Nicaraguan Health Care: Where Hospitals are Cemetaries

I've been trying to write about this experience for the past few months- and each time I sit and put my thoughts into it I find myself too irate to begin. The story must be told to all who will hear, and if you are reading this right now I thank you for your interest in something that rarely affects those in the first world, something that reminds us of the harsh reality of the incomprehensible lack of proper health care in the third world.

November 2008...

One of my best girlfriends here in Nicaragua, Mayerling, waltzes into the room with her own soundtrack which sounds something like a funky rhythmed snare drum. She is strikingly beautiful and her dirty humor and easy smile have filled many a night in our home with light and laughter. Today Mayerling knocks on our front door and enters the house a changed woman, the sexy swagger in her step now turned into a saddened shuffle.

“My grandma is dead.”

Mayerling’s eyes lower to the ground, her voice a flat line wavering with choked emotions.

Mayerling tells us that her grandma, who had been in perfect health at age 70, fell and broke a small bone in her hip the week before. The health center’s ambulance took her to the public hospital in Somoto where she was informed that she needed a surgery. Here healthcare is free up to a certain point, but when surgery is involved the family must contribute a certain amount. Mayerling’s family took out a $2,000 loan (the US equivalent of an entire year’s savings) and paid for the surgery, which included placing pins in her hipbone. The next day, the doctor forced her grandma to walk on her newly pinned hip and only let her rest when she began to cry in pain. The wound became so infected (IN THE HOSPITAL) that the doctor decided to re-open it, clean the pins, and put them back in. It was too late, as the infection spread to her blood and left her in a desperate life-or-death fight. Mayerling heard the doctor snidely remark to one of the nurses that he sometimes “operates on people for fun, not because they really need the operation”. Ethical.

Mayerling’s family decided they’d had enough and attempted to take her out of the hospital but the administration (backed by the doctor) refused the request and her health worsened by the hour. The doctor pulled Mayerling outside at one point and told her,

“Your grandma will not make it out of this hospital alive.”

To which Mayerling replied, “and if she doesn’t it is YOUR fault.”

He laughed. In her face.

The next morning found Mayerling’s grandma on her death bed, the infection having spread through her entire body. The family decided to move her to another hospital by force. The doctor was so angry he told them to never come back; he said if they ever tried to return to the hospital they would be removed by the police. Mayerling got her grandma on a bus headed to Esteli (the second biggest city in the country, which is about an hour by bus from Somoto).

She died in that public school bus.

She died because a doctor (who probably does not have any medical training beyond an “internship” of a year after college) faked that she needed surgery, infected her with dirty instruments, then left her to rot away unattended without an ounce of care or compassion.

Mayerling tells us now that her family wants to sue the hospital but knows that because the hospital is government-backed, there will be no way around the bureaucracy. She reports that this doctor has been denounced by multiple former patients on both radio and television, yet continues to hold his post as the head of the hospital in Somoto. They could file the paperwork, but how will they pay for a lawyer now after they just racked up a $2,000 loan? She shakes her head in disbelief, “my grandma was here one week ago. She was fine. They killed her in that hospital and I cannot do anything about it”.

In the United States, or in any developed country for that matter, this man would be put in jail without a second thought. He would be spending years there, thinking of how he wished he had not laughed in Mayerling’s face about the oncoming death of her grandma. Instead Mayerling’s grandma lies in a shallow wooden cross-marked grave in the pined cemetery in Cusmapa and the doctor resides king of his phony hospital.

The real problem stems from the following:

In Nicaragua the current government (so-called Sandinistas who have nothing to do with the actual ideals or actions of the popular revolution in the 80’s) backed by wannabe dictator current president Daniel Ortega use all of its government offices to back movement of the Sandinista (“el Frente”) party. The doctor publicly announces his diehard Sandinista beliefs all over the same radio waves thorough which his former patients denounce him. He will never lose his job because he is untouchable. He is untouchable simply because of his claimed political beliefs, it has nothing to do with the way he runs the hospital or if he kills his patients on a regular basis.

