Strengthening our “defenses” with “my Mom´s Green thumb”
René Mendoza Vidaurre, Fabiola Zeledón and Esmelda Suazo with Anabel Cardoza, Glensis Carrasco, Selenia Cornejo, Adalis Orozco, Milson Cantarero and Jarithmar Gonzalez
COVID-19 is a cowardly virus that attacks the most vulnerable people whose immunological system is weak. Strengthening those “defenses” of people is imperative. This would be possible if each family had their own garden.
It seems simple. But it is not. Many times, aid organizations and governments have promoted gardens and farm diversification wanting families to “nourish themselves.” These projects last as long as the donation does. Why? How can families take up gardening? We write this article from our experience of wrestling with these questions in the communities.
Why have rural families quit planting gardens?
As the colonial and patriarchal capitalist institution of mono-cropping was imposed, backed by universities, credit, technical assistance and organizations established by external initiatives, crop diversity and biodiversity ended up cornered, and on the road to disappearing. The garden was swept up in that dynamic as well.
What is important with mono-cropping is money, that comes once a year with the harvest of that crop, and it is the man (husband or father) who is responsible for that monocrop in terms of markets for capital, the product itself, its agrochemicals and knowledge. Nothing is comparable to the monocrop: “I am not going to neglect my coffee by monitoring a squash plant”. Their rule is: “everything is bought with the coffee”, “our food is bought with the sugar cane money”. The women who used to work on diversified farms and were responsible for gardens, lost that space and were confined to the kitchen, while their menu of food said goodbye to soups and stews. At the same time, people ended up reproducing the idea of the elites: “There is no room for a garden”.
Seen in this way, it is funny to see governments and aid agencies promoting gardens, when they have backed mono-cropping over the last 200 years, as if peasant families did not have a memory. More than funny, we recognize their anti-peasant intentionality in their formula: they give away seeds of crops demanded by the market (carrots, lettuce, cabbage or tomatoes, mini-vegetables) as opposed to “weeds” (mint, oregano, rue, native garlic, medicinal plants) that are more for family and community consumption; they promote gardens in spaces separated from the home; done collectively, connected to a leader. All these elements are contrary to the peasant practice of gardens, which is why they are silently resisted by the peasantry.
In addition to deconstructing mono-cropping which undermines gardens, and the fact that its modern promoters follow ahistorical rules, we also identify beliefs and rules that are counter to peasant viability, but are reproduced by peasant people themselves. “I do not have room”, as if the garden required “additional space” to what is available. “With coffee I buy everything else”, when people live in debt for depending on one crop, and time and time again end up dividing up their land. “I am not a cow to be eating grasses”, rejecting vegetable foods that could strengthen their “defenses.”
How can women and their families recover their gardens?
Parallel to deconstructing, we dig into peasant memory. Our grandmothers and grandfathers still remember the gardens of their Mothers. What do they remember? They talk about “My Mom´s green thumb”. That is the garden, indigenous “chacra” in the Andean countries. This small area that exists along with the chickens, turkeys and pigs. What is this garden for? “To give flavor to food, aroma to drink, and medicine to the sick.” They were products that today, coming from the cities, are called “wild”: mint, rue, oregano, native garlic, chayote, squash, passion fruit, lemongrass, smilax, onions, peppers, chicory, wormseed, camphorweed, guava; many of them are used as medicine for parasites, treating fevers and anemia and hemorrhaging.
The more we dig into the memories of our grandmothers and grandfathers, the more practices emerge full of life. It was the women who mobilized the family labor force to take care of the garden. Plants like mint were on any tree trunk. Gardens were close to the house to grow under the eye of the women who cared for them from the kitchen. They were the product of family effort and neighborly exchanges; it was farming that was done by hand and using a mini-hoe. Its production, consumption and social relations were linked; the more diverse the garden a family had, the less debts they had, and less domestic violence was suffered in the home. Decisions were decentralized, women led the garden in a family where seed and fertilizer was obtained in the house itself and the community.
When we establish gardens, women leave their homes, walk around the yard, touch the plants, daughters and sons join in …and the husband. This practice clashes with that rule of “man as provider”, reduces pressure on men, helps the family increase their income, and return soups and stews to the menu, adds tea to the table and medicine to communities. Neighbors visit one another more, the exchange of products increases, their “defenses” are strengthened…
If the advantages are obvious, how can we recover and expand them?
If we recover our memory of “my Mom´s green thumb” and we light our interior fire to do gardens, the steps to follow are: obtain seed and plants, which in part are found dispersed in the community itself; the plants can include ginger, garlic, onions, cilantro, chicory, oregano, lemongrass, mint, peppers, tomatoes, celery, beets, cabbage, squash, cucumbers, rue, basil, wormseed, camphorweed, guava, smilax…
On establishing the gardens, people see different uses for it: “Before we were disorderly, chicory growing in the pastures, now with the garden it is more orderly, they are all in one place; previously we cleaned mangos on our pants, now we wash them with water.” Hygiene and the garden go hand in hand.
As we harvest, we can enjoy teas, soups, stews and salads, use them as medicine. This strengthens health, helps to appreciate what we have, and we are making ideas enter through the tongue. We recommend the book of Jaime Wheelock (1998, La comida Nicaraguense), it is a book that summarizes indigenous food, Spanish food, and the confluence of both.
Few rules are needed. Which ones? That women take on the leadership of the garden and that the entire family collaborate with the garden. That the cooperative, the community store, the school or the church offer seed or plants to be paid for by the harvest, following the principle of “help those who help themselves” (Law of talents, Matt 25). If a family prepares the soil, they are provided seed for 5 crops; if they plant those 5 crops, they are provided another 5. The evolution of each garden is observed by the family, and it is the leader, her daughter or son, who records the data on that evolution – by crop, behavior, health of the plant… The organization or institution that accompanies them, helps them to analyze that data and consequently to innovate in their gardens, diet and health.
To multiply gardens, organizations or institutions can create a prize for the best garden every 3 months. As the gardens become realities, they will catalyze new initiatives: people who want to set up nurseries, dry fruit and bananas, people who buy products to sell them in the neighboring communities, community stores that sell small amounts of seed (retail), community technical advisers; healers; community celebrations; product exchanges….
Are there risks that the gardens will not work?
Assuming that we overcome the anti-peasant practices that we identified in the projects, there are also risks in gardens worked by families. Chickens can dig up and eat the plants, pigs can have a party in the garden, some birds tend to call in their communities to wipe out gardens…In the face of this risk, each family takes measures: protecting the garden with barbed wire, using banana leaves to form a fence, placing a doll with a red rag to frighten off the birds, putting wire and cone on the pigs…The entire family observes each difficulty and achievement, innovates in intense discussions to overcome these difficulties, studying more and more their own data…
A second risk is that the men take control over the garden, the risk here is like with the projects that look for “the head of the family”, and where he is guided by custom that has become law: work with machete, some days of the month, imposition of “women in the kitchen and taking care of the children” and only work on crops to be sold. One measure that can be taken is to work every day in the garden, and over time attract the other members of the family, in this way the person who is in the house every day ends up assuming shared leadership. A second measure is that the youth discover how boring the mono-cropping system is, where you only have to weed, fertilize and harvest, while the garden is a space for intensive, fun group therapy, open to innovation based on recording and analyzing information, and it is very participatory. A third measure is being open to men also trying their hand at cooking; it is not just the fact that men want to experiment, women also have to encourage them to do so; on this topic the article of Sergio Ramírez is enlightening (“El diablo en la cocina”, in El Faro, https://elfaro.net/es/202002/columnas/24037/El-diablo-en-la-cocina.htm‘P) it captures the assumptions/beliefs that keep men from going into the kitchen.
Do the gardens have an impact on changes in rural organizations?
Organizations tend to dance to the music of mono-cropping. Their membership tends to be mostly male, their structure more hierarchical, dependent on the market as its patron. The peasant garden, not promoted by market forces, can help them to change, because of the diversity of the crops, the demand to innovate in small areas, and the fact that families do not go into debt. Organizations can reorganize themselves to process and sell surplus products from the garden, they can provide technical accompaniment services, they can decentralize their decisions, they can get closer to working by hand, hoe farming or garden farming.
