Emilio Yaser Pando Hernández, a family doctor who graduated in 2019, reports that at the outset of the Covid-19 pandemic in Cuba the shortage of doctors went unnoticed, but ultimately grew dire.
"Many people went out because they had children and such, in the case of women; other people got sick. At those isolation centers it got to the point where there was one doctor for a large number of patients," this young man explained to DIARIO DE CUBA, who worked providing care to Covid-19 patients in Havana before traveling to Madrid to study for a Master's degree.
The limited availability of doctors, Dr. Pando said, "has a negative impact on the quality of care. Even Havana, for example, sometimes asked other provinces for doctors, because we couldn't cope."
Regarding the means provided to protect him from the virus, the doctor explained that "unless you’re right at the isolation center, they don’t provide you with any type of protection. You have to fend for yourself for the consultations, the daily work, the duty shifts... those means of protection are up to you."
To work in the isolation center, they gave him "the green outfit, cloth masks, and caps," which the young doctor judged insufficient. "For this type of virus, I saw them as inadequate for the risk you are exposed to."
However, when it came to identifying what was most difficult for him while grappling with the Covid-19 pandemic, he did not cite the long hours, or the poor quality of the food provided. Nor did he identify infection due to the insufficient protection afforded by the means provided, as the worst aspect.
"What was most trying for me were the scant resources we had to care for the patients, because there were times when we did not have what we needed to give them in cases of Covid-related complications, whether it was because the country did not have them at that time. moments, or for whatever reason ..."
"There, being in the red zone, with patients of all kinds directly infected with the coronavirus, some who did not suffer from comorbidities (compounding diseases), and others who did, we had the same treatment for everyone. It shouldn't be like that; each patient should receive care according to the characteristics of their underlying diseases and how their condition is developing at any given time."
"It was very painful, I felt helpless to see patients deteriorating like that and not having the tools necessary to save them or help them improve quickly. There was a grandmother, one of the first patients I had at the isolation center, whose case made a real impact on me. She was a lady who was determined to live, but she had an underlying condition, heart disease, compounding her Covid. At times I did not have the medicines needed to help her, and the fateful day finally came when she passed away. I complained profusely about this issue because I saw my own grandmother in that bed," said Dr. Pando, who was even afraid to go home due to the possibility of being infected and spreading it to his family.
On social media many Cubans have voiced complaints that the official numbers of deaths from Covid-19, despite being higher and higher, do not reflect the actual number of deaths from the virus. Many relatives of victims of the disease have reported death certificates from doctors that erroneously record the cause of death.
Dr. Pando explained that these discrepancies in the reporting of deaths are due to a decision "that is out of our hands" and that involves reporting only the deaths "of those patients who did not present comorbidities."
"In the cases of all those patients who contracted coronavirus, and their base diseases worsened as a result, fatally, coronavirus was not indicated as the cause of death on the death certificate. Thus, these deaths are not put down to coronavirus, even though it was, in fact, the cause of their death, by aggravating their underlying condition. That was the method they came up with, and why the data announced on the news the next day was misleading."
The young doctor had to explain to relatives of his deceased patients why, even though they knew that their loved one had died from coronavirus, this was not the cause appearing on the death certificate.
"It’s a very awkward situation. What they told us to do is to put the direct cause of death. It's like trying to convince them that, even though he had coronavirus (their relative), he really died from his pneumonia, heart disease or diabetes. It’s a way of fudging the numbers, reducing the deaths from coronavirus," explained this young man, whom it pained to not tell the truth to the relatives of the deceased.
In his experience, no patient with symptoms was ever sent home, although the time came when there was not enough room in the hospitals or enough medical staff.
"Schools and universities had to be used. At first, patients who were symptom-free were sent there. Every so often during the week a doctor was sent to visit, but those people lacked daily medical attention; perhaps it was twice a week when (the doctor) could go. "
"Those who were sent home were patients who, despite being positive, did not present symptoms. There was no isolation center to put them in. They were to be monitored by the health area. If any other symptoms appeared, they were to be taken to an isolation center."
"It is true that there were cases of patients who tested negative using a PCR, went home, and died. I don't know the whole story about all that, actually. As with all serological tests, there can be false negatives and false positives."
"The community doctor's main job is to monitor those patients who are asymptomatic at home. That is the link in the chain that may break at some point, due, of course, to the lack of doctors to deal with the situation."