Dying in Nicaragua in the Time of Coronavirus

According to the Citizens Observatory COVID-19, more than 1,688 Nicaraguan’s have died within the last 3 months, without goodbyes or posthumous homage.

By Keyling T. Romero  (Confidencial)

HAVANA TIMES – “Rosie” died June 3rd at 10:30 pm. Her death certificate confirms it. Yet her family didn’t hear of her death until 4:30 in the afternoon of June 4th, eighteen hours after her death. At fifty-eight years old, “Rosie” died without saying goodbye to her children as she’d had no contact with them since being admitted two days prior.

“Rosie’s” family was never told that she had COVID-19. Her death certificate states that she died from “respiratory insufficiency and atypical pneumonia”. However, the manner in which “Rosie’s” case was handled indicates that she was infected with the novel coronavirus. “Rosie” didn’t have a traditional funeral. Her children buried her quickly on Friday, June 5th, after the city’s mayor’s office provided them with the coffin because they didn’t have enough money to buy one. The only one of “Rosie’s” children to identify her body was her eldest child. The rest had to remain with nothing but their last memories of her when she was alive.

“Rosie’s” daughter, “Marcela”, who asked to remain anonymous for fear of reprisals, still cries when speaking about her mother. “It still hurts,” she says, her voice breaking, as though an explication were necessary.

This time, their mourning has been even more painful than others, and they are not alone. This story and others, in all their variations, are repeated in dozens of homes in Nicaragua where, officially, 64 people have died; although by this time the majority of people know of a neighbor, friend or family member who didn’t survive the virus. And the total is obviously more than 64.

As of Friday, June 19th, the Citizen Observatory COVID-19, which independently monitors the pandemic, reported 1,688 suspected COVID-19-related deaths…1,688. The number is more than 26 times that of the official (government) number. And it’s more than double the 813 deaths projected by the Ministry of Health (MINSA) for the 180-day period following the detection of the first positive case of coronavirus infection. This means that deaths have superseded the official projection by 100%, in half the time.

Double emotional toll

COVID-19 changed life as we knew it. We distanced ourselves from those we love, it tore from us our tranquility, eliminated our plans, and filled us with the fear of dying, or of losing someone we love. Local psychologists note that the current assault comes on top of all the unprocessed mourning and open wounds resulting from the social, political and economic crises which became more profound in 2018.

“We are carrying accumulated stress along with a series of socio-depressive manifestations which are not yet quantifiable. And when psycho-social reactions relevant to the intensity and frequency of the pain are seen, the situation can get worse. That’s when we see anxiety, anguish, depression, stress and fear,” explains psychologist Javier Barreto.

All these feelings have invaded “Marcela’s” life, in one way or another. Losing her mother was something she didn’t anticipate. “Rosie” began to have symptoms after going to the health center for back pain, where “Rosie” was told that her back pain was caused by kidney problems. Several days later she began to have difficulty breathing, headache and fever. Finally, she agreed to let them take her to the hospital.

“Rosie” was admitted to the Fernando Vélez Páiz Hospital in the late afternoon of June 1st. Hours later, her daughter was told that her mother should be intubated but she said no. Yet later the doctors told her that her mother had signed the authorization. “I checked the authorization to make sure they had informed her and saw her signature, saw that she had signed.”

Around 10:00 pm Tuesday night, “Marcela”, who had decided to spend the night in the hospital, although not in the waiting area, saw from afar how they put her mother into an ambulance bound for the Alemán Nicaragüense Hospital, one of the 19 hospitals which the government says are equipped to treat COVID-19 patients.

After that, “Marcela” didn’t see her mother again. On Wednesday, the day she died, “Marcela’s” brother was asked to bring adult diapers and moist wipes, but the family couldn’t bring them until Thursday. Hospital personal received the supplies as though nothing had happened. But at 4:30 pm that day, the hospital called to tell them that “Rosie” had died. They didn’t give further details.

“What we are going to see here is people being unable to accompany their family member, and not being able to be there in their last moments is very hard for anyone,” says Barreto. “This can generate feelings of rage, of guilt, and in addition, a feeling of impotence, of not being able to do anything,” he added.

