Coronavirus Is Being Tackled By Nicaragua’s Community-Based Health System
Above photo: Nicaraguan community health center from “Strengthening the Family and Community Health Care Model in Nicaragua,” the World Bank.
Nicaragua’s Sandinista government is – like every other government – engaged in a struggle to limit the effects of the Covid-19 pandemic on its people. But Nicaragua suffers two additional handicaps. One is that it is subject to US and European sanctions, which severely limit the aid it gets from abroad or from multilateral bodies. The other is its internal opposition, which aims to use the pandemic in its latest attempt to destabilize the government and turn opinion against it. To do so it employs a wide range of propaganda methods, at home and abroad. These were very evident in a recent article in the progressive platform Toward Freedom by Rafael Camacho, whose very title shows it is going to repeat the opposition’s messages: Coronavirus met with denial and silence in Nicaragua.
Sadly, almost every criticism made in Camacho’s article reflects the opposition’s arguments and ignores the reality of Nicaragua’s efforts – successful so far – to contain the pandemic. Here in brief is what the government did to prepare for it. Back in January, jointly with the Pan-American Health Organization (PAHO – the regional wing of the WHO), Nicaragua’s health ministry published its plan to tackle the virus. At this point most countries outside Asia had not even acknowledged the threat. Nicaragua intensified its health checks at all border points, later followed by 21-day quarantine for all new arrivals, with compliance monitored by health officials. It trained all 36,000 staff in the health service on how to face the epidemic. It began house-to-house visits, which now number over five million, to give advice direct to the population. A free telephone line was set up, which has received a huge number of calls. One hospital was set aside exclusively for respiratory cases during the crisis, and 18 others were also prepared for Covid-19 patients. These and other measures are set out in the Sandinista government’s 75-page white paper, published in May (and available in English). Camacho makes no mention of it.
Such achievements were possible because, far from having a ‘battered’ health system as Camacho claims, it has 19 new hospitals built in the last 12 years since the Sandinistas returned to power. The proportion of Nicaragua’s government expenditure going to health services (one-fifth of its budget) is one of the region’s highest. By May 2020 the country had more hospital beds, at 18.5 per 10,000 people, than Colombia or Mexico, and proportionately more intensive care beds than Japan or the UK. This is despite it being the poorest country in the Americas after Haiti.
Camacho begins his article by quoting a letter signed by 700 doctors, which is of course just part of the torrent of anti-government propaganda during the pandemic. The letter ‘warned about the collapse in the public and private health systems’ and the expected ‘saturation in the hospitals.’ What he doesn’t say is that this never occurred. The system was stretched by the crisis, as anticipated, but it certainly didn’t come close to ‘collapse’. In June, an epidemiologist monitoring the position nationally told us that hospitals were reporting that the peak had passed and funeral directors he’d spoken with reported a fall-off in business. We checked with a local hospital, one of the 19 dealing with virus cases, and its intensive care unit still had Covid patients, two on ventilators, but wasn’t full. Patients treated with the virus have been carefully followed up, with family members also monitored for symptoms. Hospitals like the one in Masaya have recently recognized the efforts of all the staff – doctors and nurses, porters and cleaners – in moving ceremonies attended by some of the patients who have recovered and who express their thanks for the attention they received.
What Nicaragua lacks are test kits, which means their use is very restricted. Official figures currently show only 3,900 Covid-19 cases and 123 deaths. Opposition groups took advantage of the limited official data; in April they created a “Citizens’ Observatory” which now reports over 9,400 cases and 2,600 deaths. The Observatory’s data, heavily caveated in its small print, cannot be verified, and are not the result of testing or of clinical diagnoses. Camacho nevertheless quotes them as if they are superior to the government’s figures.
Camacho criticizes the government for “silencing” health service doctors who spoke out about supposed deficiencies in the hospitals. What he fails to say is that there was a huge propaganda drive by opposition groups, including doctors, to deter people from going to hospital, on the grounds that there they would catch the illness, would not be properly treated and, if they died, would be buried in a communal grave. This was partly successful – we know personally of people who were deterred on this basis. One Covid-19 victim known to us (a middle-aged pastor in Managua) only went to the public hospital when he could barely breath, having been turned away from two private hospitals. He was treated properly and has since recovered. A clinic in a poor barrio in Ciudad Sandino, funded by US volunteer groups, also received many patients who had been scared by the propaganda into not going to the local hospital. The opposition was, in other words, capitalizing on the pandemic to defame the health service and undermine trust in the government.
