Whistleblowing Doctors Complain of “Unsafe Conditions” in Nicaraguan Hospitals

People waiting outside the Emergency Room at a Managua hospital. Photo: EFE

They’re not allowed to use masks or gloves, or to speak of the pandemic. The group Medical Unity demands of the Health Ministry “protection for the health workers.”

By Confidencial

HAVANA TIMES – “I’m going home and not coming back. I don’t care if they fire me, my life comes first,” said Graciela, a doctor who’s been working at the Health Ministry for more than ten years. Her assertion stems from the “irresponsibility” of her superiors who are treating the Covid-19 pandemic with “negligence”.

Graciela, like her colleagues Humberto and Sofia that work in different hospitals and health centers, requested that their real names not be used. They’re afraid. They feel that the guidelines that the government has been issuing to the country’s health centers expose the doctors, nurses and patients to possible contamination, as well as everyone who walks the hospital corridors.

Since before the Covid-19 virus “entered” Nicaragua, the first order that the doctors received was not to share with their patients any kind of information about the pandemic, so as to avoid “collective hysteria”. Graciela recalls one of the doctors that directs the hospital in which she works telling her that since [at the time] the virus wasn’t present in the country, there was no need to touch on the topic. 

“That ended up opening my eyes. I felt that it was time to launch a national campaign, but they did nothing,” says Graciela. Her frustration increased when on March 18, the date the government announced the country’s first positive case, the order that came from the El Carmen presidential bunker was the opposite of what all the countries of the world were doing.

They told them that they couldn’t use masks, and that the use of gloves would only be permitted for “very necessary” work. The orders that the regime imposed in the hospitals weren’t well received by the health personnel.

Graciela recalls that the day after these measures were announced, several of her colleagues requested face coverings to carry out their routine work station activities, but the response from the administration was to specifically control the use of the masks, to check if their use was really necessary and to distribute a reduced number.

“They said that everything would be fine, that there were only a few cases, and that if we covered our faces we would alarm people,” Graciela expresses, adding that after that day, and seeing that several patients came in to the hospital with symptoms of Covid-19, the disagreement and fear increased. Now it was not only a matter of not speaking to the citizens about the topic but exposing the health personnel unnecessarily to risk when seeing suspected cases.

Fear began to travel the hospital corridors. The medical personnel didn’t understand why this decision was being taken, when in other countries such as China, the doctors were using a lot of protection.

“We’ve seen patients that come in with symptoms and go through all the rooms coughing, in front of patients who are healthy. They put them at risk and they don’t care,” Graciela repeats. She feels that this was an unnecessary exposure, since some of these people are later sent home, or they just tell them that it’s not Covid-19, just a common fever.

The Covid-19 virus “has no political color”

On the national level, the Nicaraguan authorities have declared that they won’t order a quarantine, nor close off the country’s borders. Pictures of children receiving the passengers that disembarked from a cruise ship, or of the thousands of state workers and government sympathizers participating in a large caravan have surprised the foreign authorities that are in charge of managing the crisis in their own countries.

“They’re irresponsible,” states Humberto, a doctor of about 35 who is the sole support of his family. Like Gabriela, his bosses have prohibited the use of any kind of mask, gloves or protection that could provoke “panic” in the patients.

In this hospital, he says, the majority of those who oppose the “irresponsible” measures are Sandinistas. “I’m one,” Humberto repeats.  However, he explains, having a political ideology in support of one band, or another, doesn’t contradict the fact that they’re risking the health of patients, doctors and their families.

“The Coronavirus has no political color,” he insists. “But we have our hands tied,” adds this doctor, who describes the tension in his work environment for the fear of infection from the virus. The idea of quitting has gone through his head, but then he thinks about the future of his family, and the state of the economy in general, and the idea dissolves.

This Tuesday, Rosario Murillo, Nicaragua’s vice president, stated during her daily broadcast that it’s important “not to give way to panic.” “Maintain calm, prudence, patience and faith in God, caring for each other, loving each other, all of us protecting each other.”

Regarding the way that the government is handling the information about confirmed cases and tests realized, Humberto notes that a lot of information is being covered up, and he doesn’t understand the motive for this.

For example, he states that in the hospital where he works a number of citizens have arrived as suspected cases, but they’re later sent home with no information with respect to the virus. Sometimes it’s fallen on him to treat this kind of patients, since after administering the test they’re sent to the other areas he oversees. With no protection and with “creating panic” forbidden, he has no other recourse than being careful.

