QCOSTARICA – It was on March 9 that Dr. Daniel Salas Peraza celebrated his 43rd birthday. A Monday. Three days after Costa Rica registered its first cases of covid-19. That day he faced the country to say that there were now nine confirmed cases and 22 people were suspected of having the virus that was already disrupting the lives of Costa Ricans.
Until then, the good doctor had been a very hard-working but low-profile person, had led the Ministry of Health for just over a year, and on that day was already beginning to feel what it meant to be a public figure in the middle of an overwhelming work: coordinating the care of the main pandemic of modern times.
“That day I got home around 11 pm, after a lot of meetings. The cake was still there and no happy birthday was sung,” he told Irene Rodriguez in an interview for La Nacion’s Revista Dominical.
That virus was beginning to give him a task as he had never experienced before.
If this interview had been a year ago, it would have been face-to-face and not on a video call. It would have been in his office; minister and journalist would not have interacted with each other through a computer screen.
If this interview had been a year ago, he would have said that his main challenge as a minister towards the population revolved around deaths from traffic accidents, sedentary lifestyle and strengthening mental health policies.
“But a pandemic came. And it came strong,” he said with a laugh.
And that pandemic changed everything. Changed priorities. His surroundings changed. It changed his life.
That pandemic angered him. Although he is reserved in saying with whom and why.
“Of course I have been angry, several times in this pandemic, but I reserve it,” he says with a slight smile as if he has already reconciled with the situation, just as we are all trying to reconcile with a pandemic that as of Friday exceeded 150,000 confirmed cases and close to 2,000 associated deaths, that includes Salas’ father.
If tomorrow they told him it is all over and there is no longer a single case of covid-19, Daniel Salas is clear about the first thing he will do and where.
“Diay, go give my mom a kiss,” he said quickly and confidently.
His smile and his eyes lit up when he says that reveal what he has publicly recognized. She, Guiselle Peraza Valenciano, is one of the three women in his life; along with his wife, Vivian Calvo, and their daughter, Padme Salas Calvo.
“I wouldn’t know where I would be if it weren’t for them. This year has been hard, “he admitted.
Feeling the meaning of each ‘regrettable death’
This year has been very hard. For him and his family.
If Salas defined 2020 in a few words, it would be “the greatest challenge that we have experienced as humanity in modern times and that has touched all our fibers.”
His is no exception.
In delivering his report on the virus, as he did, live in front of television cameras, every single day for months, Salas would speak the words “regrettable deaths” (lamentable fallecimiento in Spanish) in giving condolences to the people who have lost a loved one in the context of a pandemic.
And he feels each of the words.
He and his mother lived through the most difficult part of the pandemic together: the death of Eduardo Salas Rodríguez, with whom Peraza was married to for more than 44 years and who died on September 16.
The minister describes it as the most painful thing in his entire life, as he had never lost such a person so close. His father, who was 69 years old, was admitted to the hospital with a heart attack, and there he became infected with the covid-19 virus.
“It was a surprise because he had never had any clear manifestations of cardiovascular disease. He had never had symptoms of shortness of breath from exertion. He had no cholesterol problems. He had a high blood pressure problem, but it was under control. It took us by surprise and even more so when I learned that it had been a very strong heart attack,” said the Minister.
“When they were doing catheterization (a procedure to ‘clean’ the arteries and allow circulation) they had to intubate him. I thought we were going to lose him. In the end, God allowed him to stay with us for another month,” he continued.
It was a month of many emotional ups and downs, as he describes.
“You have hopes as a son, although as a doctor you sometimes saw the darkest issue; I am a son and never lost hope,” he acknowledged.
That son had to face this stage in one of the busiest moments when the sanitary measures were relaxed and masks were just beginning to be mandatory in closed places.
“I took a vacation and was able to go see him at the hospital several times. It was very difficult. And when he was gone well, I just accepted it. One goes through denial and through all the stages of grief, but of course, it is part of life, and that is why I said that we must treasure it while we have it,” he said.
In the midst of all the support, it was also difficult for this doctor and epidemiologist that his father’s death occurred in a context where goodbyes are more difficult.
