Fear and dying in pandemic-enveloped Bolivia

Milan Sime Martoinic writes in The Week:

Bolivia is bewildered about the concept of being held hostage by an invisible enemy

A health worker holds a sign that reads “Immediate supply of biosafety equipment!” during a protest demanding better working conditions amid the COVID-19 pandemic, outside the Del Norte Hospital in El Alto, Bolivia | AP

Parallel universes of fear and death play out life on tracks where others live out quarantine in comfort and safety. In between, others are trapped between a virtual devastation and an uncertain hope. Nowhere is this more real than in today’s Bolivia. There is no official denial of the danger in the landlocked nation, but there is a public distrust of government actions, a general bewilderment about the entire concept of being held hostage by an invisible enemy, and a realization that the collective efforts of the country and its resources are no match for a COVID-19 attack on any one person in Bolivia. From comfortable homes in closed neighborhoods to hungry street masses choosing to find food today and worry about death tomorrow, there is a gripping fear. Those stricken are finding it impossible to get medical treatment; with doors closed on them by one clinic after another, they are dying in the streets.

“The bodies on the street are met with typical Bolivian inconsistency of concern,” says Kelly Barton, an American business-owner in the city of Cochabamba in central Bolivia. “Everyone freaks out, insisting that the city drench the street where he lay with chemicals but equally defend the government returning the known infected body to the foyer of the family home,” There are zero winners, explains Barton. “People who aren’t scared to death, are dying. The streets are full of people putting imaginary needs over personal safety. Some needs are real, but sheer volume tells me people are inventing reasons to be out and about.”

Hospitals are collapsing. They do not have space available, nor medical personnel, nor personal protection but I know people who still blindly think, ‘Oh, mom fell, nothing is broken but let’s take her to the hospital to get her checked out’, not realizing that the sick and dying plus their likely infected friends and family are all in the streets surrounding that hospital, and in its halls and lobbies, said Barton.

As bleak a picture as this is, it is the far eastern regions of Santa Cruz and Beni that comprise most of Bolivia’s 3,400 km border with pandemic-ravaged Brazil that are Bolivia’s worst-hit.

“It’s unbelievable,” says German businessman Michael Kiehne, who resides in the city of Santa Cruz. He is incensed that an acquaintance has just informed him that she has COVID-19. “Then I see photos from two days ago, celebrating her birthday with a lot of people.” This will soon lead to photos like what we saw from Ecuador, believes Kiehne. “How can they risk other’s lives like that?” The surreal nature of the situation does not escape him. “Where I live it is just like a sci-fi movie.”

“I suppose there are people who have not even gone out their door,” says Rucena Rodriquez Quiñones, a Bolivian international NGO consultant living in another sector of Santa Cruz. When this hit, it made stark the class differences, she says, highlighting the difference with the privileged neighborhoods. “Where I live there is no delivery service; to go to the market for food is a dangerous feat. My sisters and I refer to the one who goes shopping as a ‘tribute’,” said Rodriguez Quiñones in a gallows humor reference to the dystopian movie The Hunger Games.

But then the mood turns suddenly sombre. “The cases began to add up, and just like that it was no longer just numbers on TV, it was your neighbor, your cousin, your grandfather. The doctors started to die, nurses, people from the municipality,” she said with noticeable angst. “And then came the news of friends who died.” When the regional governor’s Health Secretary announced that the entire State Health Department (SEDES) staff was in quarantine for being infected, that is when the dam broke, explains Rodriguez Quiñones. “The ones who were supposed to protect us were now all sick and in quarantine.” Then it got worse.

“Two weeks ago, we began to see videos of hospitals rejecting the sick for lack of room, and we saw them die at the doors of hospitals.” In my case, she continues, I have lost various colleagues and people I know from the teacher’s college―good teachers, they were young still; then died aunts and uncles of my friends, then brothers. It just exploded.

Health workers protest outside a hospital demanding higher salaries and better working conditions amidst the outbreak of COVID-19 in La Paz, Bolivia | Reuters

“When I started to read the obituaries of my friends, all I could do is cry,” relates Rodriguez Quiñones, adding that every single one of them was buried without a funeral. “What hurt my soul was to remember them so full of life, community leaders, exemplars―and overnight they died, drowned in themselves. I cannot imagine a more horrible death.” It is a grief that can’t be spoken. She wrote this down.