Organizations, hand in hand with women, can change for the good of humanity. For example, a peasant community store should have “a peasant face”: selling products from outside and also peasant products, hanging a bunch of plantains and bananas in the window, selling cooked palm fruit, potted plants, cassava, bunches of peppermint, eggs, baked goods. More than just a business, vegetables, and a garden, behind those products is the recreation of indigenous and peasant culture.
Here is the beginning of one of the alternative paths to colonial and patriarchal capitalism. A peasant path, organized, de-centralized, and with organizations that respond to these realities, more democratic and closer to the people. “My Mom´s green thumb” is capable of mobilizing vivid determination.
The best ideas are not implemented due to the mental frameworks that we carry with us. Peter Senge (1990) in his book “The Fifth Discipline” points out: “we carry in our minds images, assumptions and stories” that block the application of proven experiments, big ideas and refined proposals.
Beliefs allied with the virus
In the face of COVID-19 there is scientific information disseminated by the World Health Organization (WHO), governments and social networks. But most people ignore it. Why? Our minds are full of beliefs that do not cede space to new information, like a bucket full of water, when we put more water in it, none of it goes in, it overflows. In the same way scientific recommendations do not get into our minds, they spill out.
What beliefs? A belief related to the destiny of individuals is probably the most damaging, which goes like this: “when it is your time, it is your time”, “everything has been written”. A drunk who drives a car, crashes and dies, then you hear people say, “it was his time”, and “God took him”; with this they justify his irresponsibility, along with his social background of getting drunk and having caused the accident. A second belief says ”there is no better doctor than God”, “chlorine bleach does not save, God does”. A third belief is “you go to the hospital to die”. These three beliefs fill human minds and control people; it is not God who controls them, and they are not the ones who are “sent.”
Consequently, people heard that one can be infected in crowds (meetings, demonstrations, religious celebrations, parties), but that information slips out of their minds. People get into crowds without protection, because their mind tells them, “when it is your time, it is your time”, “God protects me”. If someone tells them, “God protects you if you take care of yourself”, that person will say, “the devil is putting me to the test, for God nothing is impossible.” And if the person gets infected with COVID-19, they resist going to the health center because “you only leave there in a box”, the historic distrust in the State that has dispossessed them of their resources ends up condemning them.
The worst that these beliefs can do is that people get resigned and only watch the days and nights go by. If everything is already written, people are the puppets of some supernatural being, which is why there is no reason to improve or change, unless that change “is written from above.”
The first step to avoid the virus: free the mind from beliefs
We do not resign ourselves to the fact that these beliefs control us. How can we free ourselves from them? A first step is talking about them to understand them, and asking questions that allow us to reflect. The very act of reflecting is already a big contribution, because the biggest power of beliefs is preventing people from reflecting. “Believing is enough, thinking makes one sick”- beliefs whisper into the ears of people. How to reflect? Let us read this conversation:
-The best doctor is God – Juan tells us, while he cleans beans.
-If God protects those who believe in God, why are so many pastors, religious, and pious people dying of COVID-19? –we ask him
-Ahh, I am sure that they did not have faith in God, I do have faith–he responds, very sure of himself.
-I wonder. Is it not that God expects people to do their part, take care of themselves and save their loved one, improving their diet? –we insisted.
-Who knows… –he no longer seems so sure. He begins to question, reflect.
This step also requires people who work in the chain of aid organizations, or the chain of State institutions, to do self-study and discover their beliefs. One of their beliefs is “people are saved with donations and training.” Correspondingly, they want the “papers” (receipts, contracts) of those donations to be “supported”, that products like chlorine get to the leaders of an organization, or that there be a health center. It is a technocratic assumption, which assumes that THE leader is going to distribute the products, that families will pay attention to what they are told, and that whoever gets sick will go to the health center. Provoking reflection includes challenging our own beliefs.
The assumption in the first belief is that “The bibles says it.” The Bible does not say that. What it says is that people have “free will” (“everything that you can do, do it with all your strength”, Ecc 9:10) and that “he who sows inequity, will harvest inequity” (Prov 22:8). In other words, each person writes their own story according to the circumstances in which they find themselves, the group in which they move, and their values. The assumption in the beliefs of many organizations and institutions, including intellectuals, is that “they know” the problem and the solutions for people.
When beliefs get examined, they appear as the beliefs that they are, they lose their power and that aura of being “sacred truths”. Then they can be expelled, even though that be painful; that belief has nested itself in the mind of the individual, who on expelling it, will feel “orphaned” and “insecure.” Nevertheless, once we are able to challenge these and other beliefs, the mind will have space to process new information, ideas or proposals.
Second step: testing new ideas in horizontal spaces
Let us look at an example of how people, on freeing themselves from harmful beliefs, can apply new ideas with better results. Up until the end of the 1970s it was believed that “the more brutish the workers are, the better they perform”, so bosses and experts would direct the work from their offices, while a ton of workers implemented the ideas of the experts. This is how the Ford car industry worked in the United States. But the Japanese in the Toyota industry discovered that belief as the cause for making expensive and poor-quality vehicles, they expelled those beliefs and tested new ideas in a gradual way and produced better quality and cheaper vehicles. What ideas did they introduce? That the experts and the workers innovate together, as a team they were all experts; that the workers should propose how to improve each action that they carried out; decentralizing decisions. It was a revolutionary change that later was extended to other industries in the world, which was possible when people realized that they write their own history.
How can communities protect themselves? Reflection, we said, is the first step. Toyota teaches us that the environment (team, understanding that each person is an expert in their area, decentralization of decisions) favors the generation of new ideas, tells us to test and adjust changes gradually. A cooperative, association or a community store should facilitate these reflections and create these favorable conditions for producing ideas and applying them. The president, manager, donor, government or intellectual, should not act as if they were “gods” dominated by the fordist belief, that they already know the problems and the solutions for people, they should go to the homes of people and talk with them. How can we protect ourselves from COVID-19 and other viruses? The lowliest person can have responses, but a favorable environment is needed in their own homes and communities in order to produce and express them.
A number of publications last week referred to information leaked by Anonymous who hacked internal documents of the Ministry of Health, confirming what is widely believed in Nicaragua, i.e. that the Ministry of Health was concealing information about the impact of COVID-19 on Nicaragua. In fact the MINSA data released by Anonymous showed that the much higher numbers published by the Citizen Observatory provide a much more accurate picture of COVID in Nicaragua, even though those figures also underestimate its impact.
Leak of MINSA data reveals that Nicaragua registers more than 9,000 positive cases of COVID-19
This data reflects the concealment of MINSA of the true impact of the pandemic on the country, given that up to August 18 they stated that there were 4,311 cases of infection in Nicaragua.
From February 28 to July 24, 2020 in Nicaragua 17,284 tests had been done to detect COVID-19, of which 9,683 ended up being positive, as revealed by a preliminary analysis presented this Wednesday by the independent physician Álvaro Ramírez, a specialist in Epidemiology, in collaboration with the Blue and White National Unity.
These numbers show the concealment of the Ministry of Health (MINSA) of the true impact of the pandemic in the country. Up until August 18 MINSA stated that the country only had 4,311 people infected and 133 deaths.
This data reflects the fact that Nicaragua is the country in the Central America region that has done the least amount of testing to detect COVID-19 and thereby, the one with less knowledge and control over the reality of the health crisis in the country. Dr. Ramírez highlighted that Nicaragua only compares to Haiti in this regard. For example, Honduras has done more than 123,000 test, Guatemala more than 200,000, Costa Rica more than 123,000 and El Salvador more than 285,000.
“Obviously this (test data) is way under what would be expected that a country should be doing. Nicaragua only compares with Haiti that has done 20,000 tests, and the country has 17,000 by July, so this is way under what a sampling would mean for public health actions in protection of the citizenry,” highlighted the specialist.
The data, as they stated in the presentation, were taken from MINSA reports leaked by Anonymous – organization of cyber-activists who are engaged in hacking data in the virtual sphere to reveal information to the public or feed social causes with which they identify. “Anonymous published this database, we had access to it and we proceeded to work on it and try to identify. There were many typing errors and data missing,” declared Dr. Ramírez, who confessed that along with some colleagues in Ireland they spent more than 150 hours in analyzing and verifying the data.
MINSA has daily reports
The documents leaked by Anonymous also reveal that MINSA reports daily how many COVID 19 tests are done in the country, and this information goes as high as the presidency. Nevertheless, MINSA weekly presents a brief report where it points out new cases and deaths, and the supposed accumulation of the data that the country records.