“We’re all bothered. They’re playing with our health and that of our family members,” he repeats, and fears that if this same situation continues, “without protective measures in the hospitals, it’s very probable that the number of cases will increase and “we have to begin burying our own.”

10 beds for every 10,000 Nicaraguans

In all the municipal health centers, the situation with regard to the prohibitions is similar to that in the hospitals of the capital, but in terms of capacity and equipment, the scant availability of beds and personnel, their situation is shakier.  “Imagine – we don’t have even a sheet to put on the cots,” Sofia, another doctor tells us.

According to the “Health Map of Nicaragua” elaborated by the Health Ministry, the Nicaraguan public health network includes 73 hospitals, 143 health centers, 1,333 health clinics, 5 specialized centers, 178 maternity houses with 2,365 beds, and 91 houses for people with special needs.

The official statistics reveal that in Nicaragua there are 12 hospital beds, 10 doctors, 8 nurses and 9 nurse’s aides for every 10,000 inhabitants.

“The pandemic is going to strip the health system bare,” Sofia indicates. She also believes that in the face of the Covid-19 epidemic, the government is being “negligent” and irresponsible”. The doctor feels that President Ortega had in his hands the opportunity for rigorous preparation, but instead of that opted for leaving Nicaragua without protection.

In the health centers like the one where she works, the directors have opted to hide the face masks and gloves and to scold personnel who wear a mask at work.

“They have the boxes in the warehouse. And they get annoyed if someone is washing their hands frequently, if we’re walking around with gel alcohol, or if we’re trying to maintain our distance from the patients,” the doctor indicates.

What the government should do

Although on Monday, March 23, the Ministry of Health reported the decision to “recommend” a quarantine for those people who arrive in Nicaragua from countries where there is “active transmission” of Covid-19, the three doctors interviewed by Confidencial all agree that this measure is insufficient compared to those put in effect in neighboring countries.

The government needs to stop calling for marches, house to house visits, and launch an awareness campaign, but without exposing people to risks, says Humberto. In the same way, he feels that while there’s no solution to the pandemic, it’s important that classes be suspended, telecommuting be encouraged and the medical personnel must be protected, since in the end they’re the ones who will be serving the population.

Sofia feels that, in addition to a prevention plan, the government needs to earmark resources to supply the municipal health centers.  When the number of patients there overwhelms the hospitals, other measures will have to be adopted, so that they can have beds, sheets and equipment to treat all the sick.

“They need to stop hiding the masks, stop telling us that we can’t talk about the pandemic. They need to raise their awareness, and begin to lead the country as they should,” says the doctor.

Graciela counseled the government to reverse their strategy and apply the recommendations that the international organizations and other countries are adopting.

“If they continue with this negligence, we doctors that value our lives are either going to resign, or we’re going to get the virus; in moments of full pandemic, that would be very grave,” Graciela concludes.

Nicaraguan Medical Unity demands protection from the Health Ministry

Nicaraguan Medical Unity, an agglomeration of some 650 health professionals inside and outside Nicaragua that is inscribed with the Civic Alliance, demanded that the Ministry of Health guarantee “the right to protection and norms of biosecurity for the health workers.”

Health professionals, the first link in the chain of attention, are at direct risk of getting the novel Coronavirus and it’s essential that they have at their disposal adequate security measures, states the report. The document includes recommendations for the government and for civil society.

The doctors need to protect themselves and demand a minimum of personal protective equipment, including, among other things masks, gloves, adequate protective clothing, and ocular and facial protection.

“It’s unacceptable that in some of the public clinics which provide health services, the medical personnel are being pressured not to use protective measures, especially masks, under the argument that this would alarm the population,” reads the pronouncement.

In addition, Medical Unity urged the health ministry to guarantee strict compliance with “the norms of biosecurity in the face of Covid-19, to protect the health of personnel who classify and attend to patients or who take laboratory samples.”

In the countries strongly affected by the pandemic, a high percentage of health personnel have been infected by the pandemic. Medical Unity demands, among preventive measures, the creation of separate installations dedicated to managing the Covid-19 patients, and a rigorous evaluation of the health personnel in terms of the risk factors for age and chronic illnesses.

“This higher risk group of the health personnel shouldn’t expose themselves to the risk of managing Covid-19 patients. These personnel should participate in virtual programs of medical advice and attention, as well as in the administrative work. All of these measures need to be implemented in both the public and private sector,” Nicaraguan Medical Unity indicated.

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