Now, “Marcela” is mourning while overcome with more worries. The principal worry is that of finding work to feed her three children. As of some weeks back there are few people that look for her to wash and iron clothes, which is what she does for employment. In addition, one of her children is sick. This is, she confesses, one of the most difficult times of her life.

Sudden death provokes an unhealthy mourning process

Our inability to say goodbye to our deceased loved ones, under any circumstances, can provoke prolonged mourning and this could become more frequent with the arrival of the pandemic. The problem lies not only in being unable to say goodbye in person during the last moments, in COVID-19 cases, but of being unable to carry out our cultural rituals. There will be no wakes, no church mass, no burials nor accompaniment of family members in mourning.

According to MINSA’s preparation and response protocol, the cadaver can be handled only by trained personnel. Make-up can’t be applied nor the body prepared in any way. The only options the families have are to cremate the body or carry out immediate burial. Cremation, however, isn’t common practice, according to Nicaraguan culture, and also due to the elevated cost. The cost of cremation in a funeral home is US $950. This is a prohibitively high cost for many grieving families in a country where the minimum monthly salary is U$220, and where 350,000 jobs have been lost in the past two years. This is a price which Marcela, who didn’t have enough money for her mother’s coffin, can neither consider nor pay.

“All of this can be traumatic and will prevent an adaptive mourning process. On the contrary, it could provoke a prolonged mourning period. In the worst-case scenario, the mourning can become pathological or unhealthy, or difficult for all persons affected, because they can’t find closure in same way one would expect when someone dies under normal conditions,” explained Barreto.  

The mourning process has five stages: negation, anger, negotiation, depression, and acceptance. These stages can vary in order but in the current context, the person affected could develop a prolonged stage of mourning.

“If we were dealing with this pandemic in a humanitarian manner, a pandemic about which there is nothing humane, we would be preparing all family members of those over 60 years of age who have entered the critical stage of the illness. We would need to provide them with psychological accompaniment, and prepare them for the mourning process,” says epidemiologist María Jesús Largaespada.

In contrast, as deaths in Nicaragua increase, we’ve seen actions that have been traumatizing for family members of the deceased, through express burials and censorship. There are cases of people who were buried almost at midnight, and of families threatened for complaining about these conditions, and even for revealing that they are in mourning.

Government prescribes rapid burials and without “scandal”

Threats against grieving families are not rare. The government has imposed a regimen of fear as the norm. In Estelí, the family of COVID-19 patient #3, the existence of whom MINSA admitted, was practically kidnapped when health authorities declared the patient “recovered” and sent the patient home. The 70-year old patient died days later.

A family member told CONFIDENCIAL that the Local Integral Healthcare System (SILAIS) prohibited them from having visitors and sent a guard to make sure they complied. And when their loved one died, they were ordered to cry in silence.

The children of Dr. Adán Augusto Alonso, who died of COVID-19 this past June 14th, decided to carry out a funeral procession through the streets of Leon, where Dr. Alonso lived and cared for his patients, including distanced-care after he was infected with the virus. Prior to heading to the cemetery, his children improvised a funeral caravan, but the National Police blocked them from entering the city.

“They are not going to let us enter with our father’s body, as we and the population had hoped, so we’re going to have change our plans and take his body through another route, in order to keep the peace. I want the people of Nicaragua to see the degree to which our family is being beleaguered, and how they didn’t let our father’s body enter the city for which he gave his life,” denounced his daughter, Magda Alonso, who transmitted the events live. 

Epidemiologist and health professionals predict that contagion and deaths from COVID-19 will increase in the coming weeks if the government doesn’t change its policies regarding confronting the pandemic, in compliance with WHO recommendations – something which the government has shown no sign of doing.

“The situation is tragic,” admits the specialist in infectious disease, Dr. Carlos Quant, “because there is a natural evolution of this disease. In the meantime, it is quite probable that we will continue in the peak of the epidemic. For how long? We don’t know.”