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The Coronavirus and Neglect in Cuba: A Family’s Ordeal at Several Hospitals

'I confess that at first I was excited, thinking that this time they’d do a good job, but now I'm sure of one thing: they're lying.'

La Habana
Illustration: Dr. Durán’s political rhetoric.
Illustration: Dr. Durán’s political rhetoric. DDC

I confess that at first I was excited, thinking that they would do a good job, that for once in the history of socialism in Cuba they would overcome the injurious apathy and shoddiness with which we do everything, and they would control the epidemic satisfactorily. "Their continuance in power is at stake if the virus breaks out," I told myself. After all, if they have been able to do one thing for 60 years, it is to maintain power.

This delusion lasted until recently. The worst scenario for Cuba - as I understood it - was that the this natural disorder, in the form of the virus, would converge with human chaos, in the form of socialist inefficiency, which we have cultivated for decades. I am afraid that this is the scenario that is unfolding, as two families' experiences confirm it, both of them experiencing that threshold that is death.

The first event occurred in August, when my 92-year-old grandmother developed symptoms of a respiratory infection. At the polyclinic, instead of showing concern and suspecting the virus, as the official propaganda would suggest, the doctor prescribed rest and the antibiotic that we had at home (at pharmacies there has been nothing for a long time), which was ciprofloxacin.

My grandmother did not improve. A few days later she suffered an episode marked by shortness of breath and high fever. She fell out of bed and suffered a small wound on her forehead. At the Calixto García Hospital ER they focused on the small wound on her forehead instead of on her respiratory infection. A young neurologist stitched it badly and told us that she could not have pneumonia because "she hasn’t been lying down" (from which I deduced that she had spent the entire class on pneumonia in that position, but I bit my tongue). Following this, she sent her home again, and prescribed ciprofloxacin, in the wrong dose. My grandmother was getting worse. A week later she suffered another crisis indicating a probable pulmonary edema - which a veteran doctor at the polyclinic relieved, fortunately. At the Calixto García Hospital they sent us to the area that treats respiratory problems for an evaluation.

The unit, known as "Respiratorios" at the Calixto García consists of a small waiting room measuring approximately six square meters for patients with respiratory symptoms to be evaluated and divided into "Covid suspected" or "Not suspected." The former are sent to isolation centers. The latter, if they are ill, are diverted to three or four hospitals designated for them.

My grandmother fell into the second category. A sullen male nurse gave me some green cloth boots as protection, and we were taken to a small room to process her transfer. There we learned that hospitals designated for "non-Covid" patients were overwhelmed. Patients not affected by the epidemic, I thought at the time, must be suffering in silence, because all the resources are being dedicated to the crisis. Thus, the wait lasted all night. On a stretcher that I placed right up against the wall, I tried to make my grandmother comfortable and prepared to protect us from anyone who might enter, considering them all potential Covid carriers.

The first to arrive was a young man with asthma, in need of an inhaler. Then they brought in a woman in a sorry state who was coughing incessantly, with a dry hacking (like that characterizing the new coronavirus) and taking her symptoms and mask carelessly. They took her to an isolation center. I did not have time to warn the next patient's companion not to sit in the same dirty chair where the previous woman had been, as I was concentrated on fixing my grandmother's mask and wondering whether the new arrival would also have the lethal virus. I hope they cleaned the chair when I told them. Her mother apparently had cancer.

We were at a huge school/hospital opened in 1896, but the doctors had no medicine. They could not prescribe medicines, they told us, because "the section wasn't for that." My grandmother spent the night without any food, or antibiotics, and hardly a diagnosis. She is a strong woman, as we will see. Her Galician blood drives her to walk a lot, still, and to oblige us to do her will, despite her dementia. This determination is the only explanation I can find for her survival.

The next day was a nightmare for my parents. At 10 in the morning (with a little milk that we brought and without any medication) an ambulance finally appeared and took them to La Dependiente, with a promise that she would be admitted. They waited in the sun for an hour at the entrance to the clinic, only to learn that there was no bed available. Then began the negotiations between the ambulance staff, their bosses and the head of the ER at Calixto García. The latter did not want to re-admit my grandmother. The ER was full, he said, and at Calixto it was against the rules to admit cases with respiratory problems. He wanted them to take her to the Clínica de 26 (our corresponding death trap, unfortunately, assigned based on one’s municipality), he said, because my grandmother was from Playa, not from Central Habana.

My parents protested, shouting that they did not admit patients with respiratory problems there either, and that they had killed my sister there five years before. The head of the ambulance staff decided to take her back to where they had picked her up, as it was not their problem. Back in Calixto "Respiratorios" did not want to admit her, and the head of the ER continued to refuse. The ambulance personnel forced her into the first opening they saw, where, luckily, they found a Colombian doctor who realized that my grandmother was dying, presenting low blood pressure and very low oxygen saturation level too.

