Marina and Socialized Medicine in Nicaragua

IMG_5793Marina and her family have been our closest neighbors for ten years. We’ve watched her five children grow into loving, responsible adults. Throughout the years, all of her children and their families have lived with Marina at one time or another.  When Jose and his wife and three babies moved into Marina’s one bedroom shack, she just slapped some old tin on the side of the house and made herself a dirt floor bedroom. Every morning, her smoky cooking pot boiled with beans for her grand babies. Every afternoon, she hung the hand-washed bleached white cloth diapers on the barbed wire fence. She’s a hard worker and very proud of her family.
IMG_1441Two years ago, Marina began to complain of a lump in her neck. “Toce aqui,” (touch here) she’d say, while grabbing my fingers to make sure I touched in the right spot. “It hurts,” she complained. That was the beginning of my limited understanding of socialized health care in Nicaragua, and the things I’ve learned through Marina’s fight for equal health care.

1. I’ve learned that Nicaraguans depend on a three-tier health system that reflects the fundamental inequalities of their society. The wealthiest Nicaraguans use private health care, often going to Miami for specialized treatment. A small minority of privileged government workers are served by the Nicaraguan Social Security Institute. The rest of the population, about 90%, is poorly served at public hospitals, usually understaffed, mismanaged, and under equipped. Marina fits in the last tier and her journey has been an eye-opener, for me, into the world of socialized medicine in Nicaragua.
IMG_49772. I’ve learned that the patient can’t choose the doctor in Nicaragua. Marina was shuffled from one doctor to another. There’s little room for shopping around or for switching from one doctor to another when the bureaucrats have to “go by the book”.   She couldn’t afford to go to a private clinic. Her options were limited and so was her economic status.

3. The doctor can’t choose the patient. Under socialized medicine, there are few referrals made to another doctor. Marina needed a specialist, but it screwed up the system. Because medical services are free, demand for them goes up, patients are put on long waiting lists, and doctors quickly become overbooked and overworked. It took two long years before Marina received a specialist who was able to diagnose her problem.

4. The patient doesn’t get consoled or consulted. “Marina, what did the doctor say?” I would ask after every trip to Managua. “I don’t know,” she would always say. “He just gave me a slip of paper for another appointment. He doesn’t talk to me.” My understanding of the role of a healer is to always give comfort, support, and encouragement to a worried patient. This is not the case in a public hospital in Nicaragua. I’ve accompanied several local friends to public hospitals in Nicaragua, and it’s more like going to the Waffle House, where the doctors are short-order cooks, dispensing cheap aspirin in a cookie-cutter, uncompetitive state-run way.

5. The patient doesn’t get well. Marina suffered for two years waiting for an operation when the tumors growing on her thyroid could be removed. She was scheduled for her operation in December, but after a long, expensive trip to Managua, she was sent home with orders to return in January because the hospital was full of patients with Dengue. Don’t you think they could have saved her a costly trip with a simple phone call? The truth is, Nicaraguans go on long waiting lists all the time because the right equipment, or medicines, or doctors are not available when they need it the most. Thus, these patients become chronically sick as a direct result of the above four points.

The only consolation in Marina’s case, is that she received her operation this week…two years after her first symptoms. There won’t be a bill, and her loving family members are gathered around her, tending to her every need. She returned home yesterday, a day after her five hour delicate operation. Julio harvested our basil leaves and Gloria mixed  a refreshing tea bath of basil, alcohol, and warm water. When I walked into her house to give her a warm bowl of tapioca pudding and strong pain pills, her daughters surrounded her, pouring basil leaf tea all over her body. The warm water pooled over the dirt floor, while the girls tenderly bathed their mother and grandmother. Marina’s mother gently walked her to the outhouse, and the rest of the family members followed behind, hands holding hips, as the little train of compassion chugged to the outhouse. Touched by the compassion and loving care of their cherished mother, I tried to hold back my tears.

IMG_5506“There’s a story behind everything..but behind all your stories is always your mother’s story..because hers is where yours begins.”
― Mitch Albom, For One More Day

Observing the tender care Marina’s children bestowed upon her, I learned that our mothers’ stories are where ours begin. It takes courage and compassion to raise loving children. Marina is one of the most courageous people I know, therefore her children carry on her legacy.  It’s a shame that economic status determines the type of health care one receives in Nicaragua. Yet, knowing Marina and her children, I have no doubts that she will recover quickly.

