When a group of villagers in the Ecuadorean fishing community of El Real came down with coughs and fevers in early April, nobody was sure if they had the coronavirus – and no health workers were available to diagnose or treat them.

Their local doctor, like many of rural Ecuador’s health workers, had been transferred to the country’s biggest city, Guayaquil. There, the COVID-19 pandemic had overwhelmed hospitals and left authorities struggling to collect bodies.

. El Real, Ecuador. Reuters/Santiago Arcos
A chicken walks along a road in El Real.

The villagers say they were only able to provide traditional remedies such as lemon and eucalyptus to the ill, 11 of whom died of what residents believe was the coronavirus. Their actual cause of death remains unknown because they were never tested.

. El Real, ECUADOR. Reuters/Santiago Arcos
Cruz carries a crate of fish caught by him and other fishermen off the coast of the Pacific Ocean.

“We practically give them first aid with natural medicine. We don’t have a health center and I think that’s why we have had those deaths,” said Manuel Cruz, 37, an artesanal fisherman who now spends much of his time helping other villagers get health care.

“I ask the authorities to pay attention to those of us in remote areas,” said Cruz, who said that El Real usually records only two deaths in an entire year.

. Guayaquil, ECUADOR. Reuters/Santiago Arcos
Cleotilde Vera, 52, (front left), Vicente Vera, 63, Victoriano Vera, 49, and Pablo Vera, 60, who are all siblings, travel by boat on the Guayas River to Cerrito de los Morrenos, to pick up their father Vicente Vera, 85, who was experiencing symptoms consistent with COVID-19, to take him to Guayaquil for medical care.

Several settlements along the South American nation’s Pacific Coast are facing similar situations, according to interviews with residents.

In some 90 small coastal settlements that live off artesanal fishing and crabbing, residents say that doctors who had for years been assigned by the government to provide rural health services were sent away and have not returned.

The situation suggests that moving doctors to cities may have exacerbated the impact of the disease in rural areas where poverty is significantly greater and access to healthcare much more precarious.

. Zapotal, Ecuador. Reuters/Santiago Arcos
A local volunteer, who is helping to disinfect buildings in his town, wears protective clothing as he disinfects a home with a chlorine solution in Zapotal.

Around 20 people who suffered symptoms consistent with COVID-19 died in the past month in the town of Zapotal, according to community leader Gloria Tomala, who said this was an unusually high death rate.

“We have asked for help from medical brigades and we are still waiting,” said Tomala. “We need doctors to come to test for the virus, because no one has been tested.”

The health ministry did not respond to a request for comment.

. Chanduy, Ecuador. Reuters/Santiago Arcos
Maria Alarcon, 54, is comforted by her children Sulin, 25, and Angel, 34, as she reacts during the burial of her husband Angel Sarango, 74, who died that day after reporting symptoms consistent with COVID-19, at the cemetery El Cementerio General de Puerto Chanduy, in Chanduy.

Angel Sarango died at 74 in the town of Chanduy after suffering symptoms consistent with COVID-19, the respiratory disease caused by the coronavirus.

His family buried him that same day in the town’s small cemetery, rather then cremating his remains, as recommended by health experts.

. Libertador Bolivar, Ecuador. Reuters/Vicente Gaibor del Pino
Family members of Reina Orrala Tomala, 69, who died after reporting symptoms consistent with COVID-19, mourn during her wake at Tomala’s home in Libertador Bolivar.

In other communities along the coast, families held wakes in their homes before burying relatives.

In early April, the government said it transferred almost 100 doctors from rural areas to hospitals in Guayaquil and other cities. Reuters was unable to determine if those doctors had previously worked in the coastal villages.

. La Libertad, Ecuador. Reuters/Santiago Arcos
Wooden crosses stand at a cemetery where some people reported experiencing symptoms consistent with COVID-19 died at Liborio Panchana Sotomayor Hospital, have been brought to be buried in La Libertad.

“We are unprotected because the doctors have not come down for two months. They must be working in Guayaquil by now,” said Angela Chalen, 31, who lives by collecting crab and oyster.

Authorities say Guayaquil’s outbreak is now coming under control but that the pandemic is expanding in the highland capital of Quito.

Ecuador has officially reported over 30,000 coronavirus cases and some 2,800 deaths, but authorities acknowledge both figures are likely significant underestimates because the health system is overstretched and many people died before they could be tested.

. Zapotal, Ecuador. Reuters/Santiago Arcos
Segundo Montoya, 65, checks his blood pressure at home after refusing to go to the local hospital, in Zapotal.

Some villagers, including Segundo Montoya, 65, have refused to go to public hospitals out of fear.

“A doctor came, but I did not want to go to the hospital, because I could be left alone to die,” said Montoya, while taking his own blood pressure at his home in Zapotal.

. Pechiche, Ecuador. Reuters/Santiago Arcos
Marina Cruz, 59, holds a portrait of her late husband Alfredo Cruz, 64, as she poses for a photograph at her home in Pechiche.

That fear became all too real for Marina Cruz from Pechiche, a village that has been heavily affected by the outbreak. Her 64-year-old husband died in the hospital and she herself became infected, but decided to stay at home.

. Cerrito De Los Morrenos, Ecuador. Reuters/Santiago Arcos
Aurelio Valenzuela shows the rosemary plant he said he used to treat himself at his home in Cerrito de los Morrenos.

In Cerrito de los Morreños in the Gulf of Guayaquil, the government set up a health center – but its doors have been closed for weeks. Residents dismiss it as an “ornament” amid the community’s small, improvised homes.