They had no choice but to accept her in the ER admissions room, making a space between beds for her wheelchair. Right there in the hallway, they gave her non-invasive oxygen, an IV, and an antibiotic. As at the entire Calixto García teaching hospital, expanded in 1920, there was neither penicillin, or any strong antibiotics, it was necessary to resort to cirprofloxacin again, this time intravenously. Several hours passed, of sun, urine and languishing, until finally they got La Dependiente to admit my grandmother. So, off we went again.

The sanatorium that we still call La Dependiente, despite its current decline, is one of the most pleasant such sites in the city. Created in 1884 by the Asociación de Dependientes del Comercio de la Habana, it still preserves the atmosphere of the country estate from which it evolved. Far from the madding crowd, fresh air wafts through the trees, and one could feel at peace there, and write The Magic Mountain... if it were not for everything else.

The hospital folklore with which we are all familiar - which includes fans because there are mosquitoes, buckets but no water, bathrooms but no soap, etc. - is now aggravated at many of them because the patients are isolated. No one is allowed in, except for one companion per patient. In normal situations, as family members we make up for these deficiencies with what we bring from home. Not now. The first few days my grandmother got by on an IV and some food that we were able to smuggle in. But, the last two days, when their vigilance increased and the IV was removed, my grandmother was subjected to a concoction that hospitals call "basal formula", which is like a kind of gray water one would feel guilty to give his dog. Thus, my grandmother was fading. Her voice, usually deep and commanding, was reduced to a pleading murmur. Fortunately, we took her away as soon as possible, and she survived.

What spurred me to write this chronicle was not, however, my grandmother's harrowing episode. I was going to let the whole thing go, because sometimes one is weary of sharing so much misfortune. What convinced me to speak out was one with a sadder ending, but features similar to what we suffered very recently as a family, and one that heralds worse misfortunes to come.

On September 3, a cousin of my mother, in Ciego de Ávila, went to the doctor because he was short of breath, had a fever and felt weak. As with my grandmother, they diagnosed a common respiratory infection and sent him home. This was the week during which Ciego de Ávila returned to Phase 1 because the virus had spread and two hospitals, the provincial Antonio Luaces and Roberto Rodríguez, in Morón, were reserved for infected workers.

Between September 3 and 5 my mother's cousin returned to the doctor again, and was sent home again. Finally, on Saturday the 5th his wife realized that his condition was too serious for him to stay there, and managed to get him admitted at Luaces. This facility, however, was not equipped to treat him. Upon checking the patient's condition, the doctors decided to send him to Morón, to see if they could connect him to a ventilator there (it should be noted that patients in serious condition like him should not be moved, as their conditions deteriorate). At Morón they found out that they could not admit him there, as there was no space. Thus, they considered taking him to Camagüey. At some point during this hesitation the ambulance staff decided to return to Ciego de Ávila, reasoning that the patient might not endure such a long journey. No family member was traveling in the ambulance because they were warned that they would have to undergo a strict quarantine if they did.

The relatives who remained in Ciego looked on as the father, the husband, and the brother disembarked at the Luaces hospital again, "white as a ghost," they say, due to lack of air. They didn't let anyone in behind him, disappearing with the stretcher down a corridor to return shortly thereafter with the news that my mother's cousin had passed away. That was September 7, 2020. They still did not know if he had had coronavirus, or whether the rest of the family had it either.

When the results of the PCR were available, three days later, Dr. Durán reported the death in his televised press conference: "We must mourn the death of (...) a 58-year-old patient, also from the province of Ciego from Ávila, with little comorbidity, high blood pressure. He was admitted on September 3 ... that is, the symptoms began on September 3. He was admitted. The disease was confirmed. Initially... Since admission he presented signs of shortness of breath, and fever. His evolution was poor, and this patient died yesterday, despite all the efforts and the use of all the treatments established to save his life. I reiterate our condolences to his family ... and, as I always say to the entire Cuban population, and to all of us working directly against this disease, it is difficult for us to announce these unfortunate deaths."

The deceased had to be him, my mother's cousin. He was the only 58-year-old patient who died of coronavirus in Ciego de Ávila that week. He had only suffered from high blood pressure, and on September 3 he officially reported symptoms for the first time.
While Dr. Durán lied so glibly, our cousin's wife was also showing symptoms, and had not been tested yet or anything. Not her, or her close relatives, or co-worker, or anyone ...

It was not until four days after his death that they came to interview them properly, to administer the tests and to isolate them. They have not been this careful, however, with all suspected cases. There were relatives who were close to the patient the whole time, and who have been ignored until today.

This is the kind of neglect and negligence that we have always exhibited and suffered the consequences of. And years of malpractice and medical negligence, with impunity, have exacerbated it. The reward and punishment mechanisms that those in use in situations like these, it seems, no longer work. Perhaps because too much time has passed since the beginning of the crisis, and the necessary tension has been lost. Thus, their remaining solution is the usual one: repression, dictating exaggerated restriction measures (with less than 40 daily cases on average in Havana, we are under a curfew and very isolated) and hoping for the best. Now I’m sure of one thing: they’re lying.

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