March 20, 2020: California began the lockdown. There were already nineteen deaths and 900 infections. The World Health Organization (WHO) labeled the virus a pandemic. An army of people rushed to the grocery stores and stocked up on essentials.
In Nicaragua, where I was born and raised, we routinely stayed at home for dengue outbreaks, violence and hurricanes. I had experienced at least three lockdowns as a child, and now as an adult, I was experiencing another. Although the Nicaraguan lockdowns I experienced happened in the 1990s, the COVID-19 lockdown was still familiar.
Nicaraguan lockdowns would be announced through a car with a megaphone driving through the neighborhood. This was before social media and cell phones. The fire station would also sound an alarm and the entire local community knew to remain home. The stores would close, but my mom knew the owner a block away and somehow we always had what we needed. The essentials were only food and water; thus, the toilet paper obsession here in the States was foreign to me. On a trip to Costco, I could not believe when our toilet paper was stolen from our cart.
Dengue outbreaks were common; we never left the house without mosquito repellent and never slept without mosquito nets. Most outbreaks and devastation were common after hurricanes. At the age of twelve, a Category 5 hurricane hit the Nicaraguan coast. There were rumors of death near the river five blocks from my house. My grandma, my sister and I went down to the river and saw the first bare deceased body. We did not get close and practically ran. Despite the death toll, there was no place or time to bury anyone. As I heard COVID-19 breaking news and travel restrictions, all these childhood memories were as vivid as ever. Even though this lockdown seemed utterly familiar to me, it still felt surreal.
Growing up, the United States was the country I aspired to travel to and live in. A country rich in freedom, liberty and the pursuit of happiness. The Disneyland of the world where anything good was possible. But somehow, during COVID-19, I feel like I am back home. In my mind and given my experience, I thought that lockdowns and epidemics only happened in third-world countries. As I saw people rush to the stores to stock up on everything, I was in shock, but I had already prepared two years before. I had extra non-perishable food and water for an emergency.
In Nicaragua, however, most stores were small businesses, and we could borrow what we needed. Essentially, the community had its own miniature stockpile of food. For some reason, here in the States, it seemed that everyone was looking out for themselves. As everything continued to unfold, and COVID-19 news from New York showed dozens of deceased bodies in iced U-Haul and morgue trucks, I could not help but remember my childhood. In many ways, it seemed there was more death here. Suddenly, the United States was not immune to massive death from disease outbreaks. Similar to Nicaragua, the health care system could not cope with the devastation. I knew there was a place for medical students to serve.
After our school administrators sent an email to cancel our longitudinal ambulatory care experiences, I realized I could no longer serve the community clinically. I reminisced on great conversations I had with Spanish-speaking patients at my assigned clinic. I remembered one patient told me she was proud of me and thanked me for helping with her medications. These interactions made the constant studying much more bearable and my imposter syndrome less poignant. After the cancellation, I felt purposeless; I kept thinking about how COVID-19 would affect our most vulnerable patients.
Data shows that Latino and Black folks are the most affected during emergencies due to higher rates of chronic conditions. For example, the U.S. Census confirms that minorities made a disproportionate share of hurricane victims. Additionally, a recent COVID-19 study revealed that minorities accounted for 50 percent of all COVID-19 cases and 60 percent of all deaths. Thankfully, in California, the infection rates among minorities are lower than originally expected. Those with lower socioeconomic statuses were more likely to be infected and die from COVID-19. This meant that a public health response directed at minorities was imperative, and it had to happen quickly.
It was around this time that a group of us medical students formed the Inland Empire Medical Student Task Force to mitigate the eventual impact resulting from the pandemic. The task force consisted of eight leaders and more than 80 UC Riverside, California University of Science and Medicine, and Loma Linda University undergraduate, graduate and medical students. This task force provided community education through a COVID-19 hotline, advocacy efforts and delivery of protective personal equipment to the poorest hospitals in the region. Personal protective equipment was secured through donations from small and large corporations such as Ford. The hotline and protocol were created and run by medical students, the School of Medicine and UCR Health. It still provides screening of symptoms, preventative public health education and local resources in both English and Spanish.
This hotline became our ambulatory care experiences and allowed students to remain involved while practicing critical interviewing skills. It reminded us that social distancing does not have to equal social isolation. My first call was to a young Mexican immigrant who had lost his job at T-mobile. I shared unemployment information and screened and educated him on COVID-19 symptoms. He was thankful for my unsolicited call. My most unforgettable conversation was with an undocumented family. All five family members contracted COVID-19 and the breadwinner could not afford to stop working. I was able to point her to resources for undocumented immigrants and personally connected with her immigrant story. I spoke to her every day for two weeks to ask about any worsening symptoms and encourage her to continue to self-isolate. Thankfully she did not become a statistic, and her symptoms improved. As a medical student, remaining involved during this pandemic put everything into perspective. The reason why I went into medicine was to serve, and I could not fulfill that purpose in the clinic. Therefore, I crafted my own socially distanced purpose.
In a little less than three months, we have over 100,000 deaths and 1.78 million infections. The task force has delivered over 40,000 masks to hospitals nearby, and the community hotline has reached out to about 200 individuals. It still remains open. As California eases restrictions and cases continue to rise, my purpose to serve my community continues. Retrospectively, I can see how my childhood in Nicaragua prepared me for this very moment.
Contributing Writer
University of California Riverside School of Medicine
Marilyn is a first-year medical student at University of California Riverside School of Medicine in Riverside, California class of 2023. In 2010, she graduated from University of California Los Angeles with a Bachelor of Arts in psychology. She enjoys hiking, tennis, and playing with her two dogs. After graduating medical school, Marilyn would like to pursue a career in surgery or internal medicine.
