The government announced a steady re-opening of the country and this scared the medical personnel at the temporary hospital in Parque de la Industria (‘Industry Park’) whp have fought each day against the COVID-19 illness and in the face of a lack of government support in to equip, support and pay them. The revelations of three doctors from that healthcare center show the true situation of the pandemic that is not spoken of in the national networks.
Pia Flores wrote at the beginning of June, in Nómada, about the problems facing the medical and ancillary staff based in the tremporary COVID-19 hospital at the Parque de la Industria, in Guatemala City. Things have not improved for staff nor the patients across the country with the already weak health system now brought to its knees and failing. Failing for lack of investment and failing because of deep-seated corruption. Even while COVID-19 is spreading through Guatemala, corrupt politicians in Congress are trying to fix the selection of judges so that they can continue to wallow in impunity. Needless to say, the business elite and CACIF remain silent, hoping at some point to surely benefit themselves.
This is the full article and any translation errors are mine.
Frustrating. The word appears over and over in Abby’s desperate account. She is a doctor and since March she joined the professional team in charge of the Temporary Hospital of the Parque de la Industria to serve patients with COVID-19. Her real name is not Abby, but she speaks as this for fear of legal retaliation for revealing the conditions in which she works.
She, her medical colleagues, and nursing and ancillary staff, have been working for 74 days in providing care inside ‘galleys with stretchers’, a place the government has named a hospital. They were not given the proper equipment nor the necessary supplies.
“We are fighting to make the team work, so that everyone keeps coming in. We’re the ones who search for solutions to the lack of masks, medicines and everything else, but we have reached a point where this is no longer sustainable. Can’t go on,” says the professional on the verge of tears.
As the frustration of medical staff and the number of patients build up, and as doctors like Abby warn of the risky situation, the government this week launched its plan to reopen the country.
Because of the President, people think it is a joke
Abby fears that the false security, that the re-opening announcement may generate, will cause an increase in cases of COVID-19 and that patients will die from the illness through failed hospitals and shortages.
“The government makes people think that this is all a joke, that the doctors are exaggerating. People believe that everything is fine and that everything is improving and that’s how it comes out,” she says.
The doctor even doubts that the data shared by the Ministry of Health, and the government, on COVID-19 cases is real. She mentions the repeated inconsistencies regarding the number of deceased persons reported by the Minister, Hugo Monroy [since left his post], and the data that has come out, for example, from the Roosevelt Hospital.
“One day they said that only three patients died in all of Guatemala, but then colleagues at the Roosevelt told us that 11 patients had died just there. That was on May 22. Everything is painted as being very good, but it is a lie,” she points out.
This week, the epidemiologist Edwin Asturias was sworn in as executive director of the Presidential Commission for Emergency Care COVID-19 (Coprecovid). The doctor from the Industry Park fears that Asturias will not have the opportunity to act due to political and commercial reasons that put pressure on the government.
The marvel plan
This re-opening strategy is directed towards the economic reopening of Guatemala. The final version was published in ministerial agreement 146-2020, on June 3, and is the first long-term strategy presented and standardised by the government after 82 days of pandemic in Guatemala.
It is based on four phases in which the restrictions that were implemented to prevent the spread of COVID-19 are gradually lifted.
Each phase depends on stable trends that last at least 14 days; for example, a pattern of decrease in new cases of COVID-19 and a decrease in the number of positive tests proportional to the total number of tests carried out, that is, less than 20% in phase 0 and, in phase 1, less than 15%.
The transition from one phase to another can occur asymmetrically in different parts of the country, depending on local trends.
The strategy also includes the extension of testing to more quickly detect emerging outbreaks and to ensure appropriate medical intervention for patients. Although it does not specify what is considered as “the sufficient number of tests”.
Guatemala has not reached phase 0. The number of people diagnosed with COVID-19, in Guatemala, continues growing, as does the number of people dying.
“We are in the acceleration phase of the pandemic. We are not even close to phase 0. We are on the scale. We are in escalation, but the escalation does not only involve cases, but also the ability to care for the disease,” Asturias explained in an interview with Prensa Libre.