Last July 21 MINSA publicly reported 3,439 cases in total, and 108 deaths, but the leaked report revealed that by July 24 there were 9,683 positive cases.
Dr. Ramírez said that he has already prepared a report on this data that he will turn over to the Panamerican Health Organization (PAHO) so they can validate the numbers. “We have a record that we are going to turn over to the PAHO, exactly about how we were able to have this refined database…the data from the Ministry of Health were there, the data was daily arriving in the President´s office,” he emphasized.
On several occasions the PAHO has reported that it has requested an official report from the Government of Nicaragua to analyze the situation of the country, and offer recommendations relevant to the health crisis, but up to now the government has not responded to that request.
More data revealed
Other data also revealed are that the people most affected are between the ages of 30-60. Likewise, it shows that in the period from February to July, 23 infants less than a year old tested positive. Among the most common symptoms that the patients presented were: dry cough, fever, sore throat and breathing difficulties.
Managua is the place where the majority of the positive cases are registered (4,238), then Masaya (757), Chinandega (711) and León (509). MINSA also registered cases in the Caribbean Coast, where the indigenous communities have denounced the abandonment on the part of the regional authorities.
The Nicaraguan government has been widely criticized for its lack of transparency concerning the impact of the COVID epidemic in the country. Unlike other countries, it has not revealed the amount of testing it has done, nor made tests widely available, nor given clear figures of test results. Numerous family members of those who have died report that the result of their relatives´ tests were frequently classified as “indeterminate”. The Social Security Administration (INSS) has said they will not state that sick leave is for COVID-19, and medical staff report that they have been indicated to give diagnoses of “atypical pneumonia” instead of COVID-19.
In light of this situation, a Citizen Observatory of COVID-19 was established. It is a “collaborative effort of an interdisciplinary team with information provided by organizations, networks, and the general citizenry who want to contribute to filling the vacuum of information on the COVID-19 situation in Nicaragua…We report on suspected cases of COVID-19 and irregularities that violate human rights, especially the right to health care. The Citizen Observatory receives numerous reports, nevertheless we only publish information that has been verified by our sources. We reflect the perception of the citizenry about the development of the epidemic in their territories, contributing in this way to filling the existing information gap. We only consider information verified if we confirm the authenticity of the report with the same or other sources. The network of informants are recognized community leaders in their territory, which allows them to verify the information.
… A person reported as a suspected COVID-19 case has to fulfill one or more of these requirements:
Presents symptoms associated or presumptive of COVID-19; or
In addition to symptoms, the person has a history of travel; or
In addition to symptoms, the person has been in contact with a case confirmed by MINSA
The Observatory does not do laboratory tests nor clinic diagnoses to determine whether a case is suspect.
The translation of their report for the week of June 18-26, 2020 follows. Note that the report also includes the official government count for the same week.
In this stage where the number of people with the disease continues to rise, it is the moment for increasing individual, family and community protection. We exhort the population to continue taking all the preventive measures like physical distancing, hand washing and the use of masks.
Yes you can, stay at home and let´s save lives!
On June 24th a cumulative total is reported of 6,775 suspicious cases, verified by the Citizen Observatory in all the provinces and autonomous regions, in 134 municipalities (87% of the municipalities of the country). 694 new cases were recorded this week, which represents an 11% increase in the period.
Managua (2,918), Matagalpa (687), Masaya (552), León (399), Estelí (325), Chinandega (272), Jinotega (208), Madriz (184), Granada (180), Carazo (169) and RACCS (153) are the provinces or regions that report the largest number of suspected cases.
Up until June 23 MINSA reported 2,170 confirmed cases, 607 active cases, 1,489 recovered and 74 deaths (death rate of 3.4%). This mortality rate reaffirms the urgent need that the government take measures to prevent infection, and that it have more detailed information that would allow directing decision making to deal with the situation.
Of the 70 irregularities [i.e. violations of human right to health care] reported this week, 22 refer to the exposure of people in activities or crowds, 17 to inadequate responses of MINSA and 10 to threats and reprisals.
Up until June 24th 1,878 deaths have been reported and verified, of which 129 (7%) are categorized as deaths due to pneumonia, and 1,749 (93%) as suspected deaths of COVID-19. These deaths have taken place in all of the 17 provinces and autonomous regions of the country. Managua (772), Masaya (224), León (140), and Matagalpa (118) report the largest number of deaths. In this week we have verified information of 189 new deaths, which represents an 11% increase in the number of deaths from the previous week.
These deaths are reported from 17 provinces and autonomous regions, 110 municipalities (72% of the total number of municipalities in the country). The province of Managua records 39% of all the deaths, Masaya 12%, León 7%, Chinandega and Matagalpa 6% respectively; Granada, Estelí and RACCN 4% respectively.
Of those 1,878 deaths, 212 (11%) took place in their homes and 18 (1%) during their transfer to a health unit.
Up to June 24th the Observatory received reports of 652 health workers with symptoms associated with or presumptive of COVID-19. This week ALL the provinces or autonomous regions reported cases (principally Managua, León and Matagalpa) and 67 municipalities.
On June 24th 78 suspected deaths of COVID were reported of health care personnel. 34 doctors, 21 nurses, 11 administrative staff, 3 medical visitors, 2 laboratory staff, and 7 categorized as “other” (technical or ETV staff, for example).
From 7 provinces or autonomous regions reports were received of inadequate response in different health units, the reports indicate:
Lack of supply of potable water
Scarcity of ventilators
Rejection of donations in health units where a need for these inputs exist
Lack of communication on the health status of the patients with their families
Lack of electric generators needed for the functioning of essential medical apparatus for patients in a critical status during the ongoing cuts of electric energy.
Little or no medical attention to hospitalized patients.
Diagnosis of pneumonia for patients who present symptoms of COVID-19
Use of neonatal ventilators for COVID-19 patients, which puts at risk babies who present respiratory difficulties.
Lack of follow up on the part of MINSA of contacts of people who present COVID-19 symptoms. Nor have the homes of the relatives of these patients been sanitized.
Sending home the majority of suspected patients of COVID-19 with treatment. A report was received of a patient who died hours after having been released from the hospital
Yes, you can, stay at home and let´s save lives!
Attached you can find the report for June 18-24, 2020 generated by the Observatory:
Suspected cases by the Observatory*: 6775
Deaths by pneumonia and suspected COVID-19 deaths reported by Observatory: 1878
Cases confirmed by MINSA: 2170
Deaths reported by MINSA: 74
*People reported as suspected cases by the Observatory, deaths by pneumonia and suspected COVID-19 deaths have been verified by the local source of information.
-Who isn´t afraid? Fear is the biggest enemy of reason. Think, Pipita, your love for others is stronger than anything…Besides, the rain is coming now!
The entire world is experiencing difficult days. People feel fear, impotence, the desire to cry. The only thing certain is uncertainty. Every person would like to support themselves with something, protect themselves under the shade of a tree. But there are almost no natural, supernatural nor social “trees” anymore. It is when that Nicaraguan phrase becomes even truer, “if you have your health, the rest doesn´t matter.” And health is like the rain, it does not fall from the sky with some prayers, it is something that is provided and strengthened with human actions. And who provides it? And how is it provided? Maybe “the love” that one feels for others provides it, maybe the love with which we were made in a passionate morning helps provide it. Maybe it is time to look farther ahead, because “the rain is coming now.”
In this article we reflect on this rural world, that thin strand between hygiene and the economy, between home, church, health center, and between individual and collective actions. To do this we list the facts or risks, we start to explain this “strand”, we look at how scientific recommendations help these different cultures revive – like plants which dry up become green again when the clouds release the first drops of water, and we point out the role of accompanying organizations. The importance of grassroots organizations in protecting their communities runs throughout the article, while the notion of community matures with the turning of each page.
1. Conditions that work for and against COVID-19
The situation with COVID-19 seems to be getting worse. The gap between the official information in any country and what is in the social networks is large, with which anxiety buzzes like a mosquito at night. In rural communities this concern is connected to the continuity of classes in school, religious celebrations in churches, and festive crowds, with or without quarantine. People think that through that “door” of the school, church or public transportation, the virus can get into their homes and pass through the community. What are the rural conditions that work for or against COVID-19?
