© 2016, © The Author(s) 2016. Nicaragua has the lowest per capita spending on health in Central America. Public clinics lack medications for chronic disease management; many citizens obtain prescriptions but cannot afford to get these filled; poorly equipped and under-staffed operating theatres function part-time while waiting lists swell. This is the context within which dozens of international healthcare missions travel to Nicaragua every year to provide surgical and primary care to the country’s poor. This article is based on research conducted in 2013 on Nicaraguan encounters with and moral framings of foreign surgical and primary care missions working in their communities. It draws on critical humanitarian studies and queer affect theory in attending to and analyzing references to gratitude within these accounts, asking what local and trans-national relations Nicaraguan narratives of gratitude toward medical aid help form, limit, and enable.