Medical care is in short supply outside of Managua , and even in the capital city, doctors in public hospitals are underpaid (earning about $200 a month) and brutally overworked. Though there are many qualified medical professionals in Nicaragua, who studied abroad in Mexico, Cuba, or the United States, there are also many practicing doctors and medical staff who have less-than-adequate credentials. Use your best judgment.
Private hospitals and clinics typically expect immediate payment for services rendered, but their rates are ridiculously cheaper than they are back home. Larger facilities accept credit cards and everyone else demands cash.
Government-run health clinics, called Centros de Salud, exist in most towns throughout the country, usually near the central plaza. They are free—even to you—but poorly supplied and inadequately staffed.
The most modern hospital in the country is Hospital Vivian Pellas, a $23-million private institution seven kilometers south of Managua on the Carretera Masaya.For dental emergencies, or even just a check-up, seek out the bilingual services of Dr. Esteban Bendaña McEwan (300 meters south of the ENITEL Villa Fontana tel. 505/270-5021 or 505/850-8981, estebanbm [at] hotmail [dot] com); Dr. Bendaña is accustomed to dealing with foreign patients and his prices are reasonable.
Many campesinos have excellent practical knowledge of herbal remedies that involve teas, tree barks, herbs, and fruits. The first medicines came from the earth, and the Nicaraguans haven’t lost that connection. Try crushed and boiled papaya seeds, oil of apazote (a small shrub whose seed is crushed for medicinal use), or coconut water to fend off intestinal parasites, manzanilla (chamomile) for stress or menstrual discomfort, or tamarindo or papaya for constipation.
A popular cold remedy involves hot tea mixed with two squeezed limes, miel de jicote (honey from the jicote bee), and a large shot of cheap rum, drunk right before you go to bed so you sweat out the fever as you sleep.
Many modern medicines, produced in Mexico or El Salvador, are sold in Nicaragua. Because of a struggling economy and plenty of competition, some pharmacies may sell you medicine without a prescription. For simple travelers’ ailments, like stomach upsets, diarrhea, or analgesics, it’s worth going to the local pharmacy and asking what they recommend. Even relatively strong medications like codeine can be purchased over the counter (in fizzy tablet form).
Birth Control: Condoms are cheap and easy to find. Any corner pharmacy will have them, even in small towns of just a few thousand people; a three-pack of prophylactics costs less than $2. Female travelers taking contraceptives should know the chemical name for what they use. Pastillas anticonceptivas (birth control pills) are easily obtained without prescription in pharmacies in Managua  and in larger cities like León , Granada , and Estelí . Other forms of birth control and sexual protection devices, such as IUDs and diaphragms, are neither used nor sold.