25 thoughts on “Marina and Socialized Medicine in Nicaragua

  1. Very fascinating post. I often complain about health care here but thankfully it is amazing. The system in Honduras is very similar to Nicaragua from what I understand. It is sad and unfair. Hopefully someday health care arou d the world will be more equitable a d affordable. Great post!

    • Thanks, Nicole. I have been lucky in that I’ve been able to help many people with my limited supply of resources and money. But, in Marina’s case I wish I was independently wealthy. I would have taken her to Vivian Pellas Hospital in Managua 2 years ago for her operation. Like I said in my post, I learned a lot about socialized health care in Nicaragua. Sad and unfair…yes exactly!

  2. God Bless and I pray swift healing for Marina. I’d heard a few stories in the past, most of which fortunately ended with Americanos with connections helping. I got my introduction after a couple of visits to the one of the local hospitals near the hotel. We North Americans have no clue just how good most of us have had it here. Granted, I’ve never visited a ‘run down’ clinic here, but I’ve certainly never seen anything to compare. I’m not judging either system. It was just an eye opener… And no.. we really do not want ‘socialized’ medicine…

    • I wish I had connections to help Marina. The best that we could do was to give her some bus money for her trips back and forth to Managua. I lent her my suitcase and bought her a bunch of things she’d need in the hospital because the patients have to supply everything…I mean everything including sheets, toilet paper, food, etc. I found out that we have the same blood type and that it’s the patient’s responsibility to find donors if they need blood. Fortunately, she didn’t need any, but I would have been there with my supply of latex gloves, which I have never seen used in any of our local hospitals on Ometepe Island. The local hospitals are really pitiful.

      • Good question, Michael. I’m not sure how to answer your question, but I suspect that many of the problems in Nicaragua are due to the fact that it is a very poor country. It would be interesting to see studies done in various countries that have socialized medicine.

  3. So glad Mariana was finally able to receive treatment and we’ll continue to keep her in our prayers. There are free public hospitals here and from what we have heard from some of our Ecuadorian friends it is a good fast system, though some hospitals don’t have all the equipment that they need. The private hospitals (clinicas) , at least for those who have a cash flow are excellent. On another note my daughter tried to apply for Obamamcare and was told online that she cannot afford it. Hopefully this is just another glitch in their system. The insurance that she has now through the Cleveland Clinic will no longer exist and she has major health issues. So don’t know what’s going to happen.

    • Oh, so sorry to hear about your daughter. I hope it was a glitch, but quien sabe? Can you receive the public health insurance if you are a resident of Ecuador? I’m curious to find out if we can apply for the public health insurance in Nicaragua. Just like almost everywhere in the world, if one can afford health care, it’s quality care.

  4. A very touching story – Marina is certainly loved and taken care of by her family members. Can’t say the same thing about the health care system…thanks for sharing her story and please pass on get-well wishes to Marina.

  5. Many more people could have INSS services if they’d paid into the system (for various reasons, they and their employers don’t do this). Costa Rica has a national health insurance system that does allow people to have choices, I believe, but the average income there is much higher than here.

    (You know me as Rebecca Brown elsewhere).

  6. The important qustion is will she survive? The US is headed in much the same direction with the haves and have nots, no matter what people will tell you. It’s quite scary. Obama care is yhe pits – there is no choice of docors etc. and a waiting line where there used to be none – even if it was expensive. Smetimes time is the only survival there is.

    • Sunni, I don’t know anything that’s happening in the USA with the Affordable Care Act since we are not eligible to receive it. But, my thought on the ACA is that at least now, those who need medical care the most cannot be denied services. Marina will survive. Although, she had to wait two years for her operation, she did have a specialist who operated on her professionally. Thanks for your thoughts.