“Now that it is no longer a curiosity, now that my friends are dead and gone, now that my relatives have come down with it, I am afraid,” said Rodriguez Quiñones. “Not for my life, but as a mother my job is not done, but I am afraid of drowning in myself. It is that death that I fear the most.”

Yet, it is the plight of others that strikes her the most. “Each day, they come to my door asking for food for their community meals. At first, we could all help, but each day what we can do is less and less,” she says. “It is painful to go to the markets and to see people begging for food for their community meals, the musicians playing sad songs for a few coins, and the ladies in their selling stalls stressed for risking their lives every day.”

And every day the newspapers carry announcements of people begging for immune plasma from those who have survived the virus, or those seeking a bed in a hospital. “A doctor asked us in tears not to go out because there is no space, nor ventilators. He said that it would not matter if we had all the money in the world, there simply is no equipment.”

In far east Santa Cruz department, the border town of Puerto Suarez, across the El Pimiento river from the city of Corumbá in the Brazilian state of Mato Grosso do Sul, “they have no place to take care of patients, and people cannot receive medical attention on the Brazilian side because the border is closed. They have no resources. They are very concerned,” says Mayza Franco Peña, who grew up in the area and has never seen it this devastated.

But it is the large tract of Amazonian forest known as the Beni region that is in Bolivia’s most dire situation. When all the doctors and interns became infected, related Rodriguez Quiñones, doctors headed to Beni, risking their lives bought hundreds of doses of medicines, photocopied prescriptions and headed to the town squares to distribute the doses. At the same time, notable Bolivian nephrologist and researcher Herland Vaca Díez called on Bolivian doctors to “combat and eradicate the virus in the country,” saying “Let’s diagnose and treat patients at home, let’s forget about the Government.” He called for the use of the US-Federal Drug Administration (FDA) and World Health Organization (WHO)-approved drug Ivermectin, used in Beni for veterinary parasite control but widely and inexpensively available due to its inclusion on the WHO model list of essential medicines. Vaca Diez along with another Bolivian doctor moved on the anecdotal effectiveness of the drug as an antiviral and prescribed a flu-like treatment with Ivermectin, with much resistance from the country’s medical establishment.

“The FDA is concerned about the health of consumers who may self-medicate by taking Ivermectin products intended for animals, thinking they can be a substitute for Ivermectin intended for humans. People should never take animal drugs, as the FDA has only evaluated their safety and effectiveness in the particular animal species for which they are labeled. These animal drugs can cause serious harm in people. People should not take any form of Ivermectin unless it has been prescribed to them by a licensed health care provider and is obtained through a legitimate source,” says a June 2020 FDA letter titled “Do Not Use Ivermectin Intended for Animals as Treatment for COVID-19 in Humans,” adjunct to an abstract by the Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia that concludes after clinical trials that showed the drug has SARS-CoV-2 viral-inhibiting properties: “Ivermectin therefore warrants further investigation for possible benefits in humans.”

Along the Beni-Santa Cruz road, in Santa Cruz’s Guarayos province, and serving an area that encompassed parts of Beni, the situation is critical. “The system has collapsed, patients are not receiving attention, all but one of the doctors are in quarantine because they have been infected,” relates Dr. Amada Daniella Gordillo Paz. “It is a desperate situation. It does not seem real. It seems like a horror film for all the things that are happening. People are dying. They are dying at home. Some get to the hospital already dead; others die of a heart attack for lack of air.”

At the Municipal Hospital in Guarayos, its director, Dr. Juan Carlos Aguirre has requested urgent help from the municipal government, but ten days later he is still awaiting a response. They need additional personnel, they need PPEs, masks, medicine. The most tragic thing besides the deaths, he says, is the lack of resources to acquire the needed equipment and supplies. Hospitals in as much as five hours away are full, he says, so the they must attend to even the most complicated cases that come in. They are seeing an increasing number of deaths in patients with base pathologies that are arriving at the hospital too late because they delayed seeking attention because of fear he says. And the COVID-19 deaths are increasing at a higher rate. “They deteriorate quite quickly; they come in, they need to be on a ventilator, and we don’t have them. We try to stabilize them, we want to let them know that we care, that we will do all we can. But complications develop rapidly, especially in diabetics, those with heart problems and the obese. When a patient has lost 70-80 per cent of lung capacity we intubate them with oxygen, but they are now asphyxiating. Panic sets in. It is exasperating. It lasts 3-4 hours. Great despair. There is not much we can do.”

