The best health care is free: Susana’s story
Susana lives with her family in the remote community of El Porvenir in northern Nicaragua. An initial test in a private clinic showed that she apparently had a large ovarian tumour, potentially cancerous. *Becca Renk tells the story of what happened next.
I met Susana when the JDC- CDCA (Jubilee House Community and its project, the Center for Development in Central America) took a visiting medical delegation to her village, the El Porvenir coffee co-op, a two hour walk from the nearest health post making access to health care difficult.
At 8:30pm Susana, who had been waiting since early afternoon, was the last of 89 patients to be seen by the doctors. Crying with fear, Susana showed the doctors the ultrasound she had had at a private clinic four months earlier: the results showed a large ovarian tumour. The doctors explained to her that she needed to seek specialised care immediately.
“I can’t,” she told me. “We don’t have the money. At the private clinic they said the tests I needed would cost C$2,000 córdobas [$55 US]. I haven’t gone back because we can’t raise that much money.”
“Doña Susana,” I explained, “You won’t pay anything. You just need to get to the public hospital.” Remembering where I was, I took a deep breath, the day long journey to Managua including walking the first 5km, the complexities of navigating even the best health care, and how important it is for people facing serious health issues to have someone to advocate for them.
“Susana, come to Managua,” I told her, “and let’s go to the hospital together.”
In the crowded waiting room, my eyes focus on the feet walking past: unpainted toes in sandals, work boots, pedicures and high heels. I am in the melting pot that is Managua’s Fernando Vélez Paiz Hospital with Susana. Although it is a free public hospital, it is not just the poor who come here; it’s one of the largest and best-equipped hospitals in Nicaragua with a reputation for excellent service – even the wealthy seek care here.
Taking into consideration the distance she has travelled, Susana has been given a same day appointment with the gynecologist, who orders an ultrasound and a mammogram. There are 40 women ahead of us in queue, mostly pregnant women, others being seen for treatment for precancerous lesions. While she is in the examination room with the gynecological oncologist, her husband Hilario tells me how worried he’s been about Susana.
“I told her, let’s sell the pig, let’s sell the horse to pay for those tests. We can replace the animals, but we can’t replace you.” Hilario shakes his head, “She wouldn’t let me sell them.”
I know why Susana refused: the pig is being fattened for Christmas, but not for their family. That pig represents a large portion of their cash income and will buy food and school supplies. The horse is invaluable as their transport and is used to haul water and provisions; their lives would be so much harder without their animals.
We’re surprised when Susana emerges smiling!
“I don’t have a tumour at all!” She exclaims. “They did an ultrasound and an examination and I don’t have any tumour. They told me to come back next year for my checkup.”
Later, I ask a doctor why the first results showed a tumour – was the private clinic simply incompetent or trying to squeeze money out of a poor family desperate to save a loved one? She tells me that while fraud is not uncommon, in Susana’s case, no one can say for sure if the erroneous results were due to negligence or maliciousness. Regardless, she and her family have spent four months worrying themselves sick for nothing.
On the way to the bus station Susana and Hilario are buzzing, effusive with their thanks and joking about the long trip back home; their relief is palpable.
In Nicaragua so many people suffered during the neoliberal years that society became scarred. Sometimes it still seems too good to be true – clean, modern hospitals with trained medical professionals for free? Thanks to the Sandinista government’s political will to prioritise the poor and its Herculean efforts to modernise and expand its system, the best health care in the country is free. Now families like Susana’s are beginning to believe it.
*Becca Renk has lived in Nicaragua, for 22 years, working with the Jubilee House Community and its project, the Center for Development in Central America that works on sustainable community development and runs a full time health clinic. The JHC-CDCA educates visitors to Nicaragua, including through their hospitality and solidarity cultural centre Casa Benjamin Linder.