Thursday June 4th saw registered the highest number of new cases: 394 positive tests representing 24.7% of the tests carried out. The previous day, 20 people lost their lives, also the highest registered to date.
The lack of supplies continues
On several occasions, medical personnel have publicly denounced the lack of supplies in the media, and at press conferences outside the hospital. Each time the official answer is that there are no shortages, as if this were an invention of the medical staff.
At a meeting on May 29, President Alejandro Giammattei alluded to a waste of facemasks when he indicated that medical teams sometimes use up to six facemasks per shift. A statement that caused outrage among hospital staff at the Parque de la Industria.
“They are on the news to say that we have all the equipment. That’s a lie! They even made us carry a container to store our mask, take it out of the Parque de la Industria, which shouldn’t be done, take it home and, in the next shift, use it again in three 24-hour shifts”, Abby says with a trembling voice somewhere between rage and disbelief.
The supply of masks, shoes and overalls has not been resolved. This contaminated equipment puts the health of the medical team and their families at risk.
There are also deficiencies that put patients who enter the hospital at risk. Since the protocol changed and asymptomatic people are sent to hotels, or quarantined at their homes, most patients in the hospital need specialized care, for example, the elderly or people with diabetes, hypertension or other diseases. However, medical personnel do not have supplies to take good care of them.
There are patients in critical areas who suffer from respiratory failure and need to be intubated. For this it is necessary to sedate the person, but medical sources indicate that the quality of the medications is so poor that it is difficult for them to carry out this essential procedure.
In diabetic care, glucose test strips are essential for adequate control in patients at higher risk. If the blood glucose levels get too high it can cause respiratory problems and neurological damage. However, they have been short of glucose test strips in the hospital for weeks.
For Abby, the problem of not exercising optimal attention is what frustrates her the most. Talking about it, she cannot stop crying.
“It’s just so frustrating that you can’t even do your job right, although you know what to do. Sorry, but it makes me so mad. I think it could be my mother, my grandmother, my dad or my brother. And knowing that you cannot do anything, anything, because there is no way to do it. Although you know what to do, there is no way to do it.”
What nobody says, except the president
So far there is no cure or vaccine against COVID-19. The only remedy is to minimise contagion, especially in the most vulnerable groups. But sources from the medical team say that, although it is a new disease, the patterns they have seen when working closely with patients are alarming and indicate that, in the long term, even asymptomatic people can have grave effects.
“People who are ill from coronavirus, if they don’t die, I think many will be left with their lungs affected. We have seen mild patients with scarred lungs. Those damages are permanent. In some patients who are asymptomatic, we can also see that their lungs are damaged when the inflammation subsides,”says Abby.
Although there is no medicine to cure patients, doctor Abby believes that with access to adequate medicines they could offer better treatment.
“We can’t do much with the disease. There are some medications that we could use to lower inflammation, for example a steroid, which would ideally be methylprednisolone, but we don’t have that. So, we have to use another, which is not ideal.”
The medical team has access to acetaminophen, ambroxol (a mucolytic), metformin (for diabetic patients), enalapril (for blood pressure), and lopinavir and ritonavir, which are antivirals, according to Abby.
The lack of supplies to adequately care for patients is serious. And it reflects the problem that the national hospitals have already failed, as has been stated by several doctors, such as at the Roosevelt and San Juan de Dios hospitals, and verified by the Human Rights Ombudsman, Jordan Rodas. The Ombudsman’s office has carried out multiple confirmations of the serious conditions and recommended that the government use the Military Medical Centre as an alternative.
Due to the extreme situation, reveals Abby, they have had to exchange some patients.
“There are many patients that we cannot manage, for example if they need hemodialysis. So, we have to talk to another hospital and say, ‘let’s make an exchange, I will pass this one to you and you pass me one that does not need hemodialysis’. So, until we are able to treat someone.”
