Drama at the IHSS of San Pedro Sula.
What I saw and heard.
written by Fr. Ismael (Melo) Moreno, sj – Director of Radio Progreso and E.R.I.C. in El Progreso, Honduras
October 17, 2018
From pain and helplessness
It has been my preference to never publish or divulge personal or family matters, and even less to make use of the institutional means where I work to address personal issues. This time I do it not only because of the deep and heartbreaking pain and helplessness that I live in the face of the deplorable state of health of my younger sister – primarily caused by the inhuman attention in the health system that operates in the San Pedro Sula Social Security hospital, but because I also feel the ethical obligation to denounce the outrage and mistreatment, the notable lack of medical equipment, the absence of medications and in general the deplorable hospital conditions that together make the lives of patients and their families an authentic torment. And I do it from what I saw and heard in the weeks when I visited my younger sister as she suffered debilitating conditions when she was in this hospital center of the Social Security (IHSS) in San Pedro Sula[i].
Rarely in my life have I experienced the most absolute helplessness I have felt in the environments and corridors, in the halls and on the benches of the facilities of this hospital center, compared only to those moments of the threats that I lived in the ill-fated times of the 2009 coup d’état when I did not know who, where and at what moment the actions against me or against any of the members of my Radio Progreso team could come true. The two experiences have to do with that helplessness that puts one face to face before the limits between life and death. This is the experience that I lived in the weeks that I was visiting my sick sister between the end of May and June of this year 2018.
One can be sure that when Social Security admits a sick family member, nothing and nobody can be assured if that relative will come back alive. But what I am sure of without a doubt is that my sister walked in to the hospital and when she left we had to carry her prostrate on a stretcher to take her to a private clinic to rescue her from an imminent ungrateful death. And we took her out because the Social Security (IHSS) authorities did not want to continue any treatment. They expelled her like a cockroach.
One situation among tens of thousands This short narrative is a testimony of what I have seen and what I have been told about the lives and treatment of patients in the Social Security hospital of San Pedro Sula as witnessed with the illness of my younger sister. At the same time this is a desperate denunciation about this health system, the defenselessness in which Honduran society finds itself before it, and the need to demand profound changes in public policies in order to achieve a health system that responds not to the interests of small political and business groups but to the health needs of a people who because they are Honduran are condemned to live mistreated and ill. What happens to the sick Honduran population is not by divine will, but by the corrupt and greedy will of those of the Honduran state who make the decisions.
“A better life”? The health situation of my younger sister is a case among tens of thousands. She is in a state of total physical collapse, and although one can notice by what she sees, what she learns and what others tell her, that theoretically she could continue towards a condition of stability and still progress to a 48-year-old life with a basic level of dignity, there remains the same impotence and frustration when we come face to face with the health system in our Honduras. I can not forget that as my helplessness grew in the face of the growing deterioration of my sister’s health, and while we unsuccessfully begged the medical staff for a treatment that could calm her cries of pain, often we would hear the voice of Juan Orlando Hernández saying that the the country was moving to higher levels of dignity and its inhabitants were beginning to receive the benefits of a “Better Life”. His words in the situation that I lived and experienced in the Social Security hospital struck me as an insult and as a blow to the liver.
Let them die outside so as not to stain the medical records After several weeks of receiving care at the Social Security Hospital in San Pedro Sula, my younger sister, Inés Moreno Coto, was diagnosed with Lupus. But important to clarify, this diagnosis was not given in the Social Security hospital nor was she attended to when she received the results of the tests. The diagnosis was revealed by an analysis ordered for her by a private doctor. When she was diagnosed with this disease, my sister had been out of Social Security system for several weeks even though the doctors had discharged her just when she had warning signs that if she did not receive emergency treatment, she could die. This treatment came in the private clinic, where she had to be admitted due to the signs of extreme emergency that she displayed. When my sister entered the Social Security system in San Pedro Sula, her condition was so delicate that in the emergency department they decided that she should be admitted. The days passed and my younger sister’s state of health continued to worsen, and, curiously, as her health condition became more delicate, the professional attention decreased ostensibly. The specialist doctor would pass by for a couple of minutes every 24 hours, he would look at her as if seeing someone else, and he would say she was better. Then at the beginning of July of this year she was discharged from the Social Security hospital in San Pedro Sula. The doctors and nurses knew that my sister was in much worse condition than when she entered. Nobody at Social Security said anything when the doctor who attended her said with indifference and without even looking at her face, that she should leave the hospital. “She is not doing anything here,” were his final and dismissing words. Several people have told me that the decision to discharge my sister in the condition in which she was at that time was to ensure that she would die outside the hospital. This would avoid the required registration of death statistics because higher death rates results in a reduced scale provided to the medical staff. As such, it is a factory to produce deaths, but the medical staff must assure that these deaths do not occur inside the hospital premises so that there is no stain on their files. Doctors in a sick and failed society The title of doctor in an overwhelmingly