You just need to dig a little on the surface of the internet to come across a kind of prophecy: reports, films, interviews, novels, documents and non-fiction books that, from a few months to several years before the first news about the new coronavirus, anticipated the imminent arrival of a pandemic - in some cases with a surprising level of precision - and warned that the world was not prepared to face it. Both things were true. But it did not help much.
Even with the pandemic on top, when the news from Asia and Europe allowed us to see what was coming live, most of the governments of Latin America were only assuming reality by force of blows, going from unjustified optimism (
the virus is not so contagious in hot climates
) to denial (
no more serious than the flu
) and resignation (
no country was prepared
), to end up in the same place where they all ended up: calling health personnel "heroes" who, until recently, demanded them for the most elementary protection supplies, and who had to bear the political errors of the present and the past . It didn't matter whose fault it was: when push came to shove, the responsibility of facing the virus fell on their shoulders, as did the lack of resources and the fragility of the health systems in the region.
How has this experience transformed the work of health personnel? Has your outlook on your tasks and professions changed? What will not be the same after the pandemic? Who are the people who today, after having seen how the world applauded them for their courage in “the front line of combat” but treated them like cannon fodder, want to dedicate themselves to caring for others?
These are some of the questions that guided the work of a team of editors, designers and illustrators from different countries in the region, who were selected by El Surtidor to be part of Latinográfica, a collaborative initiative to promote visual journalism from Paraguay.
In alliance with EL PAÍS América, the nine Latinograficas scholarship recipients set about searching, producing and illustrating the stories that make up this special, following the slogan of a famous phrase that the Ecuadorian writer Jorge Enrique Adoum once found in the streets of Quito: "When we had all the answers, they changed our questions."
"The way we see patients will no longer be the same"
Pedro Guevara, physician,
26 years old (Placetas, Cuba)
For Piter, as his friends know him, the worst day of the pandemic was also the one that made him feel like “the proudest doctor in the world”: he was on call at a field hospital with four seriously ill patients who needed oxygen, but only there was a bomb. Desperate, the young doctor broke his stethoscope and used the “Y” shaped hose to allow two patients to breathe at the same time. All four patients survived.
Pedro Guevara had graduated as a doctor less than a year ago when he became the “hero of the stethoscope” in networks, in August of this year. When the pandemic escalated, he was first called up for a national mission in Havana. He had to leave his wife and one-year-old daughter alone in Placetas, a city in central Cuba, to find the impact of the disease. After a while he returned to his city and went to work in the high-risk ward of a field hospital 24 hours a day, with ten beds in charge, and did everything possible to save the patients despite the supply shortage.
The pandemic, Píter believes, turned out to be stronger than health. More than 7,500 Cubans have died as a result of covid-19, the severity of which was multiplied by the precariousness and resource limitations that already existed on the island before the pandemic. The virus also proved to be stronger than his own health: 26-year-old Piter became infected, developed a serious illness and had to be hospitalized. "The pandemic made us more sensitive," he says. “Now I look at the patient with more affection, also for having been in his place. The way we see patients will no longer be the same, I think the link has become closer. "
Piter hopes the change will be reciprocal.
During the pandemic, the population saw that the work of doctors is a challenge, that they risk their lives daily and, at the same time, put the health of their families at risk.
The pandemic affected everyone and showed that there are people who would do anything for the lives of others.
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"I cannot imagine an epidemiologist who does not know a little communication"
Zulma Cucunubá, epidemiologist,
35 Years (Bogotá / London)
At the beginning of 2020, Zulma Cucunubá's WhatsApp began to fill with messages from friends who knew her work: “Is this a manufactured virus? We are going to die? They asked me very funny things and I answered them, but at one point it was exhausting, ”recalls Zulma, who is an infectious disease epidemiologist and works as a researcher at Imperial College London and the Department of Epidemiology at the Javeriana University, in Colombia.
As the news grew more alarming and doubts were reproduced at the same speed as misinformation, Zulma found a way to communicate what he knew to everyone at once: Twitter. In January 2020, two months before the World Health Organization (WHO) declared the pandemic, she wrote a thread of explanatory tweets about the origin and direction of covid-19, with emojis and links to articles describing how science developed in real time.