Bureaucracy that stops contracts and wages
In addition to the risk of getting infected, due to the lack of adequate equipment, and the powerlessness of not being able to do their job well, due to shortages, there is also the lack of recognition for the work of the medical, nursing and ancillary teams in the hospital.
Elizabeth [not her real name] is also a doctor at the hospital. Both she and Abby maintain that the human resources team hinders the process of formalising personnel contracts.
“They give us every excuse. For even minimal details, an upper or lower-case letter, commas or full stops, they reject all the paperwork. But they don’t tell us until a week later. They sent us the template of how to fill out the invoice, but then they also reject invoices that follow their format. Up to two months afterwards they ask us for planning and operating reports.”
The problem is not only administrative, it is also health. Doctors know that physical distancing is the only way not to spread the virus. That is why many try to strictly comply with it, but for every time human resources reject any part of their paperwork, they have to see where they can print, take a photocopy or request an affidavit. Each procedure implies a cost..
“It is more about the principal, not just the money. They are not recognising us, but making fun of us. We are there risking our skin and they can’t even pay us. Those who have a separate job are doing well. But many of the residents are young and have no other income. A colleague told me ‘I haven’t even been able to pay the rent,’ and he owes it two months now, “says the doctor.
Doctors now struggling to pay the rent are afraid to expose their families’ health by working with COVID-19 patients. They don’t want to, nor should they have to, move because they haven’t received wages in two and a half months. Others have begun to accumulate debts on their credit cards. Several of those who had another job as a source of income were fired for taking a job at one of the temporary hospitals.
It was the Ministry of Health that requested personnel to begin emergency work at the hospital without first formalising contracts and paperwork. It was only early May, that staff who started in March received their contracts. Some who started working at the hospital in April are still waiting. The contracts establish a 4-month labour period that ends in July, without a risk bonus, without affiliation to the IGSS [Institute of Social Security], and without insurance.
None of the sources interviewed considers that the hospital will be obsolete and that the pandemic will have diminished in July. Even if it were, Abby is struck by the fact that they are making the process so complicated when it comes to temporary contracts.
“The worst thing is that the ones we are taking the most risk are the ones that are being treated the worst. They have been putting so much on us but, with everything, even the paperwork is so exaggerated, when they are not offering us permanency. The contract ends now in July. We have already started June and we have not even been paid. Almost that we are going to end the contract period first and we are never going to see the salary.
No right to rest: unworthy treatment
Both Elizabeth and Abby highlight the derogatory attitude, and the lack of will, to facilitate their work; this is the treatment they say they receive from the hospital’s deputy director and human resources personnel. This is also confirmed by Erick [not is real name], a doctor who described the conditions at the hospital in a text published in Nómada.
Erick even explains that medical staff is aware of various donations from private companies to hospital staff, such as food, candy and chocolates that only went to the administration.
But they also recognise that the medical team is not the one that receives the most inhumane treatment in the hospital. They point out that nursing personnel do not even have the right to rest during 24-hour shifts.
The different units of the hospital have an area with beds for staff to rest during their shifts. The medical, nursing and ancillary teams work 24-hour shifts.
The doctors organised their shifts in order to rest for a couple of hours while others attend to patients. They also included the nursing staff and, on one occasion, more beds were requested to have enough for everyone. But Elizabeth and Abby indicate that the Nursing Supervisor and Assistant Principal do not allow the nurses to have breaks.
“It has been such an inhumane treatment for everyone. They treat us like we are worth nothing. The doctors still have a little more good treatment from the authorities, but if I speak to you about nursing … they were told that they have no right to sleep at all. Then they fall asleep in the chairs or on the floor with the protective gear,” explains Abby.
The deputy director also indicated that it is not the responsibility of the hospital authorities to ensure the well-being of ancillary staff, because they are subcontracted through the [agency] Grupo Mansersa company. Abby has repeatedly observed ancillary staff asleep in the bathroom area.
“The cleaning staff are essential in the hospital. In addition, and it involves a risk of contagion for them. If one of them becomes infected, or one of us, we are going to infect everyone, because in the area where we eat we are all without protection. We have tried to explain to human resources that it is not only for them that we ask for better conditions, it is for everyone.”
