Marina 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.
Two 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.
2. 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.
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.