"I had to remove the notifications from the cell phone because that exploded and I think it was because in Latin America no one, up to that point, had written anything or made many statements," he says. I was worried. She knew that the region was not prepared for a pandemic, but she worked hours collecting information to analyze and then fulfill the outreach work she had undertaken. "It was very rare that role of communicating without frightening, but without diminishing the importance of what that was," he says. Finding themselves in that same dilemma, the WHO asked the scientific community to enter social networks and begin to report.
"Several Internet greats, such as Twitter and Google, made this alliance with the WHO, to put the official contents of health entities first," he explains, "and on Twitter the option was to certify scientists, so that our opinion would weigh more than influencers. We became authorized voices, if you will, on the networks ”. Along the way, he began to reflect on the importance of a more multidisciplinary epidemiology, because, although he works with public health, mathematics, immunology, biology and engineering, it is necessary, for example, to involve the social sciences.
"I cannot imagine an epidemiologist who does not know, at least, a little of communication", he enumerates, "of economics to understand the society in which it operates and of anthropology to understand how to put that information into the mathematical models that we make ”. It is a matter of seeking more diversity, he says, of gaining more contributions and more methods, of "bringing in more women, more communities and minorities."
Zulma believes that one of the keys to preparing for the future is to start educating in epidemiology from school, since they should not be considered knowledge reserved for the scientific community.
And also train resilience.
“For this pandemic 15,000 Intensive Care Units (ICUs) were needed and if 40,000 are needed for the other, what are we going to do?
That resilience is given by adapting and being flexible.
What does having a backup mean?
Having more people trained than is ultimately needed.
I would summarize that preparation is based on planning to be resilient ”.
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“The opportunity to make a mistake with a patient was lost”
Laura Catalina Londoño, nursing student,
23 years old (Manizales, Colombia)
On March 7, 2020, Laura Catalina Londoño was chatting with her fellow practitioners and had coffee at a patient's home in Villa María, a town near the city of Manizales, when a teacher who was accompanying them looked at her cell phone and announced news: the first case of coronavirus in Colombia had been confirmed. Nine days later, although no infection had been reported in his city, the country went into quarantine and studying became a challenge.
Laura is in the seventh semester of nursing and has attended three virtually. He had to learn about diabetes, hypertension and even surgery through a screen. He has not been able to do his clinical practices at the hospital. His teachers have juggled to teach him: they have made their own homemade models of organs out of cardboard or plasticine, they have drawn some mechanisms of the human body and used mannequins to explain how CPR is done.
But Laura believes that human contact is irreplaceable: “You don't really see what a person with advanced diabetes looks like. That in a certain way makes us a bit dehumanized, in the sense that we are no longer really going to realize how a person is affected not only physically, but also in the social, family and emotional spheres ”. For her, these gaps in training will be the main challenge that the nurses of the future will face. It is a constant topic of conversation with your peers. "There are students who are in the seventh semester and do not know how to channel a vein, they never had the opportunity," he says. "We missed the opportunity to make mistakes that we students have: make a mistake with a patient, in a diagnosis, to ask questions and have a superior to answer us."
During the emergency, Laura worked as a volunteer in the organization of the epidemiological fence at her city's airport and taking calls from her home.
He also became involved in representing the students of his faculty.
Thus, the pandemic transformed her vision of nursing: it taught her that her profession goes far beyond assisting patients in the hospital.
“I realized that nursing has the power since long before the disease to control a little the high occupancy rates in hospitals and repression in health services.
I understood that if I teach people to make positive decisions before they get sick, I am helping health systems stop having such poor service in the future, because there are many people to attend to ”.
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"Telemedicine is here to stay"
Henry Cohen, gastroenterologist,
66 years old (Montevideo, Uruguay)
“It is better to spend a minute more than one less, one more smile than one less and always be accompanying the patient.
I learned that in 40 years as a doctor, but it was never more experienced for me than this year and a half ”.
This is summarized by Henry Cohen, a renowned gastroenterologist and health coordinator of the Honorary Scientific Advisory Group, which advised the Uruguayan government in the management of the pandemic.
This group made up of more than 50 scientists from various branches published analyzes and recommendations on the virus in almost real time amid uncertainty due to the lack of scientific evidence and worked to strengthen the intensive care centers in Uruguay. Several times they used football metaphors to explain scientific information to people. “One of the virtues of the pandemic, or where you find most positive things, is in the relationship between scientists. The contract is with science, so this democratization of access to scientific information is very important ”, he explains.