This is the so-called-Sandinistan way of making Nicaragua a BETTER place.

Ortega does not stop at exploiting public hospital administrators for his political benefit; he also uses nurses, teachers, public school administrators, police officers, and any other person who holds public office in order to make his party appear to be supported by the masses. During the current mayoral elections (in which the Sandinistas refused to let in international organizations to monitor voting procedures- leading many to believe in widespread fraud and corruption) Ortega MANDATES that all government employees protest and march in favor of his government. If an employee is unwilling to participate in Sandinista rallies, he or she loses either a large portion of his or her paycheck OR job.

My friend Kelly, a fellow Fabretto volunteer in Managua will lose her elementary school’s director next year. Soledad is a woman who’s built the school up from the ground. Spending any amount of time at the school it becomes obvious that Soledad is a true community leader. The teachers and students at this school are dedicated, happy, and learning. Yet, Soledad is not a Sandinista. She cannot remain in a leadership position under this government if there remains the potential of her denouncing the government’s actions in any manner. She will be replaced by a Sandinista party member regardless of the fact that she is a GREAT administrator and leader, regardless of the fact that she’s given her heart and soul to this school for the past 10 years. After the elections ended here in Cusmapa, the health center “let go” its’ director and a few nurses, leaving only those who participated in Sandinista rallies here in the village throughout the campaign season. They leave the 16-year-old nurse and the quacky doctor and fire competent nurses simply because of political ideals.

To top it all off, after the Sandinistas won the elections (whether fraudulent or not, it’s been decided and they now hold 86% of the mayoral seats in the country) Ortega mandated that all of the government employees AND their families in Managua (the capital city of 2.5 million) rally in 4 of the city’s central rotundas (where the main roads meet). I passed a few of the rotundas in a taxi last Thursday and was, for the first time in my two years in Nicaragua, completely frightened for the future of this country. I witnessed people waving black and red flags in a brainwashed fervor and masked teenagers holding fire throwers and lead pipes and bricks. Apparently (according to the Nuevo Diario, Nicaragua’s only remaining news source that does not support Ortega) the government is paying ex-gang members to incite chaos and to track and terrorize journalists who oppose Ortega. People are dying and wounded every day in this conflict.

And the conflict is not being raged by the losing party “los liberales”, the party that was ravaged by corruption and falsification throughout the whole electoral process. The Sandinista party incites the chaos, backed with their motto of “united Nicaragua will triumph,” singing “what we want are jobs and peace”. In the echoes of the song of peace Ortega supporters throw bricks at civilians and shout “death to the liberals!”

I am baffled.

And at times speechless.

Especially when people inform me of things like my friend Brenda told me earlier today, that Ortega is now talking of the evils of the internet. He apparently wants to block internet access because it feeds people “false information” about his government. He will intend closing down all the television channels except Canal 4, the Sandinista propaganda channel. Ortega’s blatant hatred of foreigners (especially Americans) may become public policy, blocking many of the aid programs upon which so many Nicaraguans rely for survival. The private hospital where Kelly’s friend Aleyda works is an NGO run by a Dutch couple who are already talking about the possibility of leaving the country next year and closing the hospital.

What I do not understand is how many people in this country cannot seem to make a connection between Ortega and former long-time dictator Somoza (whose lethal 60-year rule caused the revolution in the 80’s which led to the Contra War). Ortega fits into the precise definition of a dictator (autocratic control with use of absolute and oppressive rule) and his current government becomes more and more of a dictatorship every single day (a form of government in which absolute power is concentrated in a dictator or small clique- in this case his hypnotized power crazy supporters).

How long will it take the Nicaraguan people to see beyond the billboards claiming “upwards the poor of the world” to the reality of a president who cruises the streets of Managua in a Mercedes Benz SUV flashing a V-for-victory sign as he pulls out the democratic rug from underneath this country?