Rural families have some advantages and some disadvantages in the face of the virus. The advantages are: the physical distance between people to avoid COVID-19 is facilitated by the low population density, and because a good number of families live on their own farms; the average age of the population is relatively young, which limits the effect of COVID-19, even though this advantage is evaporating because of poverty; living in areas with little air pollution; communities that have grassroots organizations with members and offices in the community itself, through which they access some information and some collective actions. The disadvantages are: if people are infected, it will be difficult for them to go to the health centers with the first symptoms and it will be difficult for them to stay at home, or prevent visits when rumors buzz along the footpaths of neighboring houses, all of which have the potential to infect more people; the quality of the health centers, in any country in Latin America, is less in the rural municipal capitals and is inexistent in rural communities.
Gatherings of people in schools and churches is the greatest risk; let us remember that in a church in Washington one member infected from between 52 to 60 members of the choir, 65 were infected in a Zumba class in South Korea, 80 people in a concert. Rural gatherings tend to happen in groups separated by the lack of connection between organizations. Cooperatives, schools, churches and party or governmental organizations (e.g. councils, mayor representatives) move in a “walled off” manner; each person in their own world, and under their own leadership. Churches move in their religious world and with their own leadership structure. Schools with their educational programs and with their own institutional leadership. Cooperatives focus on the economy with their own leadership structure. And so on. This separation means that the gatherings move separately, isolated, which is why people tend to behave in an opportunistic way: “let others spend on hygiene to prevent COVID-19”, “I don´t care, I don´t have children in school”, “I am going to church because God is protecting me, what better doctor than God?”
This separation is worse with external institutions. Markets are reduced to offering hygiene products, raising their prices because of increasing demand, and move by means of intermediation; States limit themselves to making an effort in health centers; aid organizations provide resources within the circles in which they move; and second tier organizations and NGOs expect to mediate resources. None of them tend to cross over “to the other side of the river”, in the sense of understanding how rural societies move, lack experience working at the community level with grassroots organizations. This limits our ability to understand rural population from their own perspectives, and limits the communities from understanding external organizations. We live in a world of one-eyed people that is attractive for any virus.
This separation or “fortress-effect” feeds the prevalence of beliefs. It is a universal truth that when there is less information and less articulate comprehension about certain habits, beliefs prevail. What beliefs? In peasant families: “If I believe in God, nothing is going to happen to me”, “lightening is not what kills you, it is just your time has come”; “long suffering people will resist any virus”; “I am not washing my hands because my hands are hot because of work”, “chloroquine and azithromycin get rid of the virus” (self-prescribing without evidence that it cures and without investigating its damaging effect on the heart; and according to the WHO seem to increase the risks and consequences of the disease). Beliefs in external institutions: “information confuses people”; “money makes the monkey dance”; “if the economy improves, all improves”; “give them alcohol and with that COVID-19 will not affect them”; “boil eucalyptus and cypress leaves”; “read the bible where it announces the end of the world”, “everyman for himself”. Doña Coronavirus laughs and is attracted by these beliefs!
We resist learning. We read about the 15 countries of the Asia-Pacific region, China, Korea, Taiwan, Hong Kong, Australia, New Zealand, Japan and the 10 member countries of ASEAN (Association of South East Asian Nations), Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam, as the region that has best dealt with COVID-19, a region that has 2 billion people of the 7.7 billion that exist in the world. How did they do it? With good public health: they closely observe the symptoms people have, if there are symptoms, they test them, if they are positive, they isolate them in their homes or in hospitals, and they do contact tracing. In other words, the more they diagnose, they more they know what to do, and thus save more lives. In contrast, national and international organizations tend not to do diagnoses to formulate and implement policies, except to appear to formally comply; our mentality of providentialism and resignation resists learning from rural populations, we do not seek to understand them, we believe that we already know them, that “the market knows more”. We are societies that seem to live like in the middle ages under the church with the inquisition, in those times “there was no reason to think, it was enough to believe”, when thinking was a sin and punished by death.
2. Hygiene in rural societies
What is it that we need to understand? We begin with some history, to then paint something about the rural reality and show the vein that we have to continue exploring.
There are several studies on diseases and the architecture of cities and homes, not much on rural spaces. Public health has contributed to the fact that the population lives longer, architecture has also done that. So closets were imposed instead of armoires, because they were anti-hygienic because they accumulated dust. In the last 150 years we know of great changes in the cities of London, Barcelona or Paris; in 1866 they cleaned up most of the river Thames in London, and that clean up saved most of the people of the city from the threat of cholera; in 1844 they redesigned the city of Barcelona, knocking down walls that contributed to the overcrowding, which made lack of hygiene worse and supported epidemics; also Paris was redesigned for health purposes. Other smaller changes also had large impacts: clean water and management of sewage to prevent malaria or yellow fever; in the face of the bubonic plague, that killed 12 million people between 1855 and 1959, they rebuilt homes with more concrete and metal to keep out the rats who carried that pestilence. In other words, the design of homes and cities for health purposes lengthened the lives of people.
Now with COVID-19 architecture is challenged to redesign homes. Even though architecture has not been able to respond to respiratory illnesses, COVID-19 can cause the redesign of the home, where the idea of what is private is reconceptualized, giving way to the home as a space for school, work, reflection and gymnasium.
Unfortunately, there are no studies about that same relationship between architecture and health for rural areas, at least none that I am aware of. In rural areas, hygiene has been in deficit for centuries, a situation that has been made even worse by the discrimination toward the rural world. This situation of hygiene is due in part to the fact that rural families every day are grappling with land, farming, agro-chemicals, small livestock, slaughtering or the fire in the kitchen, and they do it without having protective measures like gloves, boots or masks, partly because they are living with limited water or means of catching water, on large haciendas the patrons customarily do not provide protective equipment to their workers, and partly because they do not have access to information while beliefs lead them to not protect themselves.
This daily work of women with fire, or men with the land leads them to bathe less frequently. This is not necessarily, however, a lack of hygiene; in fact, many people during the winter in Europe and the Andean altiplano do not bathe very frequently. The difference is that peasant families think that after work a person should not touch water, it is an understanding about the combination of temperatures; so it is that after making tortillas they do not wash their hands, after weeding they do not bathe “because the body is hot”. Also the lack of water and minimal infrastructure has conditioned them to carry out certain practices; women gather dirty clothes to go to the river to wash them, they spend little water to wash dishes. Likewise, little access to information has an impact on daily life, for example, dishes are not washed with Clorox that could contain the salmonella bacteria, which tends to be found in food contaminated with animal feces. We mention these points to illustrate how difficult it could be the fact that, now with COVID-19, they have to wash their hands frequently and with soap, when customs and their natural (water) and economic conditions weigh in.
Most rural homes, particularly those of low-income people, have dirt floors and are closed structures with little ventilation. For example, it is known that Chagas disease, that “forgotten illness” because the pharmaceutical industries do not see it as profitable, mostly happens in homes with grass roofs and cracks in the clay walls where the insects that cause this disease tend to live. Peasant homes are a prolongation of the farm, or the reverse, for example corn is stored inside the home or above the hearth, while the cats deal with stalking the rats who are after the corn…
These rural practices became customs, and those customs, laws, which tend not to be seen by the eyes of State institutions, markets and international aid agencies. External actors, instead, tend to see agriculture or ecology as separate from hygiene in the home and family, and the economy as separate from health, education and religion. External actors, when they touch on the issue of hygiene, do so viewing the rural reality from the urban experience, and so any weed seems dirty to them, any home for them should be in towns or villages, any farm should be mono-cropped, and any insect should be fought with agro-chemicals. From the urban perspective it is hard to understand that a home on a farm probably is healthier than a city with an over-populated cattle industry, or chicken or turkey industry, which are true virus factories.
We need to scrutinize the relationship between hygiene and agriculture, home and farm and school and church to understand the culture of hygiene in rural populations, to then look at improvements and changes to be made. Without understanding, one cannot see, Rodrigo López told us, a peasant from Waslala. How true that is! Otherwise, how can we imagine that just using chlorox and alcohol is going to prevent COVID-19? Without understanding, how they can reflect on and change their habits coming from their own cultures and farming systems, any chlorox or alcohol that they are given runs the risk of ending up in the municipal markets, as has happened with the donation of tin roofing sheets, pure bred hogs, coffee roasters or grain silos. The community, that heterogeneous amalgam of disputed realities, is like a book, inside of which dance letters, pages and imagination, opened up only by the reading of those who love it, a reading which is like a person who shells a corncob sensing a hot tortilla with “”cuajada.
