I'm sitting in a shitty little hospital room in Granada, Nicaragua. Cats and dogs of every breed and size are running in and out of the patients' rooms while family members bring in food, fans, and toilet paper. The man in the bed next to where I'm sitting is handcuffed by his ankle to the bed frame. He's quite handsome and keeps smiling at me. But I have to remember that he killed someone with a machete last night. In the process he received a nasty gash on his arm. Every so often he to calls to the policeman just outside the room to uncuff him and take him to the bathroom. They seem to have developed a quite jovial relationship.
I'm sitting next to De Valencia, my illicit Nicaraguan love affair which we had decided to end last night before the accident. Now he's lying on sheets brought in by his mother. They took the plugs out in surgery and now his earlobes look like two sagging worms. Half his face is swollen, similar to mine, and his arm is bandaged up. He keeps moving his fingers to make sure the infection hasn't spread and he'll be able to keep his hand. I tried last night in the ambulance to apply pressure to the open artery but the floor was still covered in blood by the time we arrived, leaving red footprints from the ambulance to the emergency room.
The doctors, a disgruntled bunch--which could be attributed to the obvious lack of funding the hospital had--were very slow moving even when De Valencia walked in with half his arm hanging off and a trail of blood behind him. Finally they did attend to him after I had taken his shirt off over his arm and face. I was told to wait outside, which I did until I realized from the looks people were giving me there was probably something wrong with my face. I went to the bathroom, and in the dim light I saw a huge bump had formed on my forehead and dried blood streaking down my nose and cheeks and mouth. I turned on the sink to try to wash some off. No water. In the hospital. I realized the gallon jugs of water they were using on De Valencia probably wasn't for sanitary purposes, the water flow from the taps just isn't that consistent.
By the time they had De Valencia all cleaned up and ready for surgery, they had already washed my face off and stitched me up. The lacerations on my legs were left untouched, and it wasn't until a few hours ago I was able to scrub them good to get the cinders out. They took our information down and scrap pieces of paper [immediately I thought of the HIPPA codes and what a heart attack those scrap pieces of paper would have given to HIPPA's creators]. I then waited for an hour or so while he was in surgery with him family until the police came.
A moto taxi, fondly called tuktuk here, is essentially a three wheel motorcycle with a cab in the back. They're not made for highways, nor are they made for rainy days. At night. Or on the weekend when there are drunk drivers galore in Granada. All things I have learned. It was in a tuktuk that we were coming back to Granada. It was pretty cozy, even for just having ended things. De Valencia was talking about something but I wasn't paying attention, as I'm apt to do, when I noticed two head lights heading straight towards us. Then the impact and we're flipping over and sideways and metal is coming in from all sides and me thinking, Shit, this is it. My dads gonna kill me for being so stupid.
But then everything stopped and I try to stand, which I can, and see I'm in the middle of the road in an overturned tuktuk. A road with no lights whatsoever except for the cars passing by. I pull myself out of the tuktuk and scramble to the side of the road. I hear De Valencia calling me and stumbling over to where I am. Half his face is covered in blood and I go to hug him when I notice his arm. Half of his wrist is either hanging off or missing and he can't move his hand. Hes obviously freaking out which kicks me into action mode. I tell him to calm down, hes not gonna lose his eye or him arm and help him into an ambulance which happens to pass by with a mother and pregnant daughter on the way to the hospital. They seem very calm even with us there and remain so all the way to the ER.
I'm telling people it was a fight to get some street cred
The guy driving the tuktuk turned up that night in the ER with thankfully only laceration on his leg. He had brought my purse which I had left at the accident [thank God because my favorite MAC lipstick was in there]. The police showed up then with the driver of the truck. He was young with curly hair down to his shoulders and large black rimmed glasses. His appearance reminded me of a student activist from the 70s and 80s that I had always romanticized. He was also too drunk to even stand.
What an asshole.
My mother told me today that when she was in Nicaragua in the eighties she worked in a woman's hospital. There were two women and two babies to each thin plastic mat, and after the women gave birth on half tables with only one stirrup, they would lay for a second with both feet in the single stirrup. Everything was plastic and there were no sheets to be found.
Instead of lying on plastic mats on the ground, there are beds now. And even though the pharmacy in the hospital didn't have all the medications they sent me to get for De Valencia [or ice for the huge bump on my forehead], they did have most medicines. I don't know if this is normal for most hospitals in Nicaragua. I assume the larger, better funded hospitals in the capital city of Managua are much more prepared. The surgery room where they took De Valencia was incredibly dirty and there isn't too much in the way of sanitation or regulations from what I can see. A piece of paper taped to the wall reads in handwritten script: Patients must be washed before 6 am in preparation for doctor's visits.
This is how it is. There is no funding here in Granada for hospitals, no funding in most of Nicaragua. Like most of the country, health care falls into the economic hierarchy that reins this country. The Nicaraguan well to do are able to afford private hospitals in which the services and treatment are similar to those in the U.S. and for more specialized cases are able to go abroad to receive treatment. Then there are government workers who have access to the National Social Security Institute, and then there's the majority of the country, over 70% that receive public health care.
The low salaries of general practitioners here [US$544/month] and constant reorganizing of the system leads to a high turn over rate for hospital workers. Only eight per cent of Nicaragua's GPD is spent on public health care and only $59 is spent per capital--$27 out of pocket.
Just like I saw in my ER trip, in 2001 it was reported that 35% of health facilities had no electricity, 45% no water or very little access to water, 35% had insufficient or damaged sanitation and sewer systems, and 68% had no sterilization system. [Sequeira M, Espinoza H, Amador JJ, Domingo G, Quintanilla M, and de los Santos T. The Nicaraguan Health System. Seattle, Washington: PATH; 2011]
Although many measures and remodelling of the system have been implemented, the decrease in government spending on the health care system began in early 1990s [thanks IMF] and since then the infrastructure and access to resources and funds of most health centers has remained deplorable.
The cost of going to a hospital and/or remaining there is a economic burden that the families must assume. They are responsible for bringing food and any other basics to the patients and buying medicines. For a country where 48% live not on or near, but UNDER the poverty line, paying for hospital expenses is hardly feasible.
Back in the hospital, De Valencia is all set up with nice sheets, a fan, and roasted chicken while the machete wielding murderer has the thin hospital sheet and tid bits of food that his mother brings him every so often. But there is a camaraderie here in Cuarto 4, Sala de Varones. The guys joke about what a mess it makes to kill someone with a machete and De Valencia offers some of his rotisserie chicken to the guy next to him. He takes it and tosses the bone to the hungry stray dog panting in the doorway. I realize its late, and get up to give De Valencia a kiss on the cheek goodbye. I scoot by the dog gobbling up the bone in the doorway and past all the family members sitting in rocking chairs outside patients' rooms. I head outside to catch a cab but its late. A tuktuk shows up instead.