“Here we are with the only doctor we have: God, who is taking care of us,” said community leader Aurelio Valenzuela. “They have left us. They have abandoned us.”


1 / 16

Slideshow

A fisherman carries his catch in a bucket as he walks in front of the Pacific Ocean.
. El Real, ECUADOR. Reuters/Santiago Arcos

A fisherman carries his catch in a bucket as he walks in front of the Pacific Ocean.

A man carries a pallet of crabs to Caraguay Market in Guayaquil.
. Guayaquil, Ecuador. Reuters/Santiago Arcos

A man carries a pallet of crabs to Caraguay Market in Guayaquil.

Victoriano Vera, 49, a certified public accountant, is sprayed with a chlorine solution, which has become a standard procedure for every person and boat arriving at the town pier.
. Puerto Roma, ECUADOR. Reuters/Santiago Arcos

Victoriano Vera, 49, a certified public accountant, is sprayed with a chlorine solution, which has become a standard procedure for every person and boat arriving at the town pier.

Emperatriz Escudero, 48, serves a customer from her van in El Real.
. El Real, Ecuador. Reuters/Santiago Arcos

Emperatriz Escudero, 48, serves a customer from her van in El Real.

Emperatriz Escudero sprays alcohol on a five dollar bill given as change to a customer.
. El Real, Ecuador. Reuters/Santiago Arcos

Emperatriz Escudero sprays alcohol on a five dollar bill given as change to a customer.

Three local volunteers, who are helping to disinfect buildings in their town, wear protective clothing as they ride on the back of a pickup truck in Zapotal.
. Zapotal, Ecuador. Reuters/Santiago Arcos

Three local volunteers, who are helping to disinfect buildings in their town, wear protective clothing as they ride on the back of a pickup truck in Zapotal.

A local volunteer, who has been helping to disinfect buildings in his town, wears a protective face mask in Zapotal.
. Zapotal, Ecuador. Reuters/Santiago Arcos

A local volunteer, who has been helping to disinfect buildings in his town, wears a protective face mask in Zapotal.

Carolina Guzman, 23, embraces her grandfather Vicente Vera, 85, who is experiencing symptoms consistent with COVID-19, before Vera travels to Guayaquil for medical care in Cerrito de los Morrenos.
. Cerrito De Los Morrenos, Ecuador. Reuters/Santiago Arcos

Carolina Guzman, 23, embraces her grandfather Vicente Vera, 85, who is experiencing symptoms consistent with COVID-19, before Vera travels to Guayaquil for medical care in Cerrito de los Morrenos.

Cristian Jordan, 37, who suffers from dengue fever and is experiencing symptoms consistent with COVID-19, lies on his bed at his home in Puerto Roma.
. Puerto Roma, Ecuador. Reuters/Santiago Arcos

Cristian Jordan, 37, who suffers from dengue fever and is experiencing symptoms consistent with COVID-19, lies on his bed at his home in Puerto Roma.

Candles burn in front of a religious shrine at the home of Emiliana Ponce in Buena Vista.
. Buena Vista, Ecuador. Reuters/Santiago Arcos

Candles burn in front of a religious shrine at the home of Emiliana Ponce in Buena Vista.

Virgilio Dominguez, 59, who is experiencing COVID-19 symptoms, lies in a hammock as his son sits in front of him at their home in Pechiche.
. Pechiche, Ecuador. Reuters/Santiago Arcos

Virgilio Dominguez, 59, who is experiencing COVID-19 symptoms, lies in a hammock as his son sits in front of him at their home in Pechiche.

Marina Cruz, 59, is comforted by her cousin at her home in Pechiche.
. Pechiche, Ecuador. Reuters/Santiago Arcos

Marina Cruz, 59, is comforted by her cousin at her home in Pechiche.

Sulin Sarango, 25, touches her father Angel Sarango's coffin, who died earlier that day after reporting symptoms consistent with COVID-19, as she mourns with her sister's Sandy Sarango and and Betsy Sarango at the cemetery El Cementerio General de Puerto Chanduy in Chanduy.
. Chanduy, Ecuador. Reuters/Santiago Arcos

Sulin Sarango, 25, touches her father Angel Sarango’s coffin, who died earlier that day after reporting symptoms consistent with COVID-19, as she mourns with her sister’s Sandy Sarango and and Betsy Sarango at the cemetery El Cementerio General de Puerto Chanduy in Chanduy.

Angel Sarango, 34, (third left), helps to lower the coffin containing the body of his father Angel Sarango, 74 at the cemetery El Cementerio General de Puerto Chanduy in Chanduy.
. Chanduy, Ecuador. Reuters/Santiago Arcos

Angel Sarango, 34, (third left), helps to lower the coffin containing the body of his father Angel Sarango, 74 at the cemetery El Cementerio General de Puerto Chanduy in Chanduy.

Family members mourn at the grave of Martin Orrala, who died at the age of 82, after reporting symptoms consistent with COVID-19, in Valdivia.
. Valdivia, Ecuador. Reuters/Vicente Gaibor del Pino

Family members mourn at the grave of Martin Orrala, who died at the age of 82, after reporting symptoms consistent with COVID-19, in Valdivia.

Doctor Bolivar Jalca, who is treating patients experiencing symptoms consistent with COVID-19, poses for a photograph outside Manglaralto Hospital in Manglaralto.
. Manglaralto, Ecuador. Reuters/Vicente Gaibor del Pino

Doctor Bolivar Jalca, who is treating patients experiencing symptoms consistent with COVID-19, poses for a photograph outside Manglaralto Hospital in Manglaralto.

This content was originally published here.