Western Nicaragua Left without Medical Specialists

A woman protests the firing of the specialists at the Heodra teaching hospital in Leon, Nicaragua. Photo: Carlos Herrera / Confidencial


“The patients lose a lot,” warns a doctor in Leon. The doctors have been fired “over politics.”

Doctors with international training and in charge of scientific research are dismissed for criticizing the government repression.


By Wilfredo Miranda Aburto  (Confidencial)

HAVANA TIMES – Dr. Rosario Pereira was ordered to leave the Oscar Danilo Rosales Arguello Teaching Hospital (HEODRA) in Leon immediately after Judith Lejarza Vargas, the director of this hospital complex, delivered her termination letter.  Three security guards compelled the doctor to leave the building, without even allowing her to collect all of the gynecological pathology books in which she was keeping a registry of cancer cases in the western part of Nicaragua.

“One of the guards told me that the order was to evict me as a criminal. I responded that hospitals are public buildings, paid for with our taxes. I’m an honest person, and my moral strength keeps my head held high,” Pereira recounted. She’s one of ten doctors who were dismissed from their jobs on July 27 in Leon, Nicaragua, as a political reprisal. Another 13 members of the hospital’s medical staff also fell victim to this form of reprisal.

Pereira and the nine other fired doctors are all specialists and sub-specialists. They’ve been trained in prestigious international universities such as the University of North Carolina, Vanderbilt, Zaragoza in Spain and the University of Texas.  These specialists have skills that are unmatched anywhere else in this area of the country. Nevertheless, nothing in their extensive resumes was considered at the moment of firing them. The argument offered by Hospital Director Lejarza Vargas varied little in all the cases: “For their politics” and “for supporting the protests against the government.”

The fired doctors don’t only work at the hospital, but they also teach at the UNAN medical school in Leon and carry out their own scientific research in Nicaragua, in conjunction with international centers and universities.

Dr. Pereira completed a fellowship in gynecological pathology at the MD Anderson Cancer Center in Houston, Texas. She formed part of the work team for a Cancer Registry of the HEADRA, a project supported by Vanderbilt University.

The titles these doctors hold aren’t very common in the medical field here, and in many cases having them is a source of prestige. For example, Gustavo Herdocia Baus is a general surgeon with a sub-specialty in plastic and reconstructive surgery. This doctor is known for his skill in microsurgery to reconstruct damaged hands. He’s the only doctor with this skill in the west of Nicaragua.

Herdocia is also on the teaching staff and is in charge of international agreements that he himself has helped to obtain for the medical students at the UNAN (Nicaraguan Autonomous National University) in Leon, thanks to his education outside the country.

“We have an agreement with the University of Wisconsin to train general surgeons in the sub-specialty of plastic and reconstructive surgery over a three-year period. The idea of this program is to place the graduated residents where they’re needed around this country. We have one graduate in Bluefields and another in Matagalpa. There’s also an accord with the University of Frankfort in Germany and Basilea in Switzerland,” Herdocia Baus explained. Baus was also fired for being one of the doctors who signed a statement expressing his willingness to attend to all those wounded in the conflicts, with no exceptions.

The Oscar Danilo Rosales Arguello Teaching Hospital (HEODRA) in Leon Photo: Carlos Herrera / Confidencial

Dr. Gladys Amanda Jarquin Montalvan is a woman of few words, a bit shy, but her professional resume is astounding. She’s not only a doctor and in charge of the HIV – AIDS clinic at the HEODRA, but she’s also an adjunct professor at the University of North Carolina. She holds two masters’ degrees in HIV-AIDS and is the only specialist in pediatric infections in western Nicaragua.

“The director told me that they were dispensing with my services. I asked her why. Lejarza told me that there were complaints of mistreatment from the nurses. I replied that if having them comply with quality attention was a complaint, then I’m very sorry because that’s part of my responsibility to the patients,” Jarquin stated.

The pediatric infection specialist didn’t discount the possibility of a political motive for her firing. “I was in the first pronouncement, in which we expressed our solidarity with the victims and emphasized that we were going to attend to patients in accordance with Hippocrates: to attend to all people, no matter where they come from,” said Jarquin.

The letters of dismissal delivered by Lejarza are brief and don’t cite any article of the Labor Code. “From this day forward, we are dispensing of the services you’ve offered in this hospital center,” read the letters that were delivered not only to these ten specialists and sub-specialists, but also to 12 nurses and 13 other members of the hospital staff.

