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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.

A woman buys medicine in a pharmacy with almost no products amid COVID19 pandemic , in Cuba

A woman buys medicine in a pharmacy with almost no products, Cuba

Glenda Boza Ibarra and Sabrina López Camaraza

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-anxiety drugs 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 Coraz\u00f3n Solidario project, Cuba.

Food and goods donations from the Corazón Solidario project, Cuba.

Proyecto Corazón Solidario / Facebook

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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FOCUS: Russia-Ukraine War

Confronting The Dangers Of A War Reporter

Of the some 9,000 journalists believed to have arrived in Ukraine to report on the war, many were under-prepared. A course in France is now training them on how to face the harsh realities of conflict and teaching them essential survival techniques.

The objective of the training is not for journalists to learn how to face dangers but mainly how to avoid them.

Marina Alcaraz

BEAUVAIS — The ground is soaked with blood. A young man screams, struggling to make himself heard amid the gunfire. The bullet-proof vest with the word "PRESS" emblazoned on it seems insignificant in this moment of horror. Under Russian fire, his colleague has to extract him before he bleeds to death. He only has a few seconds to decide how to transport the injured man, who is weighed down by his equipment. Just a few more seconds to evaluate the severity of the wounds. Two serious injuries, a wounded eye… There are only a few minutes to save his life by applying a tourniquet and taking his pulse before calling emergency services, which will in any case only arrive two hours later.

Stay up-to-date with the latest on the Russia-Ukraine war, with our exclusive international coverage.

The crackling of the bullets, the adrenaline, the fear and the silence that follows… the whole scene is utter chaos. Except this is not Ukraine, where the war is still raging. It's a shooting range about 75 kilometers north of Paris.

Emergency training

This simulation is the result of a course organized for journalists and technicians who work in danger zones. In May, a dozen employees of the French public broadcaster — some with experience, others without — spent a week in immersive training. This meant a few days of preparation before leaving for or returning to Ukraine.

In order to cover the war, which takes place just a few hours' flight from Paris, media organizations sent a huge amount of reporters — some 9,000 accredited journalists, according to Reporters Without Borders (RSF). Young freelancers also went of their own accord, sometimes without even the most basic survival knowledge.

"Ukraine has created a sort of training emergency," says Jean-Christophe Gérard, security director of media company France Médias Monde. "The 'press' vest or badge no longer offers the protection it used to.”

Yan Kadouch, an editor and participant in the course, says: "I have been on several fronts, but often behind the army. In Ukraine, I really felt unsafe. With the artillery fire, it's a lottery."

In danger zones, every decision can lead to death

In Ukraine, eight journalists have lost their lives since the start of the war and 16 have been wounded, according to numbers by RSF. The death of French journalist Frédéric Leclerc-Imhoff a few weeks ago has left its mark. "He had not even taken any irresponsible risks. This tragedy reminded us how dangerous this war is," says Omar Ouahmane, a senior reporter at Radio France, who has been doing this job for years.

Patrick Chauvel, a veteran photo journalist, agrees. "Unfortunately, you don’t have to go to the front to be killed. In Ukraine, the military uses very heavy weapons, which are rarely seen elsewhere." This training was actually born out of a tragedy: the kidnapping and murder of two French journalists working in 2013 in Mali. Since 2015, this course has welcomed a total of 460 journalists and technicians from audiovisual and print media.

What war preparation involves

Participants are trained by former members of the military. The objective is not to learn how to face dangers but mainly how to avoid them. A bullet-proof vest or even a chemical suit is not enough in Ukraine. It is important to “always be vigilant,” says Michael Illouz, a security expert. “Knowing how to react in certain situation is already a good start.”

For example, in the heat of the first aid exercise, none of the trainees remembered how many shots were fired, and none thought to put on gloves before touching their colleague's wounds. A lot of the advice given is common sense: do not carry your backpack behind you in a minefield to prevent something falling out, do not step too far away from your car to relieve yourself, do not stand next to the armed forces.

To confront them with other possible situations, the journalists are placed in a messy room: an overturned table, chairs on the floor and a pack of cigarettes with a file still intact, in broad daylight. “Everything that seems incoherent should alarm you: there could be explosives,” warns Stéphane Ulhen, a former army mine expert, now a security consultant.

“In danger zones, every decision can lead to death,” he emphasizes. In 2017, three journalists working for a French television program were killed during a mine explosion in Mosul, Iraq. A big part of the training is also focused on gestures that can save a life, following the acronym MARCHE (M = Massive bleeding, A = Airway, R = Respiration, C = Circulation, H = Head & Hypothermia, E = Everything else).

“Bleeding out is the number one cause of preventable death," says Fabrice Simon-Chautemps, a former army paramedic and now a trainer. And the training is quite rigorous: the participants are, for example, capable of treating an evisceration or a thoracic wound affecting the lungs as a first aid measure.