Since 2014, Cohen has directed ECHO Uruguay, a project in which medical specialists provide virtual advice to general practitioners and health personnel in rural areas to diagnose and treat complex diseases. During the pandemic, the project served to share knowledge about the coronavirus with colleagues from other countries.
In his words, "one of the lessons learned from the pandemic is that telemedicine is here to stay." The need to decongest hospitals made it possible to think that it is not necessary to go for any ailment. “There are some who think that just as we go to the bank less than before, it would also be good for people to go less to hospitals, to stay for really valid situations. This comes together with what would come to be a paradigm shift in health: that it should be less focused on the curative and more on the preventive ”, he says.
For Cohen, this medicine of the future requires doctors with new skills from other disciplines who, of course, do not forget the human importance of their profession: “We have to teach a number of things so that new doctors can adapt to this situation without leaving to understand that due to more artificial intelligence, due to more big data, holding the hand of a patient and giving a companion or relative a hug will always be very important, and nothing will replace it.
Our contract is neither with the mutual insurance company, nor with the health administrator, nor with the hospital director: it is with the patients ”.
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"If we do not reach the community, we are arriving late"
Belén Ramírez, humanitarian doctor,
42 years old (Paraguay)
Belén Ramírez believes that if with the pandemic it has not been learned that in health it is necessary to work from the territory, no more is learned. For eleven years he has worked for Doctors Without Borders and during this time he had the opportunity to visit countries such as Yemen, Nigeria, Sudan, Guatemala and Colombia to treat diseases such as cholera and measles. But it was Ebola that best trained him to face covid-19 in Paraguay. "With the great Ebola epidemic in 2014 we understood that if we do not reach the community, we are arriving late."
He planned to return to the Congo in 2020, but decided to change his mission when he learned of the first cases of Covid-19 in the region. “I chose to work in my own country out of fear. There is my most vulnerable world, my family ”, he says. He had to go through the pandemic in months when little was known about the virus. But he dedicated himself to doing what he does best in these situations: arriving at a place, looking at it, understanding it, evaluating, proposing and implementing. He visited hospitals and shelters throughout the country, spaces set up by the State where Paraguayan migrants fleeing the explosion of cases in countries such as Brazil, Argentina and Spain had to do mandatory quarantine and who hopefully had soap and water. In those places, he made sure to establish minimum biosafety protocols with the people. But it was not easy.
Belén says that several times in her evaluations she suggested that health promoters be located where they were needed.
But they repeatedly told him that they did not count on such people.
"Who explains to people how to take care of themselves if there are no health promoters?" He says.
Thinking ahead, she is sure that this role must be strengthened.
“We need to train health personnel from the university in epidemiology, infection control and prevention, hospital management.
We need to put a lot more emphasis on nursing.
The nurse played a crucial role in the pandemic.
And we need to put a lot of emphasis on what primary health care is, ”he says.
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“If the patients are well, the health personnel are better”
Ivo Corbalán, ambulance driver,
21 years old (Santiago del Estero, Argentina)
The first song that Ivo Corbalán sang to Carlos Oviedo, a patient who was in intensive care, was a classic by Sandro de América: “Your crimson-red ruby lips seem to murmur a thousand things without speaking. And I who am here, sitting in front of you, I feel myself bleeding without being able to talk ”. Ivo did not know that patient, but encouraged by the director of the health center where he works, who knew about the bad personal and work situation of the patient, he sang the song on the other side of the door of the room where he was isolated. For a moment, Carlos smiled again and waved his hands in time to the music.
Ivo began to be an ambulance driver at the Mama Antula Health Center in an unexpected way.
He used to work as a driver for a media outlet, but was unemployed months before the first covid case in Argentina and found a place in this care center in Santiago del Estero that was so new that it did not even have staff, but that ended dedicating itself exclusively to the treatment of patients with covid.
When the pandemic began, he was a beginner in the area of health, but he did not hesitate for a second to continue in Mamá Antula.
"At 21 years old, what do I have?
I have the strength, desire and will to work and to put my chest to this bullet.
That is why I have come forward, to drive the ambulance and to collaborate in whatever way I can, ”he remembers thinking when his bosses asked him.
