I stop mid forkful of beans with a blinding headache. No, this is no ordinary headache, neither cluster headache nor typical frontal migraine, but excruciating pressure originating in my eye sockets. Like they were zipped in a vacuum-tight sealer, sucked dry and lifeless like preserved meat.
Solution? Mid-day nap.
Ignoring the chickens and dogs, I lay my head down for a few hours.
WAIT. What is this pain in my legs? This is not that twitch that supposedly means I’m down on potassium or dehydrated or something … THIS is different and it ain’t good.
Dengue, Day 1.
I was lucky. I was very lucky. I had a case of classic dengue that lasted about a week, uncompromisingly painful, especially since the only analgesic permitted is non-Aspirin pain reliever so as not to damage the liver, which turned out to be important. Unfortunately however, Tylenol doesn’t quite do the trick when your hands and feet feel as if they have been robbed three layers of skin and simple exposure to air resembles shards of glass jabbing into the sinews of your raw being. But in time, the pain passed and although the recovery has been slow with some impediments along the way, I am on the road, or so I hope.
Besides permanent antibodies to the virus that remain in my system, I am walking away (mostly pain-free) from the experience with some insights and a broadened perspective about Nicaragua’s healthcare system and how being sick from a common illness here made me feel simultaneously more integrated and more ostracized from my community.
Dengue Fever, caused by the dengue virus, is endemic throughout Nicaragua, where the mosquito-vector Aedes aegypti lives and thrives. This year we have seen a serious epidemic of the virus, boasting higher rates than usual across all regions of the country. While mosquito prevalence increases during the wet season (winter) from May – November, this year’s winter has been rather dry, meaning there is more standing water in populated communities, thus allowing the mosquitos to quickly breed and spread the virus. In addition to upping the numbers of dengue and malaria cases (thankfully malaria is not prevalent where I live and there are only a few cases in the country, so Mom, take a breath), a dry winter wreaks havoc on food security which has been the cause of some civil protests regarding the market price of frijoles, not to mention less advertised protests of children silently fighting the unmet demands of their rumbling tummies. But, back to Dengue.
Since treatment of classic dengue is only symptomatic management, most Nicaraguans suffer in their homes and once strong “enough” continue about their lives. Some patients presenting symptoms visit the health center where their blood is taken and sent to a lab, and then they are whisked away with a handful of acetaminophen and rehydration salts, free as part of the country’s socialized medical program. While my town has reported the highest number of suspected cases of dengue fever in Nueva Segovia, vigilance is still a problem: blood samples are often sent to the lab after they are viable and patients are not informed as to whether the virus was ever confirmed. However in my case, after suspecting and confirming dengue at a private laboratory, I was sent to Managua to consult with Peace Corps doctors, where I could have access to the best hospitals, specialists, and laboratories in the country.
Many Nicaraguans have never been to Managua, just like many Americans have never traveled to Washington, DC (although you should!), or New Yorkers to Albany (but let’s be honest, NYC is the real capital — no offense Bobby Beach). But I often wonder, what are the implications of Peace Corps Volunteers maintaining a vastly different understanding of Nicaragua than many Nicaraguans, who for reasons of culture, finance, or competing priorities don’t leave their small pueblo or travel much beyond? Many Peace Corps Volunteers have the travel bug; eager to save Out Of Site Days to explore different parts of the country, and while this understandably separates us from our Nicaraguan colleagues, my experience with the dengue bug proved to have a similar effect.
I explain my absence from town. “Tenia dengue – I had dengue”, which is received mostly as a line of solidarity with Nicaraguans – mosquitos don’t discriminate foreign vs national blood when they go in for a feeding. In fact, the majority of Nicaraguans I have spoken with have had dengue once in their lifetime (twice means trouble), but when/if I continue to explain that I stayed in Managua, confusion inevitably arises. And here is the truth: in a condition without real treatment, I was treated differently; and in a country where medical services are free, money still talks.