Our challenge is to rethink community spaces from a perspective in which health and economics are embedded in each other. Homes on farms with materials that protect them from rats and the insects that carry Chagas disease, and at the same time are ventilated spaces, and agro-forestry farms, in communities with spaces for food, reflection, social interaction, entertainment, open field school and collective actions. Communities with fresh air, revived, which end up being the “tree” to protect oneself from the virus. This is the vein to dig into.
3. It is the moment for organized rural societies
While we study, let us not lose the pulse on COVID-19. What should we do? If classes and/or religious celebrations continue, and if markets and States do not show they are effective, grassroots organizations (cooperatives, associations, parent-teacher committees, water committees…), located in the communities, must act to protect their communities. The effectiveness of these organized rural societies can be better if supported by organized global societies (international aid organizations).
How? These grassroots organizations must turn themselves into entities that inform, connect with schools and churches to accompany them to understand the problem and their prevention practices in the face of COVID-19, and look up while they deepen their roots.
3.1 Informing yourself and analyzing the information
Dry cough + sneezing + body aches + weakness + high fever + difficulty breathing = coronavirus
Source: Pathology Department, UCH London
In the first box are the elements to tell whether a person has coronavirus, flu, a cold or just air pollution. The scientific community reveals that a person with COVID-19 can show mild symptoms, and days later have other more serious symptoms. In other words, a person could have a cough and sneezing, and not have a high fever, which does not mean that they do not have COVID-19, in the days following the other symptoms may appear. Box 1 is a simple aid to differentiate, it does not assure you that you do not have COVID-19 with the first symptoms, but at the same time helps you to not get alarmed with the first symptoms, helps you to stay calm and discern; this is a big help in rural areas where it is difficult to go to a hospital.
COVID-19 is not just a new virus, but the scientific community still does not know much about it. Current evidence reveals that a little more than 40% of people with the virus were infected by people who did not have symptoms of COVID-19. This obviously makes prevention difficult, at the same time, knowing this helps us to get a grip on the problem and respond in the best way possible.
Box 2. Recommendations
1. Do not touch your face–because the virus enters through the mouth, nose and eyes
2. Wash your hands with soap – the virus is dissolved with 20 seconds of hand washing.
3. Maintain physical distancing (1.5 mts) from another person; avoid groups of people
4. If you do not feel well, stay home. The family can help you determine whether it is coronavirus (see box 1)
5. Avoid meetings in closed spaces without ventilation
6. Above all, think, think, and think–it is the most vital thing that we should practice.
Box 2 has information also based on studies. Grassroots organizations can disseminate it in their communities, but first they should read and analyze it: why shouldn´t you touch your face? Why should you wash your hands with soap? Why maintain a distance of 1.5 meters with other people? Why should you stay home when you have a cough, mucus and sneezing? The more we think about it, the more we understand it, the more we are going to put it into practice and tell other people. Talking through information allows us to think about reorganizing activities, for example, the measure of maintaining a physical distance of 1.5 meters can help so that in a religious celebration, a meeting in the cooperative, or a class in the school people take their seats maintaining that distancing, so that the meetings be for shorter periods of time or with frequent recesses, or so that the meetings might be better prepared in advance so that, like chickens, you go straight to the “grain.” Information that is thought through can save lives.
Grassroots organizations also should reflect on other contributions from scientists. Let us look at 3 contributions. The first, studies show that children under the age of 12 do not get infected much, compared to adults; in the cases when they are infected, they almost never get seriously sick, nor are they great transmitters of the virus, like they were in the case of the flu, because the amount of receptors that COVID-19 needs are less in children under the age of 12, and consequently the viral charge (in other words, the amount of the virus that they can gather) is much smaller. Statistics confirm this statement, minors under 12 are less than 0.2% of COVID-19 deaths.
Second, statistics how that men become more infected by COVID-19 than women, and they tend to suffer more from the virus than women who are affected. This is due to the fact that “the blood of men has higher concentrations of the converter enzyme of angiotensin II (ACE2) than the blood of women (…). This receptor is found on the surface of healthy cells, and helps coronavirus infect them” (see: https://www.iprofesional.com/actualidad/315900-coronavirus-por-que-hombres-se-contagian-mas-que-mujeres ). Active genes linked to the X chromosome provide women (XX) greater protection against coronavirus than men”. In addition, be it for the type work in which rural women are more involved, in general they have more hygienic habits than men, for example, they wash their hands more frequently, be it because they are washing dishes, clothing or for personal care. This indicate the importance of hand washing.
Third, studies also tell us that the use of masks is preventive, but they also warn us of the risk of reusing them, because they can become a means of infection, because the virus can remain for hours and even days in the masks. The masks are more for infected people, with or without symptoms, so they do not infect other people. Why the masks? Because they reduce the particles that come out of the mouth when a person breathes or talks. When should masks be used? They can use them in school during classes in closed classrooms with little ventilation, in relatively closed churches during celebrations, when it is not possible to maintain physical distancing, when the interaction lasts a certain length of time, in places with human crowding (banks, markets…). They should also be used when you travel to town, on returning home you should wash it, in this way the mask will be ready for a new outing or meeting. Countries that have overcome COVID-19 have used the masks as part of their strategies, which is why rural communities probably will have to introduce the use of masks as part of their culture of care, particularly for the moments we just pointed out.
3.2 Linking to and contacting schools and churches
It seems easy to connect to and assume that any organization or institution will be happy to be contacted. Nevertheless, churches, schools and party structures are not accustomed to coordinate with community organizations, except to “orient them” about what to do, and treat them as their dependents. Their worlds and leadership which we mentioned previously really carry weight, they are true walls to community coordination. How is a grassroots cooperative going to react if the pastor of a church tells them, “God is our doctor, we trust in God?” What is it going to say and do if the principal of a school tells them, “we can only receive support if it comes through the ministry of education”? What are they doing to do if a committee of a political party, the councils or mayor deputies say that “directions and projects only come from above?”. What can you say to the parent of a family who only believes in the patron of their hacienda? How difficult it is to be community and work for the community! There, where things get complicated, money will not even make monkeys dance.
In the midst of these worlds we have learned the following steps. First, discussing the information in figures 1 and 2 really empowers people, it is in-forming, and informing is forming. Information can be an antidote to despotic religious, political and economic leaders. Second, the cooperative or association should start from what it is and has; what do they have and who are they? Each member has, at least, a family member who is a student, believer of some religion and/or is member of a political party; they should talk with them, discuss the COVID-19 situation, and the information provided here. Third, members of the organs of the cooperatives, having now conversed at the grassroots level, visit the parent/teachers committee of the school, people with positions in the churches, (e.g. deacons, delegates of the word) and party members or government authorities, reflect with them and discuss the information. Finally, the board members of cooperatives communicate with the parent/teacher committee of the school and with deacons and delegates of the word. In other words, connect with the grassroots of different organizations and institutions, their intermediate leaders, to then connect with the leadership of the organizations and institutions. In these steps, it is not a matter of convincing anyone, but of listening, bringing together elements that help to understand, and once each person understands, they will be able to see and then act – it is like preparing the soil and planting a seed, then you have to let the seed germinate and struggle to grow.
Table. Cost of kit for 90 people (1 month; in US dollars)
Chlorox (cleaning equipment) (liters)
Hand towel (units)
Bar of soap (units)
Re-usable masks (units)
With these steps, each organization can supply itself with a kit of hygiene products to prevent COVID-19 (see table). Cooperatives have a social fund that they can use to acquire the kit, unless they have used it for other social agendas that they tend to have. Schools can, through the parent/teachers committees, gather resources to acquire the kit. If the cooperatives, with or without international support, can gather resources to support the schools and churches, it could make a difference, strengthening the bonds in the community, and the entire community would benefit. The more bonds there are, the more autonomous the community will be.
