my experience. Future posts will expand on each theme. Please comment, share resources and let me know what you are interested in.


I started using FitBit to improve my health and to understand the technology

I am passionate about changing the world! Technologies that have transformed many industries are now offering new possibilities to the health sector. Although senior leaders are driving adoption of eHealth, the NHS can be slow to embrace change. Because I believe that patients and citizens will lead this revolution, I chose to test the potential of wearable devices.

I knew I was overweight and was concerned it would lead to ill health. My catch phrases used to be: “It’s rude not to” and “I’m stuffed – never eating again!” I ate too much, took no exercise, had insufficient sleep and never drank water! My goal was to lose 20% body weight in 6 months. I began collecting baseline data on 9th June 2013 and started the lifestyle changes on 1st August 2013.


FitBit supported me to eat less and move more

FitBit Flex is a band worn on the non-dominant wrist 24/7. It tracks movement and sleep. It links to a smartphone app and website to record your data and encourage behaviour change. I changed my diet in two ways. Firstly, I use the 5 + 2 diet. This limits intake to 600 kCal a day for two days a week (500 kCal for women). On the other days I can have a normal amount. In order to maximise the rate of weight loss, I selected the FitBit option of eating 1,000 kCal less than I burned every day! The exercise regime is to aim for 10,000 steps a day.  I also invested in the FitBit Aria scales (including percentage fat and wifi link) although this is not essential.


My FitBit obsession has changed my relationship with food and drink

I measure every calorie eaten, every millilitre drunk, every step taken and every minute slept. Soon I will record every flight of stairs climbed! I stop eating / drinking when I have reached my daily allowance. Although … I have discovered I can increase the allowance on the “5” days by walking more! My diet has changed so I rarely snack, I eat more fish and vegetables and fewer processed foods. I check the calories on food before buying or eating it and choose low calorie options. The portion size has decreased and I no longer finish a bottle, simply because it is nearly empty! I also drink 1,500ml of water each day. I have discovered the sensation of hunger and think and talk about food a lot more!


I now exercise regularly, encouraged by a supportive community

Whilst 10,000 steps initially sounded impossible, I now achieve it most days! This started by avoiding lifts, parking farther from the entrance of buildings and walking whilst on the phone. Most surprising for me is that I walk each evening to complete my target! It takes 10 minutes to walk 1,000 steps and 1 hour and 40 minutes to walk 10,000. I walk around the country where I live (as late as midnight) with a torch and rain coat, posting updates on social media. The community really helps to encourage and celebrate progress. I have found FitBitters via the Android App, on Twitter, FaceBook and real life! The app has a leaderboard showing weekly step count and I try to keep up with Mark, Katie and Karina!


I have lost 19% body weight in 15 weeks of actively trying

My weight on 16th November was 77kg (18kg loss!). It has decreased every week since 9th June apart from a single gain of 300g last week. That “failure” drove me to become more disciplined with intake and targets. In the following five days I lost 1.8kg!! I have reduced my waist from 38” to 34” and treated myself to new Armani Jeans and a Ted Baker top as a reward!


Wearable devices have great potential to improve health and wellbeing for all

In conclusion, I strongly believe that wearable devices will have a transformational effect on public health. The core concepts are: making measurement easy (#QuantifiedSelf), simple user-defined goals, game mechanics (#Gamification) and community support. Whilst many individual apps can be combined for free, FitBit has proved effective because of its integrated interface.

I will continue to blog about each element above to share more of my experiences. I have not received any financial support or sponsorship from FitBit. If you live in the Midlands, please join Health 2.0 Birmingham (also on LinkedIn). This is a new group of clinicians, developers and patients who meet to connect, learn and innovate.