Thursday, May 28, 2020

Ecuador and Inequality

Ecuador's coastal city of Guayaquil has been one of the hardest-hit areas of COVID-19 in Latin America. Last month, photos of dead bodies lying in the streets or on park benches flooded social media, showing the collapse of the local healthcare and mortuary systems.  Human rights workers say the virus has highlighted the city's vast social inequalities, and has disproportionately affected working-class families. Many of these families now find themselves jobless, turned away from saturated public hospitals, facing inflated costs of medication and mortuary services, and having to adapt to a quarantine they cannot afford.  Ecuador's strict quarantine measures have weighed particularly heavily on these families in Guayaquil. Like most places in the world, lockdown measures include social distancing and the prohibition of all non-essential businesses, but it also includes a strict 2pm curfew, enforced by military and police, that has been in effect since mid-March. The coronavirus has also disproportionately affected African descendent communities in Guayaquil, which has the largest Black population of any city in Ecuador. Most in this community are informal workers who live in the same marginalised areas that were harshly affected. Those most affected by these hospital conditions have been the marginalised urban sectors, where families survive off of their daily income so have been unable to maintain quarantine.

According to official figures, there were 37,355 confirmed coronavirus cases and 3,203 COVID-19-linked deaths in Ecuador as of Monday, but many say the numbers are drastically underreported. Last month, the state registry released data showing that over 10,000 deaths were recorded for the months of March and April, just for the province of Guayas, where Guayaquil is located. Officials say this is nearly 6,000 more deaths than the same time period in the last two years, leading many to conclude that the vast majority are COVID-19 related. They also include deaths that could have been prevented had the healthcare system not collapsed under the weight of COVID-19, yet no data exists to make this differentiation.

Some of these neighbourhoods include Monte Sinai, Bastion Popular, Suburbio, and Trinitaria in the northern and southern peripheries of the city. Many of these communities do not have access to basic services like sewage systems or drinking water, and have high population densities. These provide the perfect conditions for a virus to spread, Billy Navarrete, director of the Committee for the Defense of Human Rights in Guayaquil, said.

"I don't agree with the government who always blames the people for not staying at home. You can stay at home when you have your necessities met, and savings in the bank," said Giselle Viteri Cevallos, with the local organisation Asphalt Women (Mujeres de Asfalto) that promotes the rights of women of African descendent.

Luis Alfonso Saltos, architect and urban planner in Guayaquil, said people who live in peripheral regions that lack infrastructure would inevitably end up being more exposed to the virus, and carrying it greater distances, as they are forced to leave their home or neighbourhood to find basic necessities.

"Understand citizen logic. If you don't have water in your house or a store nearby, that obliges you to have to leave and find it," Saltos said. 
Saltos collated reports left by families on social media platforms, begging for help to remove the cadavers of their loved ones from their homes and produced a map. The map indicates that the vast majority of these reports came from either the city centre, where there was a large flow of people, or in the peripheral areas in the north of the city, where there are higher population densities and lack of infrastructure, he said. Although this data is not conclusive, it provides an idea of the dynamics of the virus, he added. 

Despite being the commercial capital of Ecuador, Guayaquil is one of the most unequal cities in the country. It has the highest poverty rate, at 14 percent, and the highest rate of workers in the informal economy. Nearly half of the working population in the city work in the informal sector, according to the national statistics institute. The informal sector includes jobs like street vendors and domestic workers, those who live off their daily wages with no social security benefits, and earn well below the national minimum wage of $400 per month.

Ecuador has a three-tier healthcare system, which includes public hospitals that serve everyone; social security hospitals, generally for people with permanent jobs who pay into the system; and private clinics. 

Ricardo Ramirez Aguirre, a retired physician in Guayaquil and head of a regional Anti-Corruption Commission, said the public and social security hospitals in the coastal city have shown "improper handling" of the COVID-19 crisis. Several people have reported hospitals turning away non-COVID-19 patients, leaving them with nowhere to go. Others reported that hospitals not designated to treat coronavirus were turning away patients with dengue thinking it was COVID-19.
President Lenin Moreno reportedly cut nearly 4,000 jobs in the healthcare sector nationwide last year. During the pandemic, the government also failed to provide protective gear to hospitals or assure long term job security for new recruits, so many healthcare workers refused to fill necessary positions, said Ramirez. At least 117 doctors and nurses lost their lives while treating COVID-19 infections in the province of Guayas alone, according to local unions.

Apart from saturated hospitals, one of the biggest struggles for families is paying for medication and mortuary services, as high demand has shot up prices. Paracetamol that normally costs $0.25 a pill can no longer be found in pharmacies, but is being sold for $4.00 in informal commercial areas, said Viteri. Some families have also been forced to go into debt, as they try to pay the high costs of a coffin and cemetery plot, which could range from $3,000 to $5,000, for their deceased family members.

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