3.3 Looking forward
The sixth recommendation in Figure 2 is the most important reason for a grassroots organization rooted in the community to exist: think, think and think. Thinking is the most important element to resisting COVID-19. Thinking is looking forward and seeing beyond our noses. A cooperative is not a church nor a political party, its members are there voluntarily, they are not subordinated to anyone, they discuss and reach agreements in their assemblies, which is why they must examine their beliefs and fight with and against them. Individually they can believe or not in God, but they should not expect God to send them angels or saints to wash their hands for them, or put their masks on, just as they would not expect that he plant beans for them or remove botflies from their cattle; they can believe in their political leaders, but it is shameful to subordinate themselves to anyone. As cooperative members they have free will, their source of power is the assembly composed of the members themselves, and their reason for being is thinking, thinking and thinking in favor of their communities.
Part of this thinking is reflecting about COVID-19: How to protect their own community? If the State does not show up in a community, the cooperative must also take on that role. If the health system capacity is overcome, grassroots organizations should discuss how to help prevent the outbreak in their communities, and how to help people who might be affected by the virus. If in any country COVID-19 is being controlled, in all countries there are waves of outbreaks of the disease, so the cooperative should keep looking for those possible outbreaks. In Central America the urban waves of COVID-19 are still ongoing, which is why the rural waves that come later, can be lethal, not just for the reasons mentioned in this article, but because we are in the midst of the rainy season, which will make it more difficult for infected people to get to a health center or any support. If a community receives external support, the cooperative must be careful that that support not be counterproductive, because there can be support that displaces grassroots organizations, and when that donation ends the community´s own autonomy and their own efforts can be left eroded.
Cooperatives need to organize how a network of women can sew masks, how to make soap with lard, how to recover old ways of making alcohol in order to use on hands, how to recover natural medicine… Cooperatives need to think about connecting hygiene, economics, social and environmental elements, thinking about the food in the community beyond COVID-19, thinking about environmental sustainability with pure air and water, thinking, thinking, thinking.
4. Role of international organizations in living communities
Even though for multiple reasons most of the international aid organizations have withdrawn from Central America, there are still international organization that are supporting the region. There also is the fair-trade network, as well as local-global networks among national and international organizations, unions, churches, social banks and universities in the world. When there is the will, there is the way, as the saying goes. If each person feels a mission of service, we can deepen those relationships of collaboration and reactivate “dead” relationships, because “where there are ashes, there was fire.” Each person and organization can play an important role if in this COVID-19 context they realize the importance of working on the community level that is organizing: what good does it do to provide individualized credit or training, as neoliberalism does, promoting mono-cropping, environmental degradation and the erosion of communities? The current situation wakes us up: people who organize and follow rules agreed upon in their assemblies, instead of gurus or chiefs who see themselves as the law, are those who really energize their communities, sustainable farming systems and contribute to social and environmental equity. Communities save communities.
Within this framework, what role do aid organizations have? Traditional donations, involving donating and awaiting reports invented by organizations “confined” to the cities, can be counterproductive, particularly if they displace the efforts of the communities themselves, which in the long term would undermine communities. Aid organizations need to connect with counterparts who really are working with grassroots organizations that meet the following criteria: they are democratic, redistribute their surplus, are transparent with their information and are rooted in their communities or specific micro-territories. This type of organization will persist in the communities, while other external organizations, or those with disperse membership, will continue treating the communities like their lovers, showing up from time to time and leaving. Forming alliances with grassroots organizations so that a donation might provide an initial push, for example, with what is indicated in the table, supporting wash basins in schools with access to water, or working on agro-forestry systems that would protect water sources, where grassroots organizations might accompany their communities, and that their national partners might accompany them in the communities themselves, being careful, but overcoming fear, is the network which need to be built now and always. The dilemma is not whether to leave your urban home or a rural farm; it is how we strengthen internal community assets, how we can take advantage of this “momentum” that exists in global awareness as an effect of COVID-19 to see the importance of communities. In this way, external financing to build a community response would decisively help the community deal with the virus and its new outbreaks, and help in the long term to democratize the community itself.
5. By way of conclusion
In this article we showed the risks of COVID-19, we have begun a reflection on the relationship between hygiene, the economy and social factors, we described the strength of communities if they build lasting connections, we have emphasized the role of grassroots organizations to reflect on their values and principles in light of what is happening in their communities, and generate ways to cooperate in the prevention of COVID-19, and to innovate in ways of accompanying their communities in the midst of the uncertainty. We showed that, through these short term measures, and starting from an analysis of the processes which we are experiencing, it is possible to look forward to the medium and long term: to improve, correct, and generate habits of hygiene connecting home, farm and nature, and home, school, health center and community building.
The impact of what we are proposing, nevertheless, will be seen above all on more structural issues. For example, an exponential increase is coming of people in extreme poverty, the goal of eliminating extreme global poverty for 2030 is going to be only left on paper. The crisis for rich families of the world is how to have less desert options in their dinner, while for our communities the crisis means that they might miss a meal or face empty plates, becoming vulnerable again to any disease. This article and the previous one on basic grains aim at preventing those impacts.
The current situation also provides us with opportunities, because “behind every adversity there is an opportunity”. What opportunity? Mitigation of climate change which, in the case of rural communities, means water, land with life, biodiversity; it is the moment to rethink farming systems and intensify more sustainable forms and farming systems that stop the loss of nutrients in food because of the decreasing quality of the soil. It is the time for communities, never before has the importance been so clear of investing in communities who organize and embrace a culture of care; now is the hour for life, amen.
To look at these structural issues we must understand that it is not the economy that solves health care, it is not a matter of knowing whether the chicken or the egg is first, now the economy is public health and community health; and health, the economy, social and environmental reality are like a mountain slope, if you are on the higher part it looks different than seeing it from below, if you are on the very top, it looks different from one side than from the other, but it is the same slope, the same mountain slope.
“Think, Pipita, your love for others is stronger than anything else…Besides, the rain is coming!”
 It is likely that air pollution facilitates the virus and makes its impact worse, which in part would explain why countries in Europe have had high mortality, measured by the indicator of “over-deaths” or “over-mortality” (number of deaths above the average deaths from previous years) as an effect of COVID-19.
 Many people even with clear signs of having been infected, decide not to go to the health centers or hospitals. Why? “They say the hospitals have no room”, “I don´t want to die intubated”, “I want my family to wake me” and “we want to now where he is going to be buried to be able to go to pray for him”. The express burials frighten the population.
 L. Engelmann, J. Henderson and Ch. Lynteris (eds), 2018, Plague and the City. Londron: Routledge. They study the relationship between plagues and measures to fight plagues and cities from the middle ages up to the modern era; they also include cities like Buenos Aires.
 Inspired in these realities and by actions of Dr. Mazza and his team, in 1995 they filmed the movie Casas de Fuego. See: https://www.youtube.com/watch?v=A6yWNBytu3U The movie illustrates the relationship between disease-insects, homes (shacks) and social inequality, the wealthy class is against homes being rebuilt, because “they are not concerned” about the millions of poor people.
The movie Casas de Fuego (footnote No. 5) illustrates the duality science/faith and committed science/academic science. The priest is opposed to science benefitting the most impoverished and affected communities; for him “faith and science are fighting over the same people”; a Manichean dilemma that smacks of the middle ages and that did a lot of damage to humanity. Also in this movie, that captures a good part of that experience, the University blocks the mission of Dr. Mazza and his team; fortunately Dr. Mazza and his team persist, their commitment is worth more than restrictive science, a commitment that nevertheless, they paid for with their lives, caused by the Chagas disease itself.
 If there are other organizations in the community, like alcoholics anonymous, water or road committees, the same is done as with the schools and churches.
 Note that traditional organizations tend to do just the opposite: the meet first and only with the leadership of the organizations, and then send technicians to “train” (in other words, convince).
 If some national or international organization wants to provide support under this spirit, they can contact the Coserpross cooperative (http://coserpross.org/es/home/) in Nicaragua, the Comal Network in Honduras (http://www.redcomal.org.hn/). Coserpross and the Comal Network accompany dozens of grassroots organizations in the region, synthesize verified information to provide to the grassroots organizations, and move about in those same territories. There are also organizations like Aldea Global and ADDAC that we mentioned in footnote 5; their uniqueness is that their network is present in dozens of communities.
 What would happen if a bee stayed in its hive? It could live as long as the food that it stored lasted, the honey that it produced, and then? We must understand that we, flowers, bees and humans, are all one network. The bee leaves its hive and goes from flower to flower, pollinizes, does it at the risk of losing themselves and of losing their lives. So is the network. So are we accompaniers, taking on the corresponding measures (use of mask and frequent hand washing), we should not “pass by on the other side” like the priest and Levite in the parable of the Good Samaritan, we should be inspired by people like Chagas and Mazza did and their teams in Brazil and Argentine that the movie Casas de Fuego portrays.