Journalists as targets

Shortly before the terrorist attacks hit Paris on Nov. 13, 2015, a production manager had taken the course. That evening, because she lived in the neighborhood, she went to get her first aid kit and was able to save lives by applying tourniquets.

“It is essential to have first aid skills. Journalists have died because people around them did not know what to do. For example, thanks to this knowledge, I was able to compress a wound on my stomach I had gotten in Panama, with a piece of my shirt and my belt, while waiting for the paramedics that only arrived a few hours later,” says Chauvel.

Even without traveling across the world, the trainees learn how to stay safe in a large crowd. Many journalists were targeted during anti-vaccination protests in France. “A journalist has become a target in certain cases,” says Jean-Christophe Gérard. “Some media outlets assign security guards to them, but I don't think that's the solution: the job is all about going out into the field, being in contact with people, whereas the bodyguard is more likely to try to get in the way. In any case, he wouldn’t be able to do much against an angry crowd.”

But the training is also intended to make people aware of their limits. One of the participants admits never having worn a bullet-proof vest and says they are “extremely heavy” (20-26 lb). Another one is afraid of not having the physical strength to carry someone on their shoulder in case of a real injury.

“I realize that I have been lucky in the past,” says journalist Marie-Pierre Vérot, who decided to take the course. “I have already found myself in complicated situations, for example in the middle of gunfire in a house in Indonesia. My first reflex was to hide under a table, which does not really protect from bullets. I will now take further precautions and think more about possible outcomes.”

A journalist taking pictures in the village of Komyshuvakha, southern Ukraine, after it was bombarded by Russian forces

Dmytro Smoliyenko/Ukrinform/ZUMA

The fixer's role 

Many of the journalists think that the course (marketed at $4,300) should also be followed by their managers, who do not necessarily realize the potential threats, whether those are physical or digital. "Journalists often leave with their personal phones and computers full of documents. If they are captured, there is a risk of finding their sources, for example," says Guillaume Barcelo, an expert in information systems security.

In conflict zones, teams of two or three people are usually tracked by their editors, who help them manage logistics. The journalists must then follow precise protocols with prohibitions and missions. But, in the end, they are the ones who are best able to perceive the danger on the ground, along with the fixer. The fixer is a key component in war reporting. They translate, give guidance on the ground, and bring their network of contacts. In some cases, they even drive and find witnesses. In fact, they take the same risks as their Western colleagues and even risk more reprisals. A fixer in Ukraine generally costs between 250 and 350 dollars a day, but the rate can go up depending on the danger.

Some have become addicted to the field

Some of them are journalists in their own countries, while others come from civil society organizations, “but they all have a sense of resourcefulness,” says Charles Villa, a reporter who has just made a documentary on the profession. In Ukraine, Villa was "surprised to see many fixers taking up arms... Now, with the influx of foreign journalists, some of them who had never done this before are participating.” Especially women. Given the difficulty of finding the right people, some American television stations used specialized protection companies like Chiron, with bodyguards who accompanied the journalists.

If the profession of war reporter is accompanied by a hint of heroism, these journalists are not at all reckless. "Fear is our life insurance," says Omar Ouahmane, who has covered several conflicts.

“We are not looking for adrenaline," says Charles Villa, who attended a training course organized by the army in the south of France a few years ago. "War reporters are mostly reasonable and rational. They seek to emerge in terms of their career, while living extraordinary situations. Some have become addicted to the field," adds Denis Ruellan, a researcher in information and communication sciences and an author of books on war reporters.

A cellar in Chechnya

War reporters know about anxiety. Journalists or technicians in dangerous areas have all come close to serious trouble or even death. Charles Villa has risked his own life on several occasions, in Yemen, or in the Congo when he came face to face with a local warlord. Each one of them recounts with humility the moment when everything changed. Omar Ouahmane remembers a report in Sirte (a city in Libya) where the experienced Dutch photographer, Jeroen Oerlemans, was shot in front of him while crossing a street. "What saved me was that I took some time to observe before I went to follow him."

Patrick Chauvel spent a few hours in a cellar in Chechnya, sure that he was going to stay there and managed to get out by running at the right moment. Not everyone was so lucky.

So what drives war reporters to do their jobs? “I love adventure, the physical side, meeting extraordinary people, living history," answers Patrick Chauvel.

”It is in conflict zones that humanity stands out the most," adds Omar Ouahmane.That’s where we belong as journalists."

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Central to the tragic absurdity of this war is the question of language. Vladimir Putin has repeated that protecting ethnic Russians and the Russian-speaking populations of Ukraine was a driving motivation for his invasion.

Yet one month on, a quick look at the map shows that many of the worst-hit cities are those where Russian is the predominant language: Kharkiv, Odesa, Kherson.

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