More specialists out

Dr. Jarquin Montalvan was also worried about what would happen with the programs they were in charge of. “I had several infectious disease programs and agreements with Vanderbilt and North Carolina Universities to send exchange students and help the population,” she explained.

Another of those fired was Dr. Javier Pastora Membreno, a gastroenterological surgeon and head of surgery at the HEODRA.  Leon’s retired doctors describe Pastora Membreno as an eminent specialist.

With support form the Universities of Wisconsin, Zaragoza, and Barcelona, Pastora managed to get an advanced endoscopy service installed in the HEODRA for the diagnosis and treatment of pancreatic and hepatic biliary pathologies. “It’s the only national center of reference for the treatment of these complex and frequent diseases. Over 2,000 patients from all over Nicaragua have received attention and benefits from this very costly and specialized procedure,” the doctors specified.

“The attention from specialists and sub-specialists for Leon and the west of Nicaragua is going to be left in a vacuum. In the end, the patients lose a lot. The western sector of Nicaragua is left without specialists,” Pastora stated with regret.

The hospital director was more explicit with Pastora at the moment of dismissing him. She told him that there’d been “no problem” with his professional services. “She told me that she was firing me for political reasons, for expressing my support to the Nicaraguan people who were protesting against the government. I told her this wasn’t a crime,” Pastora recounted.

Lejarza didn’t respond to Confidencial’s telephone calls to hear her version.

Armed police in the operating rooms

Yamileth Ruiz Carcache, anesthesiologist and head of the operating room at the Oscar Danilo Rosales Arguello Teaching Hospital (HEODRA) was fired for questioning the police who entered into the operating room while they were operating on those who were wounded in the repression.

“The hospital director told me that the reason for my dismissal was for having shown disrespect to the police. I never did so, but only told them that they couldn’t be in this area,” said Ruiz Carcache, who studied for her specialty in birth analgesia in Valencia, Spain. “There were always police at the edges of the operating rooms. I can’t understand why. They (the police) told me that the patients were prisoners, I imagine only for being at the marches. The officials said they had orders from the director to be there.”

The administration of the HEODRA were especially concerned about the bullets that the surgeons extracted from the victims. According to the doctors, they forced them to hand these bullets over to the director immediately. The doctors were also in disagreement with the hospital’s failure to follow the normal hospitalization criteria; some patients needed to be admitted but were returned home.

Although the doctors affirmed that the hospital administration had never explicitly forbidthem from attending to the wounded, they noted that there were “situations” that discouraged people from coming to the emergency room. For example, the hospital was surrounded by paramilitaries, and the building as such had been militarized. It was very stressful for them to work with this “persecution.”

Among the dismissed are: Dr. Aron Delgado, specialist in oncological surgery; Edgar Munguia, specialist in pediatric intensive care; Cesar Vargas, an orthopedic specialist with a sub-specialty in the spinal column; and Jorge Aleman Zapata, a pediatric pneumonologist, among others. These doctors had been working at the HEODRA for an average of over 20 years

Ana Maria Hernandez, nurse at the outpatient clinic, was fired this Friday. Photo: Carlos Herrera / Confidencial

Ana Maria Hernandez, a nurse in the outpatient clinic, was also dismissed. Her public denunciation of her dismissal went viral on social media. The nurse accused the HEODRA hospital administration of wanting to “gag” them.

“The straw that broke the camel’s back was when I announced to Dr. Vargas’ patients that he had been dismissed because he wasn’t in agreement with what the Ortega-Murillo government was doing. At that point, all the bootlickers around me went running to Dr. Lejarza, and within 20 minutes the entire hospital mob fell on top of me. They surrounded me and told me that I couldn’t continue working because I was mistreating the patients,” Hernandez related.

This Saturday, Hernandez joined a march in support of the Leon doctors. The march made a stop in front of the HEODRA building. “They want us to keep a gag in our mouths and not express anything about the massacre that they’re carrying out…the live images. There’s no one blinder than a person who doesn’t want to see. We saw the kids they killed in Subtiaba. The police were throwing them onto the stretchers like they were sacks of garbage,” the nurse affirmed.

It was also made known today that some forty people from the medical staff in Jinotepe, Carazo department, were also fired as part of the wave of political reprisals.