This call for a National Quarantine by 34 Medical Associations in Nicaragua is in response to the exponential growth of infections, and increasing national and international criticism of the Nicaraguan government for its response. It was published as nearly a half page ad in La Prensa June 2, 2020. The same day the announcement was released COSEP announced their full support for this call.
In the face of the unstoppable advance of the Coronavirus pandemic in Nicaragua, we the different Medical Associations of the Country, address today the Nicaraguan people and the International Community, to once again warn about the dramatic situation that our country is going through, and that threatens to worsen in the next days and weeks with terrible and fatal consequences for Nicaraguan homes.
As had been warned by International Centers for disease control and different National Medical and Epidemiological Specialists, the exponential increase in COVID-19 cases has caused a collapse in the public and private health care system of Nicaragua: saturated hospitals, lack of beds, lack of medicine and such essential products like oxygen are added to the fact that dozens of doctors and health care workers are infected by COVID-19, with the result of an important number of deceased Doctors, nurses and technicians. Which is reducing the number of medical and paramedical resources in different institutions, causing overtime workloads, physical and emotional exhaustion on the part of health workers.
Nicaragua finds itself currently in the phase of accelerated expansion and community transmission, which will continue worsening with greater loss of life, if the corresponding authorities continue denying the situation, and anti-epidemic measures are not taken urgently and at a large scale to try to contain the advance of the pandemic.
With the moral, academic and workforce authority that the fact of being in the front lines in treating this dramatic health crisis confers on us as doctors, we the Medical Associations of Nicaragua call on the people to urgently begin a voluntary NATIONAL QUARANTINE, that might help reduce the impact of this disease with the reduction of Contagion, transmission and death among the population. This NATIONAL QUARANTINE consists in staying at home for at least 3-4 weeks, doing food purchasing once a week, ensuring distancing of at least 1.5 meters between people, using face masks or protective screens outside of the home, and constant hand washing.
We demand that the private sector take strong measures in the face of the propagation of the virus and protect life, instituting actions that might reduce the risk of exposure and transmission, not just with personal hygiene measures, but with actions like the temporary closing of non-essential businesses until the growing number of those infected be reduced.
As of today, all of us are potential sources of contagion and transmission of the disease; which is why we reiterate the call to the Nicaraguan population, private enterprise and public institutions to stay at home. We are capable of controlling the pandemic with your decisive support and the power that you have to avoid the spread of the virus. This is the only way that has demonstrated the control of the disease based on the experiences of other countries who have mitigated and diminished the transmission, obtaining the flattening of the curve and control of the Pandemic.
The COVID-19 pandemic came to the world without anyone expecting it, even more, without anyone being prepared to confront it.
Also, the pandemic came to our beloved Nicaragua, an impoverished country with the aggravating circumstance of a social and political crisis.
We note that all of our faithful people are aware of the fragility and vulnerability in which the health care system finds itself, the speed at which the infection is spreading, the truth about the number of those infected and deaths caused by the virus. With our people we are suffering their uncertainty, grief and death. The grief and impotence lead to desperation, families who are mourning their dead without saying good-by, the fear and insecurity that the population is suffering in light of the silence of the State, and the disinformation about the progress of the epidemic, the fear or impossibility of visiting hospitals, suffering diseases in the silence of their homes, the manipulation of consciences, coercion and political opportunism in the management of the pandemic.
We reiterate our prayers for all the sick, those who have passed away and the families affected by the virus.
We are happy and grateful for the effort of the doctors and nurses of our country, and we encourage them to be faithful to their vocation and mission.
The contagion of COVID-19 in Nicaragua coincides with the liturgical seasons: Lent and Easter, privileged times of grace and blessing, that for the common good of our faithful and the entire country we have celebrated in empty churches, masses without the presence of faithful but – we give thanks to God – strengthening the faith of many Catholic families as domestic churches, celebrating in the intimacy of the home the passion of the Lord and his glorious resurrection.
Let us take care of life.
In the face of this global, national and family tragedy that threatens our lives, what is our response? What can we do? We are afraid of losing our own lives and the lives of those we love, but, life is a gift of God, it is in his hands, like we also are also in his hands, as all of humanity is in the hands of their Creator.
Nothing is more important than life, “life is above all else”, the problems that come after the pandemic are many, the challenges very big, and just remaining alive and united will we be able to face them; many of us have maintained social distancing, and we have done it out of responsibility and love; we should continue doing so, when contamination is local and the risk of contagion is greater; the most important thing now is protecting life, and that each one does what is necessary and possible to preserve and protect the lives of others, those who are stronger, generous and compassionate carrying those who are weaker; those who have wealth, may they multiply their works of mercy to share with those who do not have anything, may they take diligent care to protect men and women who are working in enterprises of production and institutions of administration and services; that all of us without exception prioritize the care of life, life above the economy, life above ideological and political interests, we repeat, life above all else. This implies the urgency of strengthening citizen solidarity. Taking care of one another and caring for others, following all the measures of precaution, prevention and mitigation.
We exhort the rulers and all sectors of the country to open themselves to alliances and consensus to seek and find alternatives and joint solutions that would prevent us from a larger human catastrophe.
During the storm, the beating of the waves threatened to sink the boat, Jesus was asleep in the stern which is the first part to go under in a shipwreck, sleeping in the most dangerous place and the storm did not disturb his sleep, because Jesus slept trusting in the hands of his Father. His disciples were afraid and shouted to him, in addition to their fear they had doubts, were men of little faith (cf Mt 8: 23-27). For us the time has come to shout, Lord, save us because we are going to drown! And of recognizing our little faith. We implore the Holy Spirit to give us the strength of faith, Christ has power, but do we have faith? More than once Jesus said to those who were tormented that “let it be done according to your faith” (Mt 9:29); “your faith has saved you” (Mt 15:28) “I did not find as much faith even in Israel” (Lk 7:1-10); let us be strong in faith and let us not doubt the love of God for us and, given that we are weak, let us implore the Lord to increase our faith (Mk 9:24).
Jesus loves us, “the greatest value of life is love.” In the face of this situation, we turn our eyes again to Jesus, we Christians should have present a response motivated by our faith. Faith implies hope. Faith without hope turns lukewarm and dies, it will not be any more than a sterile knowledge. We human beings, we are such fragile people that crises undermine our emotions and thoughts, that is why faith and hope must take their place in the face of threats, in this way we also are careful about our actions.
In this crisis and throughout our lives Jesus comes to encounter us, He, conqueror of death, leaves the empty tomb and comes to the encounter with his disciples, “let us open the doors of our hearts wide open” (St John Paul II) so that Jesus might enter, live in us and we live in Him (cf Jn 14:20).
St Paul encourages us with these words: “Because in hope we were saved; but the hope that is seen is not hope; because who hopes for what they already have? But if we hope for what we cannot see, with patience we await it. And, likewise the Spirit helps us in our weakness; because we do not know what we ought to pray for, but the Spirit himself intercedes for us through wordless groans” (Rom 8:24-26). Do not give in to the night: remember that the first enemy to defeat is not outside of you: it is within. Therefore, do not give way to bitter, dark thoughts. “Trust in God and trust also in me” (Jn 14:1) – Jesus says – God does not disappoint: if he has placed hope in our hearts, he does not want to destroy it with ongoing frustrations. Everything is born to flower in an eternal spring. God also made us to bloom” (Pope Francis).
“Do not listen to the voice of the person who spreads hate and division. Do not listen to those voices. Human beings, as different as they may be from one another, have been created to live together. Love people, Jesus gave us a light that shines in the darkness: defend it, protect it. This light is the greatest wealth entrusted to your life. And above all, dream! Do not be afraid to dream. Dream! Dream about a world that cannot yet be seen, but that certainly will come. Live, love, dream, believe. And, with the grace of God, never lose hope” (Pope Francis).
Follow the path of love.
The pandemic will end, “because everything has its time under the sun.” Once the crisis is overcome, it will be up to us to ask ourselves, what lessons have we learned? What meaning will God continue to have for my life? What will be my attitudes toward others from now on?
