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Nicaraguan Doctors in Shackles

Either spend ten years working for the Nicaraguan Ministry of Health, or “buy back your freedom” for the sum of US $61,700


Elthon Rivera Cruz

31 de marzo 2024


The famous philosopher Plato coined a phrase which – given the current situation – now resounds in the mind of the health professionals. For those of us who dedicate our efforts to bettering people’s health, his assertion recalls the nobility and dedication with which we should be doing our work. The phrase goes: “Wherever the art of medicine is loved, there is also a love of humanity.”

Plato’s words hold great truth, since the art and science of healing our neighbor is an act of love for life itself. However, for this to be manifested, one fundamental characteristic is needed: having humanity.  Not only in the sense of the person’s own nature, but also from the point of view of the emotions – those elements that allow us to demonstrate compassion, solidarity and empathy. Lacking these, you can’t love medicine, since there’s no love for humanity itself.

Without framing this reflection in excessive romanticism about the profession, it’s understandable then that those of us who take the step of entering the service of medicine accept that we’ll be dedicating a large part of our lives to our preparation. It’s no secret to anyone that to achieve the crown of a medical degree requires around six years of study in most of the world’s countries. In countries like Nicaragua, we must add on two years of social service, and later between three and five years of specialization. That means that a specialist in a medical field has spent at least ten years preparing, and depending on their profile, it could be more. A large part of our youth is lost in the universities and hospitals, not to mention the entire process of continuous professional education we must engage in, to stay abreast of the new advances and problems in health.

It’s fair to say, then, that after so many years, these doctors have earned the freedom to decide the manner and the place in which each one wants to exercise their career. We should also take into consideration the fact that all those years of preparation aren’t well remunerated, and their pay is nowhere near proportionate to the workload assigned to the residents in each specialty. It’s likewise no secret that in Nicaragua the health profession is seriously exploited and mistreated.

Nonetheless, now the Sandinista government led by Daniel Ortega and his partner has taken one more step in their policy of repression against all the social and professional sectors – they’ve imposed a new rule that doctors wishing to enter a residency program must sign a contract obligating them to serve up to ten years in the public system before they can be released with their specialist’s certification. Those who don’t wish to do this – doubtless the majority – must pay more than US $61,700, an impossible sum for a Nicaraguan, given the economy.

It’s outrageous that those who’ve stepped forward to protect the health of the population, instead of receiving incentives and gratitude for their labor, are left essentially chained to the Health Ministry. The policy turns them into game pieces on a board, pieces that the government can move anywhere at any moment, and for the period of time they feel like, thus rendering invisible the desires and needs of each doctor. This can be compared with the era of slavery, when the options were forced labor or buy your freedom. The Sandinista regime is putting leg irons on the new generations of Nicaraguan doctors, for a period of ten years, with the appalling alternative of “buying their freedom.” Once more, the Sandinista Party is demonstrating their little or no respect for human dignity.

With these actions that violate the doctors’ rights, they’re crushing the dreams of these health professionals. Because for many the dream of medicine isn’t really complete until they’ve attained a specialty. In addition, they’re taking advantage of the economic needs of these health professionals, since in a country like Nicaragua, the salary of a general physician leaves a lot to be desired and if you want to command a decent salary, you have to be a specialist.

For the health sector, this adds another action by the state against health professionals. Let’s remember that attacks against the medical field are nothing new in the country. In the context of the sociopolitical crisis alone – which will mark six years this coming April – we could mention such grave transgressions as the expulsion of dozens of medical students from the university for opposing the government, cases I know well, since I’m one more of them. The firing of doctors from all the specialties for having cared for those wounded in the context of the 2018 demonstrations; and those later expelled from their workplaces for speaking out about the reality of the Covid-19 pandemic that Ortega tried to hide; and, finally the firing of medical faculty in the universities.

All this can be proven beyond my words – it’s enough just to review the data from the Inter-American Commission for Human Rights, where you’ll find alarming numbers. For example, in the latest informational bulletin published by the OAS Special Monitoring Mechanism for Nicaragua, corresponding to the period from August – November 2023, they estimate over 400 firings of health professionals. We can add to this the number of doctors that find themselves forced to leave the country due to political persecutions, or who are directly expelled and banished.

We might ask ourselves what it is that the regime is pursuing with these actions. However, in reality, we already know: total control over the institutions, the professions, and even the people. They know that the medical field is very important, and they have to control it and manipulate it to avoid any kind of insurrection. Let’s recall that after April 2018, the Ortega government was left traumatized, even more so than they already were. Ortega knows that the doctors who want to become specialists will have to keep their mouths shut and obey, to avoid being stripped of their specialty. In addition, the administration of the country is failing ever more – many people migrate because they’re fleeing the chaos that the Sandinista government has created. The best idea the dictatorial couple can come up with is to chain up the doctors with that terrible contract that forces them to stay in order not to lose their medical residency.

It’s not enough to say that this is worrisome – it’s beyond alarming, and a clear sample of the progressive deterioration of freedom in Nicaragua. The government’s steps towards Cubanization are more than clear. The universities, civic organizations, churches and now the medical sector are being swallowed up and transformed into clay that can be molded to any shape the government finds convenient. Given the historic experiences of our country, it’s clear that what’s convenient for the red and blacks is gravely harmful to society.

Not everyone manages to understand the work of medicine beyond a scientific and professional vision. It’s evident that the authoritarian regime that’s governing Nicaragua doesn’t comprehend it at all. The Sandinistas, who lack a sense of humanity by any measure, have committed among other cruel crimes the act of pointing their guns – physically as well as figuratively – against the health field.

We’re left here to wonder: What will happen now? Will this strategy work? Sadly, we can’t discount the fact that it might prove useful to them, but neither can it be denied that these are counterproductive acts. Measures that smother the medical sector aren’t convenient for the Sandinista doctors either. The regime adds more repression, but this same pressure produces the resistance of a population that yearn ever more deeply to have Ortega and Murillo out of political power in our country.

Finally, I can’t leave out the reminder that this doesn’t only affect the health profession, but all the Nicaraguan people. There’ll be fewer doctors willing to tie the noose this contract represents around their necks, but instead will do everything possible to leave the country and study outside. Many, perhaps, will end up staying there, outside Nicaragua, where their labor is valued and respected. Or else, they’ll simply opt to remain in Nicaragua as general doctors. The equation is simple – the less highly qualified human talent in the hospitals, the lower the quality of the medical attention. Given this, the resistance against these actions shouldn’t be a matter only for the health professionals, but for all of society and the international community. I wish I could tell you the when and how of such resistance in this reflection, but unfortunately, like many of you reading this – I don’t know.

This article was originally published in Spanish in Confidencial and translated by Havana Times


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Elthon Rivera Cruz

Elthon Rivera Cruz

Estudiante de Ciencias Políticas. Antes estudió Medicina en la Universidad Nacional Autónoma de Nicaragua (UNAN), de la que fue expulsado por su participación en la Rebelión de Abril de 2018. Se dedica a la investigación social con enfoque en educación superior y derechos humanos a la educación, y derechos de los jóvenes.