Nicaragua's health care looking sick


By Sue Medlock

Seven hundred children died in a single measles outbreak in Nicaragua this year. The worst outbreak of this disease in years was primarily due to the fact that many children had not been vaccinated.

The immunisation program had been disrupted because the new government refused to transport health workers to the villages. In the end, it was left to the Sandinista Army to step in and organise the transport. But according to Leonel Arguello, an epidemiologist with the Nicaraguan Ministry of Health between 1979 and 1990, some parts of the immunisation program were "a disaster" because many children were not vaccinated in time.

These are among the effects of President Violeta Chamorro's coalition government, which came to power in April 1990 promising to cut public expenditure. The health budget has been one of Chamorro's targets, winding back the incredible gains of the Sandinistas and the Nicaraguan people over the previous 10 years.

Before 1979, under the repressive dictatorship of General Anastasio Somoza, social services were virtually unknown to peasants and workers. Many people had no access at all to health care. Ninety per cent of medical services catered for only 10% of the population.

The revolution brought about a reversal. The Sandinista government saw the provision of democracy as more than simply holding elections, but embracing wider humanitarian issues. "Democracy also means offering education, health and housing to the people", said former President Daniel Ortega.

During its 10 years, the Sandinista government implemented programs which eradicated polio and dramatically reduced the incidence of measles, malaria, tetanus, diphtheria and whooping cough. It opened nearly 100 health centres and 266 health posts in cities and rural centres.

In the April 6 issue of New Scientist, Phyllida Brown reports that the new Chamorro government has cut the health budget to almost half of its 1989 level. The results for the people have been that previously free medicines for children must now be bought, drugs and other supplies are running out at clinics and that public transport to health clinics has become increasingly expensive because transportation subsidies have also been withdrawn.

According to Arguello, growing poverty has once again led to widespread malnutrition. He says that people are now being forced to choose between medicines and food.

The decline in infant mortality in Nicaragua during the 1970s and 1980s was spectacular. In 1986, after only seven years of social health programs under the Sandinista government, the rate of infant 61 per 1000 live births. In neighbouring Honduras, 180 babies die for every 1000 born alive.

Since the election of the coalition, the infant mortality rate has begun to soar, and health workers are placing the blame at the feet of the Chamorro government.

Arguello is now working for an independently funded AIDS education program in Managua. His view of Nicaragua's ability to fight the increasing threat of HIV is grim. In Honduras, with its United States military bases, there are more than 300 cases of AIDS. So far in Nicaragua there are only seven reported cases of AIDS and a similarly low incidence of HIV-positive people.

But Arguello predicts that HIV will soon become much more widespread as a consequence of declining standards and accessibility of health care, and the increasing incidence of prostitution as the unemployment rate among women rises.

Health education, perhaps the key weapon in the fight against AIDS, has also been targeted by the Chamorro government. In schools, which under the Sandinista government emphasised the development and improvement of the physical health of the learners, sex education has now all but disappeared. This has occurred since the appointment of a Catholic traditionalist as education minister. The leader of the Catholic Church, Cardinal Miguel Obando, has publicly spoken out against the use of condoms.