“I’d Rather Die at Home than Go to a Hospital”

Rivas resident Lino Guevara, 33, spent five days with body aches, extreme fatigue, fever, a sore throat and persistent cough. On Tuesday, June 2, he decided to go to the health center in his town of Buenos Aires, in the Rivas department. By then, he had also lost his sense of smell and taste.  Despite these clear symptoms of COVID-19, the diagnosis the young man received from the clinic was “severe respiratory infection”. They sent him home with five tablets of acetaminophen and a little bag of rehydration salts.

Guevara didn’t want to go to the health center in the first place, since he was afraid he’d be sent to the Rivas Hospital.  “Everyone knows that if you go to the hospital, they throw you in there like an animal, locked up and all alone. I told [my family] that I’d rather die at home than go to the hospital to die like some old animal that not even my family can see. I’d rather die here, locked in,” Lino declared.

Lino had arrived at his local health center with a temperature of 100.4 degrees (38? C). The doctor who attended him listened to his symptoms, then took his blood pressure, his temperature and listened to his heart. “At the end, after two hours of questions, the doctor, together with the center director, began to explain to me what was happening, which they obviously knew.”

The words “Covid-19” were never pronounced by the doctors at the health center. They didn’t do a blood test or x-ray his chest. Lino suspected that he could be infected with the novel Coronavirus and asked a friend who was a doctor and another friend who was a nurse to come and see him that same night. “They told me everything I needed to do, and that if I had complications, then do X, but that I should never go to the hospital.”

“If Lino’s conditions hadn’t received this opportune intervention, we wouldn’t be seeing the results we are now. A part of success in improving the course of an infectious diseases is opportune treatment. If therapy is delayed, that’s when the severe or serious cases manifest the most. He (Lino) reached a moderate stage of respiratory symptoms,” the doctor-friend who attended Guevara explained to Confidencial via telephone.  The doctor preferred to withhold his name.

Generalized fear of the hospital

According to the few statistics the Nicaraguan Ministry of Health offers, there have been no cases of COVID-19 in Rivas, a small department a little over 60 miles south of Managua. However, medical sources and family members of patients in that department report many cases and a number of deaths.

In fact, the latest report from the independent monitoring group “Citizen’s Observatory” lists Rivas department with 98 suspected cases and 55 deaths related to the pandemic.  Doctors from the departmental capital believe that the population isn’t visiting either the public health centers or the hospitals when they need attention for COVID-19 symptoms.

One of the best known cases of COVID-19 patients that didn’t want to go to a hospital was that of the now-deceased doctor Luis Ocampo Donair, 32. Dr. Ocampo recognized in himself the symptoms of the virus, but asked his family members “not to send me to the hospital for any reason.” The young doctor died last May 21, after being treated at his father’s clinic. His father, Dr. Luis Ocampo Jara, is a forensic doctor in Rivas.

“People don’t go to the hospital because they’re afraid that if what they have is Zika, Chikungunya, dengue or any other infection whose symptoms are respiratory difficulties, gastrointestinal problems, or fever, they’ll automatically be classified as a suspected COVID-19 case and be sent to the COVID wing. People say: ‘And if I don’t have it, then I’ll get infected,’” commented Gilberto Gonzalez, a private surgeon who runs a clinic in the town of San Jorge, in Rivas department.

“I can assure you with certainty that 80% of the patients are being treated privately at home, or in whatever way they can. I’ve had patients from the rural areas who have decided not to bring in their relatives, that it’s better for them to die at home,” said a private doctor, who preferred to withhold his name to avoid reprisals from Sandinista fanatics. This professional affirmed that since March, he has attended some 60 people with suspected cases of COVID-19.

“Gag order” in the hospital

There are local health centers in each of the ten municipalities in Rivas department, but only the one Rivas Hospital which has a COVID area.

According to reports on the local media, that “COVID area” covers two units and what was formerly the emergency areas.  Together, there are more than fifty beds, and the hospital has nine ventilators – five in the general COVID area and four in the Intensive Care Unit.

“There’s a ‘gag order’ in effect for all of the health personnel. No one is talking about what goes on in the Covid area. No one has access to the results of the COVID-19 tests that are realized. The information is managed only by the directors of the Silais [Centers that manage all the local health centers] and the hospital administration,” denounced the private doctor.

The Ministry of Health also keeps under wraps the data on the number of health workers who have been infected with the novel Coronavirus. Nevertheless, “Citizen’s Observatory” reports nine cases of health workers in Rivas who have become sick with ailments suspected to be COVID-19.

“Among the health workers, the first ones infected were the nurses. There were two or three nurses who were severely infected, but who have recovered. There’s one that has been left with a very severe consequence: irreversible pulmonary fibrosis. She’ll have to seek a permanent pension for disability as a result of this illness,” the doctor highlighted.

“Citizen’s Observatory” has registered a national toll of 61 deaths among health workers due to suspected cases of COVID-19. These include five deaths in Rivas.

Home care

Lino Guevara is one of the economic supports of his family. He works as a cook in one of the town’s bar and restaurants. At the moment, he’s not sure if they’re holding his job for him.  He lives with his parents, one sister and her two children. During his illness, the young man has been confined to a small room in the family home.

Guevara and his family have limited economic resources. They had no way of paying for the COVID-19 treatment, which the Health Ministry didn’t allot him. For eight days, a health brigade visited Guevara, but only took his temperature and checked his respiration. They never gave him more than the five acetaminophen tablets and little bag of rehydration salts.

The private doctor that oversaw Guevara’s care indicated that the medications were obtained “through the help of a nurse who’s a friend of his and a sizable contribution from the community at the Church that we both belong to. Aside from causing physical and mental wear and tear, this disease also brings an incredible economic burden.”

Gonzalez, the surgeon, noted: “the way they’re speculating with the medicine and hoarding it is incredible.  They’ve made a great business out of COVID in Nicaragua. The prices have shot up: one azithromycin tablet that might cost some US 58 cents up to maybe US $1.16, is now priced at US $3.50, $4.50, up to over $8.50 for a single pill.”

The economic cost of home care comes on top of the mental toll of the quarantine. “It’s very hard to be locked in. I get desperate, sometimes I want to just run away, throw myself out the window, because it’s very hard to be shut in between four walls that way: psychologically it destroys you. I can’t sleep, because anxiety overcomes me; my nerves explode. Sometimes I feel like I don’t have any air, but I realize it’s not really that, it’s the anguish, the anxiety that’s killing me.”