Ivo is an evangelist and sings Christian songs, he loves doing live broadcasts on Facebook where he encourages and plays music for his friends. And in his work he managed to integrate his passions: he sings when he washes the truck, plays the announcer while transporting patients to encourage them and sings to keep them company at the health center. He remembers, for example, how he encouraged Rosario, a woman who had to take to the center for a tomography, doing the voice of an announcer: “We are listening to the music that continues to be played here through Radio Nacional. We greet our patient Rosario, who is there listening to the radio as always, as every afternoon. We also greet the entire Mama Antula Health Center. Thank you very much for being on, girls, greetings to all, handful of kisses for all ”,account he said while driving the ambulance.
But while he drives, he says, he is focused, never nervous, even if he has to go fast and with the siren on.
He is aware of the importance of the lives he leads to the hospital.
“Patients must be treated as a loved one, as a relative, as a brother, as a friend, as something of the best.
So that they feel well accompanied.
If they are well, the health personnel are better ”, he says.
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"The doctor cannot live in a sea of tears all the time"
Sofía Rondón, medical student,
24 years old (Caracas, Venezuela)
Sofía Rondón, who voluntarily attended the maternity area of the Central Hospital Dr. Miguel Pérez Carreño in Caracas, was, like everyone else, afraid of being infected. Rather than developing a serious illness, what he feared was infecting his family. Still, he was surprised to see the reaction of some healthcare professionals when they encountered a covid case at the start of the pandemic. "They saw a positive patient and they screamed, they ran, they left the hospital and I thought: 'The patient is there, he is listening to you.'
Sofía believes that the least a doctor can do is empathize, but that it is necessary to find the fine line between putting herself in the shoes of the patient and being involved with their pain. The pandemic brought suffering, but the doctor "cannot live in a sea of tears all the time," he says. In Venezuela, which officially registers some 5,000 deaths from covid - a figure that could be five to seven times higher, according to researchers - the situation has been exacerbated by the lack of supplies. There are not enough beds or high-end equipment, basic medicines were in short supply and biosafety items were rationed.
“Patients are seen when there is space, but they have to bring ampoules, antibiotics, solutions, because sometimes there are and sometimes not. And if the patient or family member does not bring it and the doctor cannot get it, sometimes he takes it out of his pocket, "he says. With the pandemic, Sofia saw that the idea that being a doctor is synonymous with saving lives was just an idealization. Even when the patient had an ICU bed, staff and medical supplies at their disposal, it might not be enough to beat COVID-19. "Sometimes it does not depend on you, but on the patient's body, if it responds to treatment, or fate, the will of God, whatever it may be."
However, at no point did the pandemic erase her desire to continue her studies and become a doctor.
Even amidst the chaos, she never thought she had chosen the wrong profession or was afraid to work in a hospital.
Instead of running away, he wanted to study more and more.
And that didn't just happen to Sofia.
He says his college peers and hospital residents had the same impression: The pandemic reinforced his desire to continue studying medicine.
Some even decided to stay in the country, which is experiencing an exodus of health workers due to the economic crisis and political repression.
“Many told me: 'I'm not going, I'm staying, there is still a lot to do here'”.
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"The doctor can no longer simply be someone who sits in front of the patient"
José Maria Malvido, infectious disease specialist,
44 years old (Buenos Aires, Argentina)
José Maria Malvido, a 44-year-old Argentine infectologist who lives in Buenos Aires, had just separated when the pandemic began.
As the process was just beginning, the visitation arrangements for her children had not yet been decided.
The court understood that he belonged to a risk group, as if it were an eternal suspicious case, and prevented him from seeing them.
There were seven months of pandemic in which Malvido mainly followed the growth of his 2 and 4-year-old children by phone.
In order not to think too much about his situation, he focused all his attention on the pandemic. He worked from Monday to Monday as chief of operations at the Alberto Balestrini public hospital in La Matanza, located in a poor and overcrowded area in the province of Buenos Aires. The hospital had only been in operation for six years when the pandemic began. The team, which did not have much experience or training, faced an unforeseen scenario. "It was very difficult that period between having to send people to do things, managing Interdisciplinary teams and still not having the trust of the same people to whom you are giving directions."
