Battle cry of better pay: Nicaraguan physicians' strike enters sixth month

Since November 2005, physicians in the public health system in Nicaragua have been striking for better pay, leaving many Nicaraguans struggling to find emergency care after being turned away from public hospitals.

U.S. doctors who have been on volunteer medical missions to the country during the five-month strike have seen the action's effect on access to care and the well-being of patients and physicians.

"They were significantly shut down. They were only doing emergency cases [in hospitals]," said James P. Spaeth, MD, director of cardiac anesthesia and associate professor of clinical anesthesia and pediatrics at Cincinnati Children's Hospital Medical Center.

Dr. Spaeth was in Nicaragua in January, a trip he planned before the strike. He volunteered for two weeks at a public hospital in the country's capital, Managua.

Retired orthopedic surgeon Howard Vesser, MD, was on a volunteer mission in February and said some surgeries were being put off until the strike ends. "Some things that needed surgery were put in casts," said Dr. Vesser, medical director of Community Medical Care Center in Leesburg, Fla.

Nicaraguan orthopedic surgeon Dr. Dino Aguilar said medical residents make $200 a month and specialists earn $400 a month. He said the public health system is hampered by the strike, which the Associated Press said involves 2,000 public health doctors and 20,000 other health care workers.

Dr. Aguilar, a private practice doctor who works in a public hospital but is not striking, said people with money are able to get medical care at private practices, where doctors are not on strike. He said poor people are suffering the most, because they can't get the care they need in public facilities.

"Poor people [are] having problems ... and some people are dying," he wrote in an e-mail.

Some U.S. doctors who volunteered in Nicaragua are sympathetic to the striking physicians. "It's not that they don't want to care for patients. There's no medicine. There's no IV tubing. They don't have anything to work with," said Janice Smith, MD, assistant professor of family medicine at the University of Texas Medical Branch in Galveston, Texas, who was in Nicaragua in February. "[The doctors] can't provide good care. Some of them are working as taxi drivers" to make enough income.