On Friday, 5th June, 46 people from the hospital’s maintenance staff were fired by the Ministry of Health for not complying with administrative paperwork. Like the other teams, the maintenance staff have not received wages, although they began work on 23rd March. At that time the documentation was not a necessity for the ministry.
Daniel Reyes, advocate for working people with the Human Rights Ombudsman, called it “administrative mismanagement” and asked the Health Minister, Hugo Monroy, to respect the acquired labor rights of the 46 people.
“You’re not to die because of your vocation”
Given the abandonment, little by little the medical team, which never reached the 100 people stipulated for the hospital, has been decreasing. Abby and Elizabeth claim that in the past two weeks, they are aware of at least two doctors from the team of 48 who quit. And Erick adds that two days ago another colleague resigned.
According to Abby, she and some of her colleagues begin to consider resignation as the only way out, since despite the fact that the conditions in the hospital have already come to light, things do not change. The authorities branded the doctors who publicly denounced the conditions as “problematic”. And they were tricked by the assistant principal, says Abby.
“They sent us a message ‘come back, everyone is going to be paid today, bring your bills’. Supposedly to dialogue and why they were going to pay us. And it was a lie. Many went and only scolded us. “If you don’t want to be here, nobody forces you, go away,” they told us. And then they turn things around, they say that we doctors are problematic and that we didn’t want the hospital to work”.
It seems to the doctor that the hospital authorities or the ministry have some selected people on the staff who talk. She says that they have received visits in the hospital, where they sent for a doctor to come out to tell about the situation in the hospital.
“They came out in a lab coat that didn’t even reach to the knees, and shoes that were too small. Still, they said they had all the necessary equipment, but we all know this is not the right equipment”, says Abby, adding that this is not the only time this has happened.
Caring for patients while afraid of becoming a patient
Disillusionment characterises Abby’s voice when she refers to the hospital where she has worked since March. She came by vocation, but now what remains is disappointment.
Frequently she sees new hospital admissions in grave health, some are people without any risk predisposition, and young. For example, patients of 30 to 45 years of age who come in need of oxygen and in need to be ventilated.
Seeing the effects of the illness up close only further highlights the risk of working without the necessary equipment.
“Who is to tell us that this is not going to happen to us?”, asks Abby who, after seeing the effects of the illness, began to support her parents with food and shopping to make sure they don’t go out.
If she has stayed in the hospital until now, it is because she does not want to abandon patients and colleagues. But the fear of getting it, and the fear of seeing people die from not receiving adequate care are pushing her to her limit. As did one of her colleagues who simply decided to resign for their own peace of mind and not even fight for the compensation they were entitled to.
“The doctors who work in el Parque, really, we are already so tired. You really do it trying to help. For the vocation. And I’m going to do it for the people. But to some extent I don’t know how much the risk is worth. You’re not to die because of your vocation, either,” she says.
The deadline to resolve complaints is passed
On Saturday, May 30, men and women from the medical team demonstrated outside the temporary hospital of the Parque de la Industria with the reading of a statement addressed to President Giammattei and the Minister of Health, Hugo Monroy.
In seven points they summarized the deficiencies of the hospital and that have already been publicly denounced on several other occasions, such as the shortage of supplies and protective equipment, the lack of qualified personnel, the absence of guarantees in case of infection in the exercise of their work, and the lack of salary despite working more than two months in the hospital.
They directly contradicted the administrative vice minister, Irma Elizabeth Quiroa, who, a day earlier, claimed that the staff had been paid and President Giammattei, who said that the medical team waste their masks.
If these problems were not resolved within a period of seven days, the members of the medical team would submit their resignation.
This Saturday the deadline expires. But to date, none of the 7 points have been fully resolved by the Ministry of Health, report the sources in the medical team. They have personal protective equipment, but they are donations. Only six doctors of more than 40 have received their wages. And there are still doctors who have not even signed a contract.
You can read the full article, including photos and other media, here, on the Nómada website.