  7. Great post, Debbie! I love the image of the “train of compassion chugging to the outhouse”. I was just speaking to a friend today about how far our culture has moved from the time when a family would have 3 or 4 generations living under the same roof as they still do here in many homes – supporting, feeding, healing one another. I am nostalgic for that time without even knowing what it feels like. It’s lovely to know that Marina will be surrounded by loved ones as she heals.
    Regarding social security, you’re so right – less than 1% of Nicaragua’s workers are insured. We are happy (and obligated) to pay to have our staff insured and fortunately we’ve seen it work. Next week, Franci will go on maternity leave for 3 months and have 60% of salary paid by INSS, we’ll pay the other 40%. She has had all of her pre-natal exams at the INSS clinic. It’s a system that can work on a larger scale
    – IF employees are all obligated to insure their employees as the law states. There are at least 2 large employers on the Moyo Main Street who avoid this by keeping all of their staff on 3 month contracts. And for what…to keep their operating costs down and product prices low and competitive for the consumer. Anyways, I’m ranting…you struck a cord 🙂
    Thanks for telling Marina’s story. I hope she can look forward to a pain-free life with her family..she’s an inspiring woman!

    • Laura, thanks for taking the time to express your thoughts. I’m glad I struck a cord. 🙂 Franci and your other employees are so lucky to have thoughtful, caring, law abiding employers. l’m not sure what else we can do, but to help spread the word about the long journeys into a mismanaged public health care system in Nicaragua for those who aren’t insured. Are all employers obligated by law to provide INSS? Is that why some employers keep their staff on 3 month contracts to avoid penalties? Are employers penalized for not providing INSS to their full-time employees? For the majority of unemployed, do they have any options for health care? I wonder how expensive it is to enroll in INSS? Can legal residents, foreigners, enroll in INSS? I’m going to have to dig into this further. I have lots of questions.

  8. At least there is something to wait in line for unlike the USA, where you would have to go to an emergency ward and have a bill of several thousand dollars later, and this only if it were a matter of life and death. Maybe the new affordable care act will help people that have little or no income… Survival of the fittest in it’s most ugly form!

  9. Great to hear about Marina. I last saw her on the Che in November on her way to Managua and looking rather stunning. My next door neighbor/gardener is concerned over a large soft swelling on the side of his neck and is very concerned. I have tried looking up info for him but have found nothing substantial. Would it be OK for him to call Marina and share stories?

      • Everything is great here. I told my neighbor about Marina and he is looking forward to meeting her when she is up to it. Yesterday his wife said he had stomach problems, unsurprisingly caused by the same things that get Ron- fruit on the ground. Today he is back doing his magic on my yard.

        On the criticisms on health care here- you actually get more than you pay for compared to the US. During the last election debates the question came up on what to do about the uninsured, the response from the audience was “let them die” which was met with loud cheers. Appalling. For those whose answer is ER, that is an enormously expensive taxpayer subsidy.

        A tourist here last month inadvertently stood on a red ant colony and went into anaphylactic shock. She was taken to Moyogalpa, treated and kept overnight for observation and two additional injections. Free of charge. Another elderly tourist fell and suffered a torn tendon. In Rivas she was treated and the injury stabilized so she could return to the US. Free of charge, including x-rays. They were both very thankful and appreciative.

        The Obamacare issues from Sunni Morris are completely and totally wrong. Obamacare is either Medicare, Medicaid or subsidized private policies. My Obamacare insurance is with Cigna and no different than a regular employee (i.e. taxpayer subsidized) policy along with the network (i.e. ‘there is no choice of docors etc’) of approved doctors. and waiting lines? Sheesh…

        I detest fearmongering. As Sergeant Joe Friday used to say, “Only the facts, ma’am.”

        • Brian,

          I guess we each have our opinions on Obamacare. I know people who have tried to sign up and either their premiums trippled, they no longer had a choce of doctor, or they were told they don’t qualify – once they could get on the website, which is broken most of the time despite how much it supposedly cost to set it up to start with.

          I have no insurance and will remain without any because if I could afford the premiums I would already have insurance way before now. I guess I’ll take my chances with being ill enough to see a doctor.

          We even have Canadians coming here because they could get surgeries cheaper and quicker than using the universal type medicine they have in Canada where waits are very long.

          I’m glad your tourists were treated for free because ours here sure aren’t, unless you happen to be an illgal alien living here.


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