Where Are My Meds? Cubans Facing Mental Illness In COVID Times
While Cuba has historically been praised for its health care system, the pandemic has struck the population hard, even those not infected. Among the victims are those suffering from psychological ailments whose prescriptions couldn't be filled because of closed borders and economic crises.
Chavely was raised with strict discipline: she couldn't bring friends home or go out to play for long periods of time, and her television and reading consumption was closely monitored.
The pressure grew in the preparation courses for university entrance exams. Chavely began to get low marks in math, physics, and chemistry. They changed her to a different classroom, then to a new school. She had extracurricular studying time and meeting up with friends became strictly forbidden. At home, she faced continuous scolding. The most difficult moment of her life was while preparing for the university entrance tests.
"My family wanted me to study a language and for that, I had to get almost perfect marks. But I was failing Math," she says. "I began to have trouble concentrating, my eyesight and my brain were clouded when I had an exercise in front of me."
Shortage of medicines
After several medical check-ups, her parents took Chavely to the psychologist. At the age of 17, she was diagnosed with an anxiety-depressive disorder and prescribed 25 milligrams of amitriptyline, an anti-anxiety medication.
Although she's been able to maintain good grades and her crises of anxiety have become less frequent, her treatment doesn't have an ending date. But since 2020, due to the shortage of medicines in Cuba during the COVID pandemic, it is increasingly harder to maintain her treatment.
"Amitriptyline is supposed to arrive at the pharmacy twice a month. But currently, three or four months can pass and it doesn't arrive" she says. "At first, through WhatsApp groups, I exchanged some medications for mine; but I ran out of reserves."
Treatments put as secondary by the pandemic
COVID-19 has also prompted ills in society that may not be seen with the naked eye: many people describe disorders associated with anxiety, insomnia and depression. Because of this, the multidisciplinary team that must care for those recovering from the virus is also made up of a psychologist or a member of the mental health team from secondary health institutions.
The World Health Organization has reported that some of the psychological conditions brought on by the pandemic will affect part of the general population from now on, whether they have been infected or not. However, the part of the population most affected are those who suffered from mental health conditions before the pandemic — and also had to face border closures and the economic crisis that prevented the arrival of proper medicines to treat them.
The months of confinement and uncertainty have been very painful for Mariela Paz, 50, who has suffered from psychosis for seven years. In her early menopause stages, she was emotionally destabilized and had to interrupt her teaching work.
I bought it on the black market
Her husband, Yoel Ramírez, explains that the first symptom was insomnia; then came the tachycardias and constant thought that she was going to die. They managed an admission to the psychiatric ward of the Hermanos Ameijeiras hospital, in Havana.
"The psychiatrist diagnosed her with psychosis, a mental illness in which the person disconnects from reality," explains Ramírez.
Mariela takes 5 mg of trifluoperazine every 12 hours and carbamazepine three times a day. In this time of overpriced medicines, trifluoperazine has been scarce because they only sell it through prescriptions issued by a psychiatrist, and in the small town in Matanzas where she lives, there are few people who need it.
" I bought it on the black market," says her husband. "I have to do it at any price because she cannot live without the medicine."
Quality of life at risk
Víctor Cuevas suffers from paranoid schizophrenia and has experienced firsthand the lack of availability of medicines to treat mental illnesses. He leads the Corazón Solidario project in Santa Clara, in which they serve more than a dozen people with these conditions.
"The most terrible thing is that a patient who has not had a seizure for years can relapse, either because they don't have the medication or because of a change in it," explains Cuevas, a graduate in Nursing. "Antidepressants and anti-anxietydrugs are scarce, and the use of some typical neuroleptics — antipsychotics — already somewhat out of use, has caused other reactions (tremors, muscle stiffness, immobility) and the rejection of patients. As a consequence, it has affected their quality of life ".
Food and goods donations from the Corazón Solidario project, Cuba.
All plagues come at the same time
Since long before the pandemic, Cubans paid high prices in the informal market for any benzodiazepine: alprazolam, chlordiazepoxide and diazepam. With the arrival of COVID, Cuba's priorities for the purchase and production of medicines focused on those drugs intended to treat the virus.
In February 2021, Mileydis went from an anxiety-depressive disorder to panic attacks. She began to experience elevated heart rate, high blood pressure, weight loss, insomnia, and chronic bruxism. The psychiatrist changed her treatment for stronger drugs: clonazepam for panic attacks and sertraline for depression.
"Sertraline is sent to me from abroad, and clonazepam is also scarce," Mileydis explains. "This is how I have managed to get them for a while".
Other patients have not had this luck, and those who received drugs systematically from abroad have seen their treatments affected by flight restrictions and the decrease in parcel shipments. In some cases, the interruption exceeds 14 months.
In addition, Cuba's General Customs of the Republic has established a list of more than 20 drugs whose import is not authorized. The list includes pain relievers and other medications for diseases related to the nervous system, such as amitriptyline, imipramine or trifluoperazine.
Distraction as a treatment
For Isabel Marrero, the most terrible thing about the day is the certainty that night will come. Sixty-six years old, widowed and childless, she cleans her house every day until it shines. She also volunteers to find bread, errands, or any other diligence for her neighbors. The goal is to keep as busy as possible throughout the day and then try to sleep soundly.
She suffers from an anxiety-depressive disorder, which manifests itself in sleep disorders and in what she calls a "jump in the pit of the stomach" (awareness of the heartbeat in the epigastrium).
I queue at the pharmacy twice a month for three or four days
"It is very hard to be awake every night, tossing and turning in bed for not having anything to drink that helps me sleep," she says.
Her treatment consists of trifluoperazine (1 mg) twice a day, amitriptyline (25 mg) in three daily doses, and nitrazepam or diazepam in the evening.
"I queue at the pharmacy twice a month for three or four days before the drugs arrive. One or two may come on the first dispatch, but never all together," she says. "It has also happened that in a month they do not supply anything I need."
Isabel's "solution" is not far-fetched. In the face of a shortage of drugs, keeping herself busy helps her treat her illness.
Víctor Cuevas agrees on the importance of occupational therapy to avoid a torpid evolution of mental health disease in the midst of a drug treatment vacuum.
"There is a maxim that says that the mentally ill person is rehabilitated while always being in rehabilitation..." In other words, we must always be busy, Víctor says, citing his personal experience.
Dr. Carmen agrees on the importance of finding alternatives to treat mental illnesses.
"The shortage of drugs is not new, and every day there are more people who need them," she concludes. "For this reason, it is vital that professionals find new ways to treat these ailments, and that these patients are not forgotten. Their well-being should also be a priority for health authorities."
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