Bogotá's lax lockdown

There's been a lot of frustration expressed on social media about the world's longest coronavirus-induced lockdown.

Even Bogotá's cows practise social distancing these days. 

Since mid-March Colombia has not only been in a state of emergency but also in an 'obligatory quarantine'. On the face of it, this appears quite intense compared to other countries. However, as is often the case here, the practice doesn't match the theory. The severity of the lockdown has fluctuated over the months.

Bogged down in Bogotá

From a Bogotá perspective, in the early, testing-the-water days, the stay-at-home orders for all but essential needs and those working in what were deemed essential services were well obeyed for the most part.

After a couple of weeks, when people who didn't buy into 'the virus is an existential threat' mantra realised that lockdown enforcement was fairly lax, we began to see a bit more movement around the city.

In response, city authorities introduced an ill-thought-out sex-based restriction. No, no, it had nothing to do with the act of having sex — although it would have been nice if born-again virgins like me were given the freedom of the place — it was in relation to gender. Only men were allowed out on one day, women the next. Trans and non-binary folk had to pick one 'side' and stick to it.

Despite reports of discrimination against transexuals, this was stubbornly persevered with for a couple of weeks after which we returned to the original stay-at-home orders.

Again, alarmed at too many people wandering the streets, an ID restriction then came into force. This remains the modus operandi. It functions thus: Those whose identity card number ends with an even number can go out for the essentials on odd-number dates, even-number dates are for those whose ID number ends in an odd digit. Geddit?

It has been said that the thinking behind this odd-even, even-odd mix is that it makes things more confusing and, so it's hoped, people will be more inclined to err on the side of caution and stay at home.

Whatever the case, this measure alone wasn't deemed sufficient for certain areas of the sprawling capital. This month, stricter (in name anyway) lockdown measures were introduced for various 'Covid-19 hot zones', staggered over a six-week period — a couple of weeks in one sector, then on to the next. For the record, my part of town, Bogotá's northern limits, isn't part of these hotspots, for now at least.

In the freer areas, one can still go out on any day and at any time one wishes without fear of interrogation — the ID number/date restriction applies to entry into banks, supermarket chains and the like only.

'The hysterical, monomaniac folk in the stop-coronavirus-at-all-costs camp feel the measures aren't tough enough. If Bogotá mayor Claudia López had her own way she'd surely be more draconian in her approach.'

The bottom line is, notwithstanding the rising case figures over the last few weeks, the measures appear to work. By 'work' I mean they have found that balance between a city/country feeling it is doing the necessary to stop the spread of coronavirus and the desire not to be viewed as too authoritarian and restrictive.

(Do note, the fact the public-private health system is under pressure has more to do with its structure, general inadequacies and tardy responses that have led to a build-up of problems all at once rather than the pandemic itself — it's been on the brink for years. The pandemic and associated panic have simply served to underscore these shortcomings. Indeed, official channels are now looking into complaints about how these EPSs have handled the crisis. A cynic might say this is simply incompetents investigating incompetents.)

'Heart over head' López

The hysterical, monomaniac folk in the stop-coronavirus-at-all-costs camp will feel the measures aren't tough enough. One gets the feeling that if Bogotá mayor Claudia López had her own way she'd surely be more draconian in her approach.

It's understandable, considering the number of people who think with their heart and not their heads on such matters, failing to see the bigger picture and the consequences of widespread lockdowns. An emotionally tuned-in politician such as López can tap into that and win some priceless brownie points.

The counterweight is President Iván Duque. I think it's fair to say that if he had his own way we'd be seeing far more economic activity and greater inter-municipal movement in the country right now, with the appropriate bio-security measures in place of course.

However, considering the emotions involved and the 'López leverage', he's had to rein himself in somewhat. The result of this clash of personalities and outlooks is what's been mentioned above. We're in lockdown alright, but with an amount of flexibility.

