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Expulsions of university students and a climate of discontent, fear, and uncertainty are shaking Nicaragua’s healthcare sector following the implementation of new requirements for studying medicine and an order to psychologically evaluate younger doctors. The measures stem from a resolution by the Technical Secretariat for University Affairs, which establishes new criteria for admission and retention in medical school, as well as a directive from the Ministry of Health (MINSA) to conduct psychological evaluations of 3,742 doctors under the age of 35 working in the public healthcare system.
“There is a lot of tension in the universities,” says Jorge, a fifth-year medical student. “They are showing up in classrooms with lists of students to be expelled, taking them away, and forcing them to sign a document in which they renounce continuing their medical studies,” he claims.
Most of these young people never return to class, and “they left the university in tears,” the student explains.
“It Is Very Cruel” to Expel Them
Jorge believes it is “very cruel” to abruptly destroy the dreams and efforts of students from one day to the next. In his classroom alone, five classmates were expelled.
“It’s very hard (to be expelled), especially for someone who was about to complete their studies and begin their internships,” he says.
The young man knows of a student who was expelled because he left the university during the pandemic and, upon returning, had to retake some courses.
“It’s very unfair because he was already about to defend his thesis and begin his hospital internship,” he insists.
He considers it irrational to require a 90-point average and prohibit failing any course when, “for a long time,” the university was flexible with students admitted without meeting those requirements.
He also argues that teachers should be evaluated because “the quality has declined,” and many instructors are no longer specialists but rather newly graduated general practitioners brought in to teach classes.
Many Medical Students “In Limbo”
Javier, a second-year medical student at UNAN-Managua, says there is “a lot of fear” because “without any prior warning, they are leaving students without a career.”
“There isn’t even some kind of grace period giving students one last opportunity. They simply decided they have the right to make people lose all the time they invested,” he says.
A third-year medical student posted on social media that she is appealing to Technical Secretariat authorities because she failed a single course after missing an exam while hospitalized. “The university denied me a make-up exam. My academic record is impeccable (…) and now all I can do is wait for my fate,” she wrote.
A Lesson or a Smokescreen?
The measures announced by the regime of Daniel Ortega and Rosario Murillo were made public days after the widely publicized case of a young female doctor who was initially reported missing and was later found in a hotel in Granada after experiencing depression linked to family problems. The dictatorship announced her suspension while she completed her recovery process.
For medical students, the new rules require a minimum average grade of 90 points for admission, psychological and behavioral evaluations, and the requirement to “act with social commitment and be consistent with cultural and national identity.”
Meanwhile, in the case of doctors, the MINSA document states that personnel will be evaluated “to ensure the safety of patients and workers, as well as the quality of services provided.” Authorities say they will seek to identify “anxiety, depression, substance abuse leading to addiction, and risk of suicidal intent.”
Mauricio, a doctor at a hospital in southern Nicaragua, says there is “widespread dissatisfaction among both students and healthcare workers in the public sector because suddenly they have become more demanding, yet they fail to see that what is really needed is better training, which starts with better teachers. In the case of medical personnel, working conditions also need to improve.”
“First they publicly exposed our fellow doctor nationwide, and now they want to make it appear that they are concerned about our mental health. It clearly looks like a smokescreen to avoid discussing other issues that have been repeatedly denounced. Moreover, they are limiting the evaluations to those under 35, when depression affects all of us regardless of age,” he notes.
“They Want to Ignore How We Work”
Socorro has worked at a health center for more than ten years and says she has seen many people on social media celebrating the regime’s measures “because everyone wants better medical personnel.”
“It is understandable to want a better-trained generation and higher-quality care, but people ignore the fact that for years the authorities have cared very little about educational quality, while medical personnel are underpaid and mistreated,” she says.
She argues that it is unrealistic to expect healthcare workers “not to feel pressured” when they face surveillance, constant dismissals, staff shortages, long work hours, mandatory participation in partisan party activities, and other violations imposed by the Sandinista regime.
“There is a clear threat against doctors, while they pretend to ignore the conditions under which we work within the public healthcare system,” she laments.
“The Entire System Is Failing”
Edith notes that if the regime were truly interested in improving medical training and healthcare quality in Nicaragua, “it would have to make a complete overhaul.”
“Being an excellent doctor does not depend solely on grades. It also depends on the teachers who train them, the education they receive from their earliest school years—everything is interconnected, and we know that in our country those areas are in very poor condition,” the doctor emphasizes.
She believes that high standards should not apply only to medicine but should extend to all degree programs in the country. “But we know the entire system is failing. Better preparation is needed in primary and secondary education to begin with, and greater investment is needed in both education and healthcare,” Edith reiterates.