Another criticism is that the government refused to impose a compulsory lockdown of the kind used in adjoining countries. This was because in Nicaragua, 80% of families depend on the informal economy to earn enough to buy their daily food and the 40% who live in rural areas needed to plant their crops in the current planting season. It was hardly surprising that the opposition called for lockdown measures, as this would have produced just the kind of massive economic disruption that would have suited them. Their middle-class supporters are also, of course, much better able to survive a lockdown. It would not, however, have helped the majority of Nicaraguans to stay healthy. Camacho says that the government has made matters worse by continuing to hold “massive events.” But the last of these was on March 14, days before a traveler brought the first Covid-19 case to the country, and the recent 41st anniversary of the revolution was marked by a “virtual” celebration.
It was also clear that a lockdown could only be enforced by the kind of repressive measures used in adjoining Honduras and El Salvador, and that they could result in widespread hunger. And the benefits of lockdown in those countries are far from clear. In El Salvador, Médecins Sans Frontières reports that the health system is close to collapse; the government is now seeking to bring in Nicaraguan doctors to help. In Honduras, where there are now around 46,000 virus cases and over 1,000 deaths, health services have collapsed in several areas and massive corruption has occurred in the use of the considerable international aid the country is receiving.
Of course, the Nicaraguan opposition makes continual complaints to the WHO and PAHO that Nicaragua is ignoring their official recommendations, and is very successful in getting international media attention. For example, the medical journal, The Lancet, published a letter which was highly critical of Nicaragua and was widely quoted in international media. It was obviously organized by the opposition, yet none of the doctors signing it were based in Nicaragua, and all but one works in the US. A reply published by The Lancet, answering the points they raised, received little attention.
What Camacho doesn’t point out is that both the WHO and PAHO have generally praised Nicaragua’s approach. During a visit to Nicaragua in March, PAHO representative Alexander Florencio confirmed that the government was ensuring that “the best conditions are being prepared” to contain a virus outbreak. He added that “It is fundamental to recognize that the country has a health system based on a family and community model able to identify a suspected case and an outbreak, which will be quickly referred through the health system.” He expressed concern about rumors and speculation being disseminated through some media and social networks: “It is our responsibility to say that provisions being made [by the government] have incorporated all PAHO recommendations.”
Camacho ends by mentioning a completely fake news story, concocted by the opposition, that 13,000 Nicaraguans who couldn’t get health treatment were at the Costa Rican border, trying to cross. Conveniently, Costa Rica’s health ministry announced that they would not be let in. There are no pictures of them, as they were not there: anyone who needs medical treatment in Nicaragua, including foreigners, can get it free at any public hospital, much to the annoyance of many private doctors who are contributing to the opposition’s dangerous propaganda.
Fundamentally, this issue is much broader than a discussion about right or wrong approaches to the pandemic. We are in a new era of hybrid war where the United States attacks countries with new tools, avoiding sending troops whenever possible. The Trump administration has labeled Nicaragua along with Cuba and Venezuela as the “Troika of Tyranny.” An important weapon in the hybrid war is undermining a country’s reputation, particularly among those who might be expected to support it. False information is used to confuse people on the left and cause divisions, where instead we should be united against US intervention. In Nicaragua, the US works with business interests, a large part of the middle class and selected local NGOs that want to remove the Sandinistas and reverse their 41-year revolution. So far it has failed but its efforts will redouble as the country’s 2021 elections approach.
It is vital that independent media outlets are vigilant and question reports about countries where the US is seeking regime change, even when they seem to chime with other media stories that have appeared. False reports about responses to the Covid-19 epidemic are being used in the US and western media, including independent and left-of-center media, as a further way of questioning the legitimacy of Nicaragua’s elected government. Such reports should be approached with skepticism, or their readers are in danger of being used in aid of US intervention and regime change.
For this reason, it is particularly dispiriting that a progressive platform such as Toward Freedom should not only repeat right-wing propaganda that serves the US administration’s interests, but refuses to correct what it has published or provide space for an alternative view, informed by local knowledge. This is exactly what happened when we approached its editor, Dawn Marie Paley. She said that Camacho’s article was ‘backed up by reliable press reports and first hand sources,’ when these sources are mainly opposition-linked groups and right-wing media. She later added that she is ‘not interested in replicating a simplistic world view in which the enemy of my enemy is my friend.’
Our motive in seeking to challenge Rafael Camacho’s article is not, as this suggests, simply because the Trump administration wants to destabilize Nicaragua, even though new evidence that makes this clear was published recently in Popular Resistance. No, we believe that Nicaragua has made a valiant and so far successful fight against Covid-19, and the world should try to learn from its unique approaches, not deride them as Camacho does. Those of us on the left who support progressive governments should be particularly aware that – as soon as they show they are successful – the right wing will try to undermine their ahcievements. The last thing that progressives should do is join in.
Kevin Zeese is a public interest attorney who is the co-director of Popular Resistance.