From a personal perspective, the frustrating prohibition on leaving the environs of Bogotá excepted, it's tolerable. While some of our leaders are slowly waking up to the fact that we have to learn to live with coronavirus, that locking ourselves away indefinitely is not the answer, for now this Colombian middle way is the about the best we can hope for from a highly spooked, emerging-market country.

It could be a lot better, it could be much worse, a motto for Colombia in general really. That being said, I'm well aware of the many whose livelihoods are practically done for, some of whom I've featured on my podcast.

For the moment, selfish as it might be, I'm glad I can still get out for my daily clear-the-head — with nose and mouth covered as they must be — walks, free from interrogation by over-zealous police officers. Here's hoping I haven't jinxed it now.
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Colombia, not up to the Covid test

In a classic episode of The Simpsons — in its heyday — a temporarily housebound Bart suspects that do-gooder neighbour Ned Flanders is about to murder his wife. 

He frantically calls the police and gets through to a ridiculous pre-record of options. In haste, he chooses regicide, whereupon the pre-record goes on to ask him, 'If you know the name of the king or queen being murdered, press one.'

So some people are getting tests, but who exactly? (Image from Facebook.)

Cartoon comedy at its best, but, of course, it would never happen like that in real life.

Honestly, it wouldn't. In fact, in Colombia — or Bogotá at least — when it comes to tackling what we've been told is the biggest peril of our time, Covid-19 (all other life-threatening conditions are now irrelevant), that Simpsons episode is actually an improvement.

I know of a handful of cases where people either suspect, with good reason, that they have the infection or they've been in close contact with someone who has tested positive. When they prudently go looking for a test they have to wait hours for their call to be answered — there's not even a pre-record of options to amuse oneself for a time.

Being on hold for ages might be OK for those with an unlimited-calls plan, but I certainly wouldn't have the patience or money to burn to wait for more than 10 minutes in such a scenario.

You give me fever

If and when one does get through to the health provider — the curate's egg that is the EPS system — there is an initial over-the-phone diagnosis. The guiding principle for being considered for a test appears to be the presence or not of a fever.

If you're fever-free, be about your business. If not, 'we'll get back to you to arrange a test.' For one acquaintance, two weeks have passed and still no word. Remember, we're talking about what effectively is the only health concern in town these days and this is how it's been dealt with.

'One reason being mooted for what is at best a tardiness, at worst an unwillingness to test, is that the system has collapsed. The more likely explanation is that they simply don't want to do it due to the cost.'

What about other potentially fatal conditions? Say your prayers and hope for the best it would seem. Sure you can beat cancer with no more than a positive attitude didn't you know? Think away that heart attack.

It must be said that for those who have been in the company of an infected person, as one friend has, there is some willingness to test. Again, though, all in its own good time. And don't be in a panic for the result, either.

One reason being mooted for what is at best a tardiness, at worst an unwillingness to test, is that the system has collapsed. The health providers are overwhelmed. They'd love to be able to test but they simply can't.

There might be a modicum of truth to that. However, the more likely scenario — considering past form of avoiding procedures on your typical José Bloggs who's not a big contributor to the system in the hope that he'll either go away and/or die — is that the EPSs don't want to shoulder the costs.

If you go privately and have, as one Bogotá hospital charges, 280,000 pesos to hand over, no problem. But if you're on basic health insurance, to the back of the queue with you, a queue that is not being attended to at that.

Immune to good governance

So while city and state authorities are imposing lockdowns to their hearts' content, without the intelligent practices of testing and contact tracing, they're effectively playing whack-a-virus blindfolded. Do also remember, the initial point of the lockdowns was to buy time for the health services to prepare for the inevitable peak.

Well, we're now entering that stage and what groundwork have they put in? Not an awful lot it seems, apart from scaremongering with case figures without any context.

What's more, considering the irrational stigma surrounding Covid-19 amongst the masses, something the government and media have played a significant role in generating (see previous sentence), properly planned wholesale testing could help to counteract this. What we have instead are people frightened to even just look for tests and a health system doing its best to avoid administering them.