Although there is a hospital 10 minutes from my house, it is not a Peace Corps approved facility. Why, exactly? I am not sure, but I can use my imagination:
Of the two infant mortalities in my town in September, one was a tragic tale of a 2-month old presenting symptoms of pneumonia and respiratory distress. Hours after the call for help was made from a Brigadista (community health worker) to the health center, an ambulance was dispatched to retrieve the baby from the mountainous community. The baby was brought first to the closest health post with a doctor attending before it was sent to the hospital. In route, the baby’s breathing worsened. Mozonte’s one ambulance, like most in Nicaragua, donated from an NGO or another country, is essentially an empty van with two long benches across either side: no straps, no stretcher, and no equipment. When the medical staff arrived at the hospital with the baby in severe respiratory arrest, in need of supplemental air, there was no infant bag valve mask to be found… in the entire hospital. The baby died.
Like most stories, I am certain there is more to what happened than solely the sequence of events I know and recounted here. But as an outsider, learning of unjustifiable* tragedies, I must fight the desire to place blame on someone or something: a mother who has more mouths to feed than she can because of a lack of family planning, a health system that prioritizes using ambulance gas money for community messaging over medical emergencies, hospital administrators who either have not demanded enough of the right equipment or poorly manage what they do have, etc. There are countless reasons why infant mortalities, like this one, are happening nearly monthly in Mozonte. I am also told that this baby had a pulmonary birth defect that would have proven insurmountable regardless of supplemental air, but whatever the truth(s) may be, poverty is the pervasive obstacle — manifesting in different forms.
*As a health volunteer I am regularly exposed to the country’s public health system: clinics, hospitals, vaccine campaigns, sanitation campaigns, etc. The last 9 months in Nicaragua left me with the impression that a certain quality of healthcare exists in this country, but in my recent experience in Managua, I realized that this reality is not everyone’s and perhaps some of what I am seeing here is truly unjustifiable, not only in the global context but with respect to what is available in this country, albeit in the private healthcare system.
The Peace Corps Medical Office sends Volunteers to a private hospital that in terms of construction and cleanliness alone, seems on par if not rivals some hospitals in the US. I am not qualified to speak to the level of care and treatment by medical personnel but can say that the environment seems highly professional, organized, and equipped — a world-away from my nearby hospital. The hospital accepts private insurance or cash, and as a Volunteer, I am fortunately covered under Peace Corps medical insurance. Looking around the hospital, a few things are strikingly evident to my jaded “campesino” eyes: people are well dressed in expensive tailored clothing and the majority of patients are light skinned. Even the hospital brochures and signage are adorned with smiling white faces.
Seeing a pregnant woman in the lobby having just left an appointment with her OBGYN, I couldn’t help but compare this attention to the controls done in San Antonio, a community of Mozonte where the club of pregnant women successfully meets monthly. Some women walk hours in broken shoes to do their controls with a generalist/social service doctor, but I always thought they were mostly motivated to attend because my doctora friend passed out some food and newborn essentials after she visited a few houses and found that the babies either went without clothes or donned adult-sized t-shirts. I imagined this woman in Managua, decorating her baby’s room with items she and her husband purchased, stuffing drawers with adorable color-coordinated outfits with matching booties, and finding spots around the house for the overabundance of gifts they have been accumulating from family and friends.
Before my adventure with dengue, I was convinced that Nicaragua was a country of the “have-nots”, at least in terms of health. Sure, I know Latin America is infamous for the inequity of wealth, but Nicaragua’s wealth is even more concentrated in the hands of a few families than many of its neighboring countries. Despite what many may think and some may say, we have similar inequality in the States. Prior to this experience, I would have said that the inequality in America is less extreme since our public programs can and often do fill some of the infrastructural gap. However, now living amongst the “have-nots”, I am increasingly aware of the effect that my surroundings can have, acting as a blinder to the other side. Now I doubt my ability to adequately assess the disparities back home – maybe I have always been blind? While the old axiom, you cannot judge a man until you have walked a mile in his shoes, rings true, I question if it is ever truly possible to experience life like the man, no matter how long you walk. The fact is, I will always be different here; my American passport does not just grant me access to a country many qualified Nicaraguans struggle to visit legally, but also it grants me access to a part of their country they likely will never know.
In my continuing quest to understand the happiness of Nicaraguans, I wonder if ignorance is bliss – maybe not knowing what opportunities evade them is a blessing after all. But for now, I know more than I did before. And that’s how I learned to keep worrying and hate mosquitos.