“There simply isn’t any trust in the system,” warn doctors who denounce the lack of measures and the increase in pressures on health personnel.
By Juan Carlos Bow (Confidencial)
HAVANA TIMES – The Covid-19 pandemic has made itself felt in Matagalpa, although the government hasn’t offered any data on this. According to reports from the Ministry of Health (Minsa) in this northern department of Nicaragua, there are no positive cases of the novel Coronavirus here. But doctors and residents already speak of dozens of suspected cases and even deaths from Covid-19.
Given the lack of official information, Matagalpa confronts the pandemic amid a growing wave of distrust of the public authorities. “Simply speaking, there’s no trust in the system. The system has lied so much, from the moment when it didn’t inform the population on how this should be prevented. What can we do?” stated a member of a professional women’s association in the city.
That mistrust causes many of the residents to avoid the public health system altogether for treating this illness; as a result, they aren’t reflected in the official Minsa statistics. In their last weekly report on the pandemic, the government admitted to an increase over one thousand percent in the country, from 25 to 279 cases in a week.
“The people who seek attention in the private sector don’t want to go to the public health centers because they see them as a hotspot of contagion. In the beginning, we weren’t prepared and there wasn’t a Coronavirus unit, so all the patients arrived at the same place. That image remained, so now the patient tries not to come to the health clinics,” explained a doctor who belongs to the independent Nicaraguan Medical Unit.
Changes at the regional hospital
Matagalpa only has one regional hospital, the “Cesar Amador Molina” hospital, to cover a departmental population of over 500,000.
Medical sources from the city told Confidencial that the “Covid-19 area” has been set up in what was previously the Emergency ward, while Emergency was moved to what had been Outpatient Consultations. These changes were made over the weekend of May 16 and 17.
These sources affirmed that the recently opened “Covid area” now holds some 30 patients with symptoms of the Coronavirus.
“Here [at the hospital], we receive [patients] from all of the municipalities, and it’s very small for this; not because of Covid, I’m speaking about before. The maternity, pre-labor and surgery wards were usually overflowing. If there wasn’t sufficient capacity in previous years, I fear greatly that there’s little capacity for a pandemic like Covid-19,” comments Magda Alonso, a doctor specializing in occupational health.
In their last report, the independent group “Covid-19 Citizens’ Observatory” counted 165 suspected cases of COVID-19 in Matagalpa and some 18 deaths associated with the pandemic there.
The medical sources stated that the majority of the cases seen in the hospital have been patients from the towns of Dario, Sebaco and Terrabona, all located between Matagalpa and Managua.
“The majority of the people [from these three municipalities] conduct all their commercial business in Managua. That’s an indication of why the outbreaks have been more severe in those places,” noted a member of the professional womens’ association.
Few hospital beds
Matagalpa is the department with the third highest number of suspected cases of the virus, after Managua with 1,051 cases and Masaya with 246. The Observatory group has reported a total of 2,323 suspected cases and some 404 deaths nationally related to the new Coronavirus.
“The health system in Matagalpa doesn’t differ much from the health systems anywhere in Nicaragua: it’s lacking and fragile. It’s a system that has a series of structural failings in terms of human resources, infrastructure and equipment,” emphasized Freddy Espinoza, a Matagalpa doctor who has a Master’s in Public Health.
“The national measure (index of number of beds per capita) is around 9 for every ten thousand (inhabitants) and the number of ICU beds is around 1.2 per ten thousand; when this indicator is broken down, and we look at Matagalpa, it’s estimated that there’s 0.6 hospital beds for every thousand inhabitants,” Espinoza explained.
“Although the portion of Matagalpa’s population that is already being affected [by Covid-19] and that might eventually require the Intensive Care Unit may still be small, the [hospital’s] capacities will certainly be surpassed,” Espinoza warned.
State harassment of health workers
The panorama for Matagalpa’s health workers isn’t anything to praise. Adding to the flaws in the system, there’s been an increase in on-the-job harassment and persecution of the health workers. This constant irritation has been present since the 2018 civic rebellion.
Covid-19 Citizen’s Observatory classifies Matagalpa as the number 2 department, after Managua, for irregularities in the health system.
“Within the health centers and clinics, there’s harassment, threats of being fired. We always say: ‘What does a doctor do outside? What does a doctor do to survive?’ Seeing patients is our life. Through colleagues we got the information that there’s a Minsa document where you resign with no right to your legal severance pay,” emphasized a doctor who belongs to the Medical Unit.
“Among personal care physicians, as well as at the second level of attention, there’s a lot of fear, a lot of anxiety among the health workers, given the characteristics of those who are at the head, those that are leading this institution. There’s fear of being denounced, fear of reprisals, fear of being fired,” said Espinoza.
Dr. Alonso concurred that she has received threats. “They’ve said: ‘give me names, give me cases (of patients with Covid-19), I want to know if it’s true.’ That’s absurd. A doctor is never going to give you that, that’s a breach of ethics. If a doctor tells you there are cases, it’s because there are cases. [If they tell you] I saw it, it’s because they saw it. Why would we invent an epidemic?”
“For me, life is more important. I know there’s a large number of doctors like me here in Matagalpa, who’ve opted to tell the truth and say yes to health and life, despite all the threats that they’ve received,” she added.
Working without protection
In addition to the harassment and constant vigilance, Matagalpa’s health workers have minimal protection. Up until a week ago, the Minsa authorities, and those from the regional hospital had fought against the use of face masks and other safety equipment.
“If you as a doctor or nurse or health worker within the hospital put a mask on, immediately they were on your case, because that mask hadn’t been authorized by the hospital director nor the health center authorities. From there, you can see how they violate the rights of the workers,” indicated the woman from the professionals’ network.
Espinoza noted that the health personnel find themselves at a “crossroads”, whether to continue “working under those conditions” and exposing themselves to risk, together with the patients, their colleagues, family and community, or “to quit” out of fear of getting sick and dying; or “to denounce” what’s happening.
Health workers with cloth masks
The situation of the regional hospital is repeated in the other health centers of the department. In some cases, it’s worse, like in the primary care facility of the town of La Dalia.
“They’ve now given the orientation to be able to use masks, but they’re not being distributed to all the personnel. The health personnel [of La Dalia] are even using cloth masks, which aren’t adequate for those having patient contact,” warned a doctor from the locale.
Dr. Alonso declared: “It’s offensive seeing legislators with face masks of hospital quality, and later seeing colleagues with cloth face masks, which is what they’re being given. That’s an offense to our profession, an offense to health, an offense to the population, because in the end if they’re left without doctors, if they’re left without nurses, who will be able to assist them? I don’t believe I’ll see any deputies attending to the patients in the hospitals.”