failed society places the professional at a level of superiority that he displays even with his gaze, which is never direct, but out of the corner of his eye or looking the other way. It is the arrogance of the professional in a failed society like the Honduran one, so much so that the generalized use of the doctors’ diminishing language towards patients becomes a nomenclature of power and contempt, which establishes the difference and distance between those who have knowledge and control of the situation about the sick person, who will always be the despised one, the one who is placed below, for the mere fact of not being a professional, and for being sick in a country where the illness of others gives doctors an overwhelming position of power. My family had to seek the help other people to carry the stretcher and hired an ambulance to bring her home. The medical authorities released my sister to die. For about two months they were killing her bit by bit inside the hospital, many times they did not give her water, and all the tests had to be done outside the system, in private laboratories, with payment extracted from the family. I witnessed the useless visits of medical specialists. Two minutes at most every 24 hours was given for these visits. They did not look at her, they did not touch her, they asked cold, sharp and sometimes cruel questions, and left without leaving with the family a diagnosis and at most a prescription for medicines that, of course, had to be bought in the private pharmacy system. “You need another brain and I cannot give it to you” My sister came out dying, unable to stand on her own. These same doctors said that my sister did not have a fatal illness, and that the infection they detected in her brain was reversible. But the hospital system in our country is able to convert all diseases into mortal threats. And from this I give testimony based on the attention that my sister received in the Social Security hospital. With support from friends, the family had to put her in a private clinic, where after six days they had to pay about two hundred thousand lempiras (US$9,000)[ii], an amount that for a family of such low income was almost unattainable. But the life of a person has no price, and not only in those six days, but in the following occasions, my sister had to be admitted to receive some attention with dignity. Today, the health of my sister depends on the amount of money that the family manages to get to continue receiving private medical care and buying medicines that represent an average of four thousand lempiras (US$200) per week, an amount that makes disease in our country either a luxury or a curse. If it depended on the service of the Social Security system (IHSS), my sister would be waiting to die. My own sister says that one day in the hospital she was suffering from a severe headache and as the doctor passed very close to her stretcher, she asked him to give her something to calm her pain. The doctor, without looking at her, and as if addressing some inanimate object, said: “What you need is another brain, and I cannot give it to you.” On another occasion, a nurse arrived with some pills that my sister was supposed to take. My sister asked her to please give her the pills because she could not move her arms. The nurse said, “I’m not your nanny to put things in your mouth.” My sister, desperate, asked her to at least bring some water. The nurse threw a bottle of water at her, but my sister could not take her pills because the nurse refused to help, nor could she drink the water because she did not have the strength to open the bottle. She had to wait until the family visiting hours so they could help her. The people do not deserve information! On several occasions when I visited my sister at the Social Security hospital, I tried to inquire with doctors about the process of her illness, and about the medications she was prescribed. No one gave me information that would allow me to be aware of what was happening with my sister. One of them just told me to have some tests done to determine if the source of the infection was viral or bacterial. But the exams, of course, had to be done and paid for at a private clinic. At some point they gave me to understand between the lines that the information about the disease and the medications was privileged information only for the doctors and that this was not shared with just anyone. That is to say, that we, the relatives, do not deserve to have information about the state of health and the medicines that they administer to our relatives. If that is the attitude that is demonstrated towards me, with my ability to understand and assimilate more of what is happening, then what they do not do and what they do not say to the vast majority of our people, whom they really treat as if they were nothing more than a hindrance is abusive. The parallel system of levers People who know the intricacies of the hospital system have managed to create a parallel and informal system of patient care. Someone who knows you gives you the recommendation of a nurse or a doctor or a friend of a member of the medical staff to get some special attention for a patient: even in small things, such as a family member staying longer, to allow the patient to receive visits outside the established schedule, to speed up the date for a surgical intervention or to access medications that are not offered to everyone but only to those in the parallel system. Sometimes it happens that before interning a patient, someone will talk to someone who works in the system to recommend the patient to someone from the medical staff. If there are connections the patient can have some advantages. Those who does not have any such contact or recommendation can expect to find a health system that crushes and discriminates. This is exactly what happened with my younger sister. This informal parallel system is what works well for some and reveals the irrationality and ineffectiveness of the official health system.
I received the testimony of a person who told me that on the same days my sister was suffering from her illness, her mother had been killed in Social Security. At 83, her mother complained with screams of pain as nurses and doctors passed by avoiding contact. At one point, when the daughter cried out because the nurse who ought to have provided care to the mother, passed by without stopping and said, as if she was not saying anything important: “Madam, I do not know why you are so upset, as your mother has already lived too long.”
Social Security: machinery to kill people. I accuse.