Malvido also worked in a private clinic and gave virtual classes but, as if all that were not enough, he decided to start a diary together with a colleague to compile everything they were experiencing. The newspaper, published on Instagram (@detrasdelosbarbijos), not only served as a form of distraction: it fulfilled the role of improving communication within the hospital itself. Employees read the stories posted, saw their names included, and felt they were working together against the virus.
It is not surprising, therefore, that Malvido believes that the pandemic put value on interpersonal attention.
During his work, he witnessed, more than once, a video call between a family member and a patient, who sometimes drew the necessary strength to fight the disease again.
He himself often found himself calling patients to check how they were doing, and believes that virtual or telephone follow-up should be increasingly common in care.
“The doctor can no longer just be someone who sits in front of the patient.
You have to break the dynamics of shifts to two months and be more aware of what is going on around you.
It was clearly observed that accompanying people is not the same as seeing them once and never hearing from them again ”.
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“For having risked our lives, now they call us 'doctors'”
Omar Casanova and Isabel García, health promoters,
28 and 29 years old (Comcaac Nation, Sonora, Mexico)
The third death from covid-19 in his community surprised Omar leaving a fishing camp.
While rearranging the nets, she learned that the lack of medical care had led to another death in less than ten days.
So he quit his job and went to the rural health center to try to do something.
“It was not an option to see people die,” says Omar Casanova, a 28-year-old young man who currently works as a health promoter in the Desemboque de los Seris, a town belonging to the Comcaac Nation, isolated in the middle of the desert and facing the sea in Sonora, northwest of Mexico. Despite not having sufficient preparation, medicines or protective equipment needed in the small clinic, Omar and Isabel García - his 29-year-old partner - managed to protect a community of fewer than 400 inhabitants during the pandemic. None had official academic training: they were a fisherman and an artisan who were interested in the health of their people.
“Teníamos un conocimiento nulo de la covid-19 y también de la medicina, aunque sabíamos lo más básico”, explicó Omar. Fueron capacitados como promotores de salud en la prevención de enfermedades crónicas como diabetes e hipertensión por el médico que contrató la Secretaría de Salud para atender a la gente, hasta que él mismo se contagió y tuvo que irse. “Ya estamos aquí, vamos a buscar la manera de parar esto”, dijeron entonces, y se quedaron a hacerle frente a la pandemia.
Durante meses estuvieron solos, porque la ayuda del Estado llegó tarde. Pero lo que hicieron —mal o bien, dicen— les entregó la confianza de la gente. “Por haber arriesgado nuestras vidas, ahora nos llaman ‘doctores’”, cuenta Isabel, quien logró combinar el uso de la medicina occidental y la medicina tradicional utilizando hierbas del desierto, infusiones con agua de mar y otros métodos que ayudaron a sanar las vías respiratorias de los enfermos cuando no había medicamentos.
“Queremos ser utilizados como herramienta, que nos den acceso a los hospitales y se apoyen en nosotros para acompañar el proceso de las comunidades, en su lengua, que nos den el crédito que necesitamos y nos empleen como debe de ser, para crecer y trabajar”, dice Omar. Hasta hoy, ambos comparten un solo contrato de la Secretaría de Salud: tienen que dividir en dos el suelo para una sola persona. Al miedo ya lo perdieron hace meses. Solo les preocupa que la comunidad siga siendo ignorada, y no poder contar con el apoyo suficiente para su gente y para ellos.
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“La pandemia demostró que hay muchos curanderos”
Otávio Mariano, estudiante de medicina
(Campo Grande, Brasil)
Más de 35.000 estudiantes brasileños aseguraron un lugar en el competitivo examen de ingreso para estudiar medicina en 2018. Para ellos, el camino próximo estaba claro: los dos primeros años serían de estudio teórico, los dos años siguientes —2020 y 2021— iban a estar marcados por la experimentación en diversas áreas médicas a través de clínicas y, finalmente, en los últimos dos años, llegaría el momento de hacer un internado. Pero no fue así como resultaron las cosas.
Otávio Mariano, uno de los 80 estudiantes que ingresaron en 2018 a la carrera de medicina en la Universidad Federal de Mato Grosso do Sul, cuenta que acababa de comenzar las clínicas de cardiología y neumología cuando estalló la pandemia en Brasil. Se interrumpieron las clases prácticas y la enseñanza se volvió remota. Toda la experiencia prevista para el tercer año de Medicina (neurología, ortopedia, psiquiatría y otras áreas), se restringió a libros y profesores.
