El Salvador: Deaths increase as health system collapses

MSF's nursing assistant disinfects ambulance equipment in Soyapango, El Salvador.
El Salvador 2020 © Alejandra Sandoval/MSF
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San Salvador/New York, July 9, 2020—The health system in El Salvador is on the brink of collapse, with an increasing number of people dying from COVID-19 and other illnesses at home before they can receive medical care, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

On March 20, the Salvadoran government declared a state of national emergency, suspending primary health care services in hospitals and health units and imposing and absolute lockdown, preventing people from leaving their homes. Travel restrictions have since been lifted but outpatient consultations at hospitals and health units remain suspended.

“We are seeing an increase in the number of people dying in their homes before our ambulance services arrive,” said Luis Romero Pineda, MSF project coordinator in El Salvador. “Admitting patients to hospitals has also become more difficult. Worryingly, community leaders are reporting deaths in their communities, some of them related to the suspension of primary health care.”

MSF has continued to operate non-COVID-19 healthcare activities in the two most populated cities, Soyapango and San Salvador, which are now epicenters of the outbreak. In the eastern metropolitan area of San Salvador, an increasing number of people are dying at home. MSF is also hearing worrying reports about the situation in some communities in San Salvador and Soyapango.

"In many instances the patient had already died when we arrived at their house,” said Angel Sermeño, MSF’s medical activity manager in El Salvador. “In 2019, this happened to [our teams] 11 times from January to June. In the same period this year, it has happened 37 times—18 times in June alone.”

The main causes of death of these patients are related to metabolic disorders and respiratory and heart problems, which have increased fourfold compared to the first half of last year. Many of MSF’s ambulance calls in recent months have been related to respiratory diseases. In several cases, the ambulance was called when patients were already in critical condition.

The increase in people dying at home reflects the enormous strain COVID-19 has put on the health system. Not only has the lack of access to primary health care services contributed to the deterioration of the health of patients with chronic diseases, resulting in more deaths, but both the ambulance system and hospitals are operating at full capacity.

Wendy, a doctor working for MSF's ambulance service, said that some patients die while waiting to be transferred to a hospital. “We have to wait for authorization from the public health system to be able to move patients to a care center, since we cannot transfer the patient from [their] home without prior coordination and authorization from the public health system,” said Wendy.

In addition, the local and national governments don’t have coordinated detection and hospitalization mechanisms for COVID-19 cases.

Community leaders in the five communities where MSF provides primary healthcare in Soyapango and San Salvador report that since the emergency was declared, more than 50 people have died after showing COVID-19 symptoms or from a lack of treatment for chronic diseases.

Stigma and fear of contracting the disease are also delaying people from seeking medical care, sometimes with fatal consequences. Many people are afraid to leave their homes for fear of being judged for transmitting the disease or being taken away from family members if they are hospitalized. Some people cannot even afford a mask.

If a person does manage to get to a health facility, they are often turned away. Victor, a patient from Soyapango, told MSF that his grandfather has chronic health problems and has to have his catheter changed every few months. "We took him to a hospital in San Salvador where he was asked to go to one in Soyapango, and from there to another,” said Victor. “They have already told him that it is better not to go to get the catheter, that it is better not to go out, that there is no equipment to treat to him." 

"It is vital to improve coordination, increase the number of available beds [in health facilities] and ensure protective measures in hospitals to guarantee the safety of staff and patients,” said Romero Pineda. “[And] increase the response capacity of the emergency transfer services in critical cases. It is also essential to guarantee access to primary health care and improve case detection and follow-up to prevent cases from becoming serious, whether they are COVID-19 or not."

During the COVID-19 outbreak in El Salvador, MSF teams have continued to provide primary healthcare and mental health services in communities, as well as psychosocial assistance in detention centers for deported people, and expanded ambulance response capacity in support of the Salvadoran Medical Emergency System.