A demonstrator during protests demanding that the government authorize the reopening of small businesses in La Paz, Bolivia | AP

The provincial government had organized brigades to go into homes and into all corners to search for the sick and dead, told Dr. Aguirre, but the effort had to be halted because the personnel is either in isolation or quarantine.

In Beni’s capital, Trinidad, the situation is horrible, says Park Ranger Ana Carola Vaca Salazar, director of the Beni Reserve Biosphere. When they could help those sick, they had to choose to use the ventilators on the young who they knew would survive and close the others off in a room with acetaminophen to die, she explains. “In Trinidad, and the populations of Guarayos, Riberalta, Guayaramerin and San Ramon people are dying in their homes,” said Vaca Salazar, “the medical system, the health system, the volunteers, everything has collapsed. Volunteers have gone back to their homes and gotten sick. One just died yesterday. In San Ramon, 70 per cent of the population is infected.”

In the roads between towns, it is a country in chaos, a war situation, says Vaca Salazar. Those bringing supplies are escorted from roadblock to roadblock to ensure no one gets out either for a sip of water or to go to a restroom. “Nobody wants anyone from outside. Supplies are delivered, sanitized, and the people are sent back.” There are people who want to come into the area, through roads, over hills, through the bush, swimming through the rivers, according to Vaca Salazar. People are organized to monitor the area, take videos, and sound the alert of a stranger or even a local returning from outside. The cattlemen provide food for those keeping guard. “It is rigid,” she says, “there are few cases in some areas, but there is a lot of fear.”

“Avei” is adios, goodbye in the indigenous Ava-Guarani language of the Beni lowlands. There, volunteer groups are trailing behind Guarayos. Their brigades are called Avei, they search for bodies in homes and the fields for a human and humane goodbye. People are overwhelmed. The government is overwhelmed. There are people across 12 million hectares of Beni wetlands.

In the Andean highlands things are calm, but the Bolivian tourist town of Uyuni is barren, reports Chris Sarage, the American owner of Minuteman Pizza. Pre-COVID Uyuni was a magnet to tourists of all walks, the super rich, and uber adventurers trekking to the world-famous Uyuni Salt Flats. “People are fearful,” says Sarage. Most of the tour agencies are empty to save on rent. The town has lived off visitors for years. He will keep his restaurant closed at least until next year. “Most of my staff went back to their farms to herd llamas and quinoa.”

In the capital, La Paz, ever the political center of the country coronavirus was not taken seriously at first, relates Vimal Menon of Mumbai. “People thought it was a political gimmick, but then they saw things gets serious elsewhere. They have been more disciplined in following recommendations.” Married to Bolivian hematologist and author Alicia Rodriguez, Menon has had a unique view of the crisis as the only Indian volunteer at the city’s blood bank. He has seen first-hand the difficulty of getting hyperimmune plasma donated as people would rather sell it than donate it. The city’s newspapers constantly offering to pay for plasma for stricken relatives raise the price of plasma from recovered COVID-19 patients to $500 and more, he said. The health system in the area is ready to collapse, worries Menon, but he sees people taking the threat in a more serious manner. People are afraid but they protect themselves more, wearing full PPE, masks, and keeping the distance, said Menon.

Back in the lowlands, fear rules: Rodriguez Quiñones comes back from the market and gargles furiously with hot water and bicarbonate, inhales “eucalyptus vapor, chamomile, and other of grandma’s concoctions” to ward off the virus.

Symptoms are as frightening psychologically as physically, says Barton. “The times I have felt a sore throat or tiny fever, I have planned out my dying, death and after events. No sneeze is forgiven these days. But we take vitamin D, vitamin C, echinacea, and propolis. We wear masks and intermittently gargle with alkaline water and salt water. We disinfect religiously to ease our fears.”

Because here you die in hospitals, said Kiehne.

Milan Sime Martinic is a writer and researcher. His debut novel ‘IRONWAY: Watching over Benjamin Hill’ has been translated into five languages.

https://www.theweek.in/news/world/2020/06/18/fear-and-dying-in-pandemic-enveloped-bolivia.html

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