Cuando volvieron las clases prácticas, en 2021, la universidad decidió resumir todas las clínicas afectadas: el tiempo normal, de dos meses y una semana, se convirtió en un mes. “Perdimos la oportunidad de ocasiones en que el residente o el médico se cansa de hacer un determinado examen y termina enseñando a un alumno a ganar tiempo. Cosas así, si no tienes la oportunidad, nunca lo volverás a hacer porque te vas a otra área. Y luego, cuando te conviertas en médico general, no tendrás el coraje de hacerlo porque nunca lo hiciste ”.
Otávio cree que, además de los problemas en la formación, la pandemia ha afectado a la medicina en su conjunto, porque ha minado la idea de que el médico tiene el control de la situación y que siempre tiene la razón. “La pandemia demostró que hay muchos curanderos. Entonces creo que el médico ha perdido un poco la credibilidad y la gente lo cuestionará más”.
En enero de 2022, si nada más se interpone, Otávio comienza su quinto año de medicina y, con ello, su internado. Sin embargo, después de todo lo que ha sucedido, se siente más inseguro de lo que le hubiera gustado: “Siento que si no hubiera surgido la covid-19, ahora estaría más seguro para servir con más claridad y confianza. La pandemia me quitó la experiencia médica. Creo que sin ella estaría más seguro para tratar a los pacientes, saber hablar con ellos, calmarlos”.
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“Necesitamos reflexionar nuevamente la solidaridad”
Vivian Camacho, directora general
de Medicina Tradicional de Bolivia
Vivian Camacho piensa que la lógica de que “solo el pueblo puede ayudar al pueblo” fue clave para salir adelante en la pandemia. Por eso los saberes ancestrales y la medicina tradicional cobraron una nueva relevancia en este tiempo. ¿Y cómo no, sostiene, si en las comunidades indígenas de Bolivia no había siquiera una aspirina para atender a los enfermos?
Vivian tiene una doble formación en salud: la occidental-académica, como una cirujana que se especializó en Bélgica, y otra tradicional como mujer partera de la Nación Quechua en Cochabamba, Bolivia. Durante la emergencia sanitaria, ella se dedicó a organizar talleres, compartir sus conocimientos y escuchar las experiencias de otras personas: habló de plantas, de sus usos y de preparados sencillos y de bajo costo que podrían ayudar con algunos síntomas del virus y de otras enfermedades. “Nuestros saberes están ahí vigentes, están ahí vivos”, explica, pero el menosprecio del saber campesino, la estigmatización, ha llevado a que “muchos de nuestros abuelos y abuelas no solo no comparten el saber, sino que a veces lo esconden”.
“La salud se construye en democracia”, sostiene Vivian: “La salud se construye con justicia social y con dignidad para el pueblo. Necesitamos reflexionar como sociedades, nuevamente, la solidaridad. El sistema de salud tiene que ser para todo mundo, no puede ser que nos quedemos sin atención, muriendo en la puerta de instituciones por no tener dinero”. Esto es una vergüenza, dice, pero tiene que acabar en algún momento, aún cuando quede mucho por andar.
“Universal, público y gratuito”. Con esas tres palabras, la actual directora general de Medicina Tradicional del Estado Plurinacional de Bolivia deja clara su visión del sistema de salud al que, esencialmente, los pueblos indígenas y “los juzgados” —es decir, la gente pobre que no podía mantenerse en aislamiento por la necesidad de trabajar y sobrevivir y que encima fue criminalizada— deberían tener acceso, con un enfoque desde el territorio, desde las comunidades organizadas.
"Decolonization for me is to look again with affection who we are and where we come from," he concludes.
“Recognize that we are peoples who, despite all the pain, have preserved profound beauty, profound wisdom and that love for life that continues to pass from one heart to another, that love that our grandparents and grandmothers have dreamed of so that we do not mistreat as they have been mistreated.
In the trench that we have to be, we will continue to accompany, we will continue to build popular health, we will continue to wipe away tears, sweat and say let's move on, we have to resist, we have to be strong together ”.
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