The Social Security hospital in San Pedro Sula is a death producing machine. I, Ismael Moreno Coto, give testimony and I stand by this affirmation. And I blame first the authorities directly responsible for this hospital system in San Pedro Sula, and secondly, the government presided by Juan Orlando Hernández and those who lead the National Party for having a direct relationship in the looting of this institution and to protect people and groups involved in this crime. I hold them responsible for the physical damage and the irreversible emotional damage caused to my sister Inés Moreno Coto. If I had the possibility of making a legal claim against these authorities, I would certainly be giving a service to the whole society, but in our country the lawyers are experts in putting the law at the service of the strong to protect them, and to manipulate the same law to jail those who cannot defend themselves.
Medical helplessness, legal defenselessness
We live in a country with so much helplessness that it would not be unreasonable for me to file a lawsuit against those responsible in the Social Security system for violating the life of my sister, and that at the end of the process I would be the one sentenced to go to jail instead of the guilty, because here our experience tells us that those who have power have the ability to twist the laws to favor themselves. If there were lawyers who are supportive and professionally competent, here they would have a case, but I clarify that my family would never be able to pay for such professional services for they lack sufficient resources other than to cover basic needs. Nevertheless, this would be an opportunity to challenge the bases of impunity and corruption in this hospital system of Social Security (IHSS based on a verifiable case.
However, my experience is that lawyers who are close have neither an ethical commitment nor the time to take on cases like these, since these offer neither the publicity that offers them notoriety nor sufficient compensation as they risk their very professions. And I say this, having an understanding of this situation perhaps better than the common Honduran citizen and with links to legal professionals, and still I feel helpless, let alone what the vast majority of Hondurans must feel and live, for whom any medical attention is an extraordinary luxury, and legal protection remains an impossible luxury to enjoy.
With prostrate hopes
My sister is bedridden, with her prostrated hopes and in a family atmosphere very close also to the same abject condition suffering this atmosphere of discouragement and depression, as do the immense majority of Honduran families who struggle to breathe and survive in the same environment. She came into the hospital system of Social Security walking, and she left carried on the arms and shoulders of my relatives, and immediately had to be admitted, as I said, in a private clinic, which was possible thanks to family contributions and the solidarity of members of my Radio and ERIC team and other friends. In situations like these you are especially grateful for this presence, closeness and solidarity.
I reiterate that the diagnosis of her illness was not given during the weeks that she was in the hospital. In the Social Security hospital she received only contempt and mistreatment. I myself witnessed several times not only the indifference, but the discriminatory treatment my sister received from nurses and doctors. When she left dying, the medical authorities did not reveal what illness she suffered as she left; they only discharged her without giving a single explanation. Discharging my sister was a synonym for a death sentence decreed by the Social Security authorities. She was discharged at the beginning of the month of July of the current year, and since then she has been totally excluded from this medical service, having to be attended by private doctors and with the purchase of medicines under the sole responsibility of the family.
Case closed, impunity sealed.
For the Social Security authorities, the case of my sister, Inés Moreno Coto, is closed. For them, my sister ought to be dead, or in any case, it does not matter, because she does not exist, whether she is alive or dead. She was just a number that went through those gloomy patient rooms. The medical staff is still in their posts exactly as if nothing has happened. And so it is, if this testimony were to come to any of them, it is that they would not even know about whom this speaks, because without a doubt, thousands of cases such as that of my sister are hapening, and in the end they will receive the same treatment while the details are buried in the mantle of impunity. Nobody knows anything, nobody gives an account of anything. Everyone carries out their own sick, all go on to bury their dead. For my part in addition to bearing the pain and helplessness of seeing my sister suffering, I leave this written account of what I have lived and felt about the health system of the Social Security[iii] of San Pedro Sula where sick people do not count, are just a number, which only count to add or erase in their statistics.
[i] To be able to access a Social Security hospital or clinic one must be employed and thus paying into this service through wage deductions. Only a small portion of the Honduran population has this health protection.
[ii] The Honduran currency is the Lempira, valued US$1 = L.22. Minimal wage earners receive L.6000 to 8000 / month ($260-370/month) , teachers earn $250-500/month, a graduate engineer may earn $600/month, for the poor self employed ; the “Living family wage” is L.9300/month ($420/month), so the cost of L.200,000 represents for someone at the lower wage level the equivalent of 4 years salary
[iii] During the 2013 electoral process the political party of the dictatorship (the National Party) stripped the Social Security Institute (IHSS) of most assets. This fraud has been directly linked to the President but only a few lower operatives have been jailed. Medicines have been replaced with cheap placebos and ordinary equipment found in hospitals and clinics have either disappeared or fallen into disrepair.
(translation and comments by Phil Little in Saltair, BC)
Honduras - Country in Pain 