By Roger McKenzie – Aug 29, 2023
Estelí, the eighth-largest city of the Central American nation, the de facto capital of the north, is also the country’s main tobacco production region. The land around Estelí is ideal for growing cigar tobacco and the city became a conclave for Cuban cigar makers who left the Caribbean island after the revolution in 1959. Since that time Estelí has become one of the most important cigar producing cities anywhere in the world.
Tobacco and the health problems that arise from it for the workers who produce it and the smokers that use it seemed to me a good place to look at the Nicaraguan health service. I later learned that in fact diabetes and hypertension were currently the main health issues in the area.
I secured an exclusive interview with Dr Mario Lazo Guerrero, the director of the integral system of healthcare at the local hospital. The hospital in Estelí serves an urban population of more than 100,000 and, like much of Nicaragua, a sizeable rural community.
Dr Lazo told me that Nicaragua has been developing a free family and community model of healthcare with an emphasis on prevention since the Sandinistas returned to power in 2007. They have an extensive community network that makes use of volunteer “brigadistas” to reach out into the community, particularly the rural areas.
Lazo and the members of his team that I met mirrored the commitment to the vocation for providing quality healthcare that I have seen in Britain and other parts of the world, but here it was mixed with the fervent support for the Nicaraguan revolution.
Lazo said, “The brigadistas play a central role in the delivery of healthcare in Nicaragua. They reach out into the community and make sure that there are no obstacles to anyone getting healthcare. This is really important when, like Nicaragua, your economy is mainly rural. It is not always easy for people to get what they are entitled to.”
As in most economies, whether capitalist or revolutionary, how women access healthcare is complicated. “The brigadistas are really vital for us in helping us to improve women’s health in Nicaragua,” Lazo told me. This is demonstrated through the priority given by the Nicaraguans to reducing neonatal deaths. The Nicaraguans place a high priority on supporting women through pregnancy and the brigadistas play a major role in this strategy.
Lazo said, “The brigadistas help us to identify mothers not attending pre-natal care. They can dig deep into the community to identify things like where women have problems with getting transport into the municipal health centres from the rural areas. The brigadistas alert us so we can have the necessary conversations to make sure that women get the transport they need, when they need it.”
He went on to say, “Doctors and nurses all consult with brigadistas over health concerns in the sector they are responsible for. This gives us early warning of any problems that might be arising at a very local level. Brigadistas get trained to know what to look for so that they can consult with or alert medically trained people on what they see. This means we can usually have a speedy response to deal with anything serious that might come up.”
Brigadistas help support patients through the healthcare system and more than half are given smartphones to help them to communicate with healthcare professionals. “We have regular Zoom case meetings, which involve brigadistas, so they are completely part of the process,” Lazo told me.
He continued, “Brigadistas are part of the birthing plan of pregnant women, particularly of those at risk. They help develop a plan to get pregnant women to and from hospital. Unlike in the neoliberal years, most women give birth in hospitals. Only 0.2 per cent of women now give birth at home.”
The level of care for pregnant women described by Lazo is astonishing and, in revolutionary Nicaragua, completely free. He explained, “In Nicaragua all women are brought into hospital or a maternity waiting home two weeks before their due date to await birth. This is completely free for all their transport, bed, food and healthcare.”
After the birth women can stay in hospital with their children, “for usually two days after the birth before being transported home,” Lazo said.
The care doesn’t end after the birth of the child. Lazo explained, “The brigadistas help us to maintain control over the vaccination programme that every child is entitled to. They help us to make sure that the plan is maintained because it’s all too easy to believe that the job is done after the birth.”
This strategy for reducing deaths among newborns is proving to be a success. Lazo stated that, “In this area in the first five months of this year there have been 1,032 births, of which 92 were premature. Of this number there were six deaths of which two were genetically malformed and would not have survived.”
In Estelí there are around 1,322 brigadistas, “which is great but we need more as the existing cohort is getting old. We are in a constant process of recruiting new brigadistas. Each brigadista is asked to identify new people to eventually replace them.”
The 2020 Covid pandemic was a massive challenge for Nicaragua, as it was for the rest of the world. But, for a country trying to build a healthcare system that did not depend on how much money you had in your pocket, this was an additional challenge.
There were no lockdowns during the pandemic in Nicaragua. The economy remained open. There was no official mask wearing policy, save for people with respiratory conditions or people providing care to patients. In hospitals and healthcare centres most people wore masks and handwashing and alcohol hand sanitisers were available throughout the country.
Nicaragua had one of the lowest death rates per 100,000 population in the world. The World Health Organisation and Oxford University both reported a rate of just 189, compared with 276 for the UK and 374 for the US.
It’s taken for granted that the US and their allies and their employees in the capitalist press will dispute whatever the Nicaraguan authorities say, but what can’t be denied is the critical role played by the brigadistas in reaching out into the community to make sure everyone received the COVID vaccine.
When you don’t travel to Nicaragua and see for yourself how people are attempting to construct their revolution, it’s easy to take the comfortable route of believing reports from what many people consider to be reputable news sources.
My advice is to go and see for yourself what this amazing country is trying to do to make sure that everyone has access to healthcare regardless of their ability to afford it. Revolutionary change takes time, but surely one of the main measures is the priority that a nation places on everyone being able to get the best possible quality of healthcare.
Nicaragua certainly puts people first and tries to involve the whole population in providing the best possible care.
The brigadistas play a central part in the process.
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