We are called to have an attitude of conversion about our way of thinking, living, and acting, in accordance with the Good News of Jesus Christ, being docile to his teachings under the action of the Holy Spirit who was bestowed on us from our baptism. “Love one another” that commandment of the path of salvation, expressing that love in works, in actions of social and labor justice, in larger investments to strengthen health care systems, in the construction of an economy where the common good of humanity prevails above all else.
Certainly poverty is increasing, unemployment is worsening the economy of families, we need to take on this challenge as a society, the needed changes must happen, and technical, economic, scientific etc. solutions are not enough. Political speeches empty of responsibility and content do not work to solve the problem, it is important to recover the direction of human life, give it back its dignity, its sanctity, from its conception to its natural extinction; it is necessary to follow the path of love.
Life of prayer
“When the sadness and bitterness of life try to crush our gratitude and praise to God, the contemplation of the marvels of his creation ignite, again, in the heart the gift of prayer, which is the principal force of hope. And hope is what shows us that life, even with its trials and difficulties, is full of a grace that makes it worthy of being lived, protected and defended” (Pope Francis).
This crisis strains all of us, demands of us more effort, the task may seem overwhelming, nevertheless, “nothing is impossible for God” (Lk 1:37). Stress causes fatigue, anxiety and irritability, even anger, it reduces the time for rest and drains energy, “the flesh is weak”, and let us strengthen the spirit persevering in prayer (cf Mt 26:41). The humble and trusting prayer: “My God have mercy on me” (cf. Lk 18:9-14), will give us back the joy of salvation” (cf. Psalm 50), and our voices will proclaim his praises, prayer will give us peace and strength to turn the stress into the energy that we need to resolve this situation.
We implore Mary Help of Christians, that “Woman clothed with the sun, with the moon under her feet, crowned with twelve stars on her head” (Rev 12:1), she is “the one that appears as the dawn, fair as the full moon, bright as the sun, majestic as the stars in procession” (SS 10:6), Mary Help of the Christians will crush the head of the serpent, and will cover us with light “like a mantle, stretching out the heavens like a curtain” (Psalm 104:2).
Issued in the Office of the Episcopal Conference on the 24th day of May 2020, the feast of Mary Help of Christians.
[Signature] [SEAL of the Episcopal Conference of Nicaragua]
This is the Executive Summary of a White Paper the Nicaraguan Government released May 25, 2020 in response to international criticisms of the Pan American Health Organization (PAHO), the Costa Rican government, and other nations to what they describe as a lack of adequate response of the Nicaraguan government to the health crisis caused by COVID-19. In addition there has been widespread national criticism of the government´s response, including six former Ministers of Health of Nicaragua, the Civic Alliance for Justice and Democracy, COSEP and over 700 Nicaraguan doctors and health care professionals.
We present to the Nicaraguan people and the international community the “NICARAGUA WHITE PAPER IN THE FACE OF THE COVID-19 PANDEMIC: A UNIQUE STRATEGY”, which has an analysis of the public policies, presenting a vision of the health care model of Nicaragua as a unique model in the world, based on the reality and conditions of the country, which responds to a preventive approach to people, families and communities with proactive actions. Within this model we have a strategy of balance between the Pandemic and the Economy, vigorously fighting Coronavirus and COVID-19 without closing down our economy. The policy is based on the fact that 40% of the population lives in the countryside, and 80% of the workers in the urban area belong to the informal sector and earn their daily sustenance. At the same time, we are defending the economic recovery of an economy weakened by the coup attempt of April 2018, that continues under attack by false news (“fake news”) campaigns and disinformation, as well as illegal coercive measures.
The country has been well prepared for this fight against COVID-19, due to:
1) The strengthening of the health care system (2007-2020);
2) Preparation since January 2020, two months prior to the appearance of the first case;
3) The entirety of the actions undertaken.
Strengthening health care 2007-2020
It presents how Nicaragua is in a better position today, compared to the sixteen years of the neoliberal period, to face the pandemic, with more modernized health care infrastructure (18 new hospitals), more trained personnel (36,649 health workers in 2020 compared to 22,083 in 2006; 6,045 doctors in 2020 compared to 2,715 in 2006) and flagship and solidarity programs that make manifest the sacred commitment of the Government of Reconciliation and National Unity (GRUN) to restore the rights of the population (Everyone with voice, Love for the smallest, Operation Miracle), since the organization of the Family and Community Health Care Model (MOSAFC), working jointly with the community network and a larger budget investment (US$ 468. 6 million dollars in 2020 compared to US$111.9 million in 2006.
Preparation for COVID-19
When the COVID-19 outbreak happened in Wuhan, China on January 21, the Ministry of Health (MINSA) held a press conference to warn the population about the risk, and to communicate prevention measures. This was almost two months before the presentation of the first case in Nicaragua on March 18.
Since the declaration of the World Health Organization on COVID-19 as a Public Health Emergency of International Importance on January 30, 2020, Nicaragua established an Inter-institutional Commission to ensure a comprehensive approach.
On February 9 MINSA released a “Preparation and Response Protocol in the face of the Risk of Coronavirus (COVID-19) in Nicaragua” to ensure the monitoring and early detection of suspicious and confirmed cases. Preventive measures were established to reduce the transmission of the virus, and an ongoing communication plan was implemented, directed to the population, and educational and border control actions have been carried out, always based on the Protocols of the WHO/PAHO.
The Protocol also designated 19 Hospitals to be specialized in COVID-19, one of them, the Nicaraguan German Hospital, exclusively for respiratory diseases; it included more preparation for the primary treatment units to address the respiratory symptoms on the national level, the training of public and private personnel, and the acquisition of protection equipment. Nicaragua also had established a capacity for contact tracing. In this way Nicaragua was prepared before the appearance of the first case of COVID-19 in the country on March 18.
Actions in the face of COVID-19
As part of the Protocol designed by MINSA in response to the Coronavirus and COVID-19 pandemic, in Nicaragua 470 people suspected or who have had contact with confirmed cases in the country, have been treated and provided responsible and careful follow up.
Likewise, more than 42,000 international travelers were the object of monitoring for 21 days to detect possible cases of COVID-19.
This follow up provided to travelers, suspicious cases and contacts of positive cases, includes doing daily control by the closest Health Post or Health Center to their homes, based on which the medical staff daily decide about the pertinent actions: continuation of the monitoring, hospitalization, or release, depending on the case.
More than 4.6 million multiple educational house-to-house visits were carried out in a country of 6.2 million people, by 98,224 volunteers to promote family and community health.
In addition to an intensive informational campaign in the media about the prevention measures, the publication of the symptoms and behavior in the face of the disease, a National Information Center has been created that has a free telephone line where prepared staff and doctors clarify any questions that the population may have and appropriately direct them about how to act in the face of the pandemic.
In addition, there is a program for the disinfection of public transportation units, collective (buses) as well as selective (taxis); popular markets, governmental buildings and schools at all levels, preschool, primary, secondary and public universities.
The Ministry of Education and the National University Council, in coordination with the Ministry of Health, in addition have adapted their physical installations, designed prevention protocols, and have adapted their study programs to include talks on preventive health and reinforcement of healthy habits for all their students.
In synthesis, Nicaragua, the second poorest country of Latin America and the Caribbean, has been prepared to face the COVID-19 pandemic and any other similar one, as well as it has been prepared to face natural disasters due to the climate, like hurricanes and droughts, or to geological phenomena, like earthquakes or volcanic eruptions, principally for reasons of its own health response model, which is a highly preventive nature based on the active participation of the family and the community, but also because it has invested a fundamental part of its scarce resources in the construction of new health units and the modernization of existing ones, as well as in the numerical growth and ongoing improvement of its medical, nursing and technical staff, in addition to their more equitable distribution throughout the national territory.
In addition, in the face of the appearance itself of COVID-19, the responses provided by the Government of Nicaragua have been carried out in coordination with the regional entities of SICA and in addition with the cooperation of sister nations like Taiwan, Cuba and South Korea.
Nicaragua ratifies, then, its confidence in the success of its policies based on the defense of the health and lives of families and communities, with their active participation in the prevention of epidemic and non-epidemic diseases, but also in the protection of the family, community, local and national economy, which has allowed for and will continue allowing for new accomplishments in the fight against poverty and for the human development of the country, even in the adverse times of economic crisis and climate change, even in times of COVID-19.