Now the jury is still out on lasting immunity to coronavirus. Yet, should it turn out that those who contract it do indeed build up defences, coupled with those who don't suffer from it at all, Colombia might just stumble into "safer" territory in a few months, albeit faced with a raft of other long-term problems.

This will have been, for the most part, despite the measures and actions taken by those in charge, not because of them. As we've seen oft-times before here, authorities have (on occasions) talked a good game but when it comes to playing it, they're found badly wanting.

We'll get over coronavirus and the associated hysteria at some stage. The maladministration, that's a far deeper issue, one that is arguably even deadlier than Covid-19. We've no immunity to it. Nor do we have a vaccine to combat it.

There is always that helpline to call. 'We'll get back to you tomorrow, sir.' The thing is, tomorrow never comes.
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Listen to Wrong Way's Colombia Cast podcast here.

Facebook: Wrong Way Corrigan — The Blog & IQuiz "The Bogotá Pub Quiz". 

Colombia's EPS: All in its own good time

After over six years based in Bogotá, we've experienced many aspects of Colombian life, from the hugely enjoyable to the utterly frustrating.

However, there's one thing that, thankfully, we've yet to sample (and hopefully never will): The health service (well, that and scopolamine).

OK, we've had to get some dental work done, but that was a private affair, not through any health scheme, and not a sickness issue either — having front teeth isn't completely essential, is it? (On that, um, front, it did take some time to find a trustworthy, reasonably-priced dentist. We got there in the end, though.)

Sura: Seen as one of the best EPSs out there ... (Image from Facebook.)

That aside, the 'opportunity' hasn't arisen to use an EPS ('Entidad Promotora de Salud', health-promoting entity), the somewhat private health service that's the default option for the majority of Colombians.

Basically, for a relatively small monthly fee, you get what results in pretty much free health care when the need arises.

For the very poor there are other, government-subsidised options, while private health insurance is a more attractive alternative for wealthier Colombians. Yet, going through an EPS is where it's at for most.

There are many of them to choose from, all operating in more or less the same way. Naturally enough, some are rated better than others — the EPS you use determines which clinic or hospital you get sent to for any specialised treatment you may need.

Thus, they function as a sort of middleman between you and the medical specialists. Minor issues are generally dealt with by a GP at an EPS clinic.

For problems of a more serious nature, but not emergency life-or-death ones, your EPS has to grant approval before any treatment is given. It does foot the bill after all — with a little help from your small monthly contribution, of course (and the government in some cases).

So that the EPS has to give prior authorisation is fine, in theory. In practice, however, it can lead to a lot of time wasted waiting in line just to get signed off for surgery or whatever.

Take the case of a friend who was in a bicycle accident recently. His EPS sent him to hospital — unnecessarily by ambulance as it was — for an X-ray of his injured arm. The doctor who saw him first up was unsure if surgery was needed or not. Further examinations were required to determine that but they couldn't be done at that specific time.

Our friend got a temporary cast on his arm and was told he'd have to come back to fully ascertain the extent of the damage. But before that could happen, he had to return to his EPS to get the green light.

In short, for practically every additional step in his treatment, he had to keep on going back to the EPS for official approval. The result was that a whole three weeks passed from the date of his accident before he was told surgery was necessary. And, before that surgery could actually happen, the EPS had to give the official stamp of approval. All rather convoluted.

Nonetheless there is some method to this medical madness. It helps to ensure that the EPS isn't forking out for unnecessary, costly procedures.

You see, so it goes, some of these institutions have been rather lax, in a beneficial way albeit, about their patients' needs, resulting in their accounts requiring some emergency treatment of their own.

Somebody eventually has to pay for expensive medical operations. And somebody has to, or at least should, pay the professionals carrying them out. That doesn't always happen in the Colombian health service. We've heard stories of doctors waiting months for their remuneration.

Being that as it is, we're happy not to be an extra burden on the system. Long may it stay that way.
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