“We didn’t even have a wake. I didn’t want a lot of people. I said ‘in the middle of the pandemic, diay, infections that may exist’. We took him from the hospital to the cemetery,” he recalled.
“I wanted to hug my mom. I wish I was seeing her and hugging her lots and filling her with kisses. Right now it’s complicated. The pandemic adds one more degree to the grief. Thankfully God is helping us. I know that many families have experienced this. They are very difficult things, I understand them, they are extremely complicated moments,” he stressed.
For these reasons it is that Salas himself, from his position as minister, is emphatic in what we must do to avoid losing a close one.
“In things as simple as washing our hands before touching our faces, wearing a mask, we could make life last longer and have the people we love for more years. One says, I will try to continue,” he emphasized.
The challenges of commanding Health at the most decisive time
At the level of public health and epidemiology, the pandemic clock always ticks, but never marks the time. It is known that it can arise at any time, but not known when.
And that “when” was precisely in the Salas administration as minister.
“Yes, of course, I have asked myself why exactly at this moment, but they are things that have to be assumed,” he said.
At the beginning of January, Salas was already reading and talking with his colleagues in other countries about the virus that had emerged in China. He followed it cautiously.
Later, when he began to see that he could not contain the siege that had been made in Hubei province where the city of Wuhan (origin of the virus), he understood how difficult it would be to stop it.
“When I saw that there were cases in Europe and how it was moving, I said ‘this is going to get here.’ Some other ministers from other countries did not think so at the time, but it saw it as imminent,” he said.
Since then, the journey through the pandemic has been made amidst the uncertainty of a virus before which we are still new at.
“At the public health level there is the precautionary principle. Get ahead and a problem does not occur. It can’t always be done, but it can be worked on. We knew and we said it from the beginning “there are going to be cases and deaths here.” The idea was, and still is, to avoid hospital collapse ”, he highlighted.
The arrival of the disease in Costa Rica came from the hand of a couple of American tourists. They taught the Costa Rican authorities how diverse covid-19 can be.
The screening test was done with the “benefit of the doubt,” recalls Salas. He had no symptoms and she, for her part, did not have the usual manifestation of the disease. She had no shortness of breath, no cough; her symptoms were gastric.
They were tested because they were notified that they had had contact with positive cases at a party in the New York, United States, and they notified the Costa Rican authorities.
“At that time, very little was known about asymptomatic patients, and although they began to talk about gastrointestinal symptoms of the virus, very little was being seen. Costa Rica entered seeing atypical symptoms, which one was not looking for,” Salas said.
Vivian and Padme: who keep him alive
How does the minister keep his sanity? How does he take care of your mental health? His wife and daughter, he admits, are the ones who have him where he is: talking to them both, playing with them, being a father and a husband.
“Padme may be very young and does not understand it yet (she is four years old), but she will know. She will say ‘my love, those kisses, those hugs, playing with you, entering your magical world. That’s all for me, it recharges all my batteries low,’” he said, not hiding the smile that one only has when you talk about what you love the most.
Other things that stand out without thinking twice: the patience of his wife for nine years, but his accomplice for “a little longer.” Being with her, being listened to, being able to talk about various topics, sharing favorite foods. It is an invaluable part of your time.
Relaxing with, playing video games, but also seeking spirituality.
“To meet the Creator, with that supreme being that gives that balance. In the end, God is love. I believe in a single, universal God for everyone, in whom I place all my trust,” he said.
For a rather introverted person it is very difficult to be part of the public eye, but Salas knows that it is the price he must pay for doing his job. And, although he recognizes that due to the measures and restrictions that he issued, he is not well-liked by a certain sector of the population that “surely sees me and does not think such good things”, he emphasizes.
“I am about working and dedicating myself,” he said.
However, he recognizes the most beautiful thing he has had in his work: “The children’s drawings (…) all that fills me,” he explained.
Something that stands out the most is that his university colleagues in Medicine created a WhatsApp chat through which they have sent him their videos, audios, photographs and messages of support for his work.
“I do not know how they formed and got numbers of hundreds. From there I have received many words of support,” he expressed gratefully.
There are times when the minister has faced those who express the opposite of admiration.
“There are people who say that I peddle fear. Do not be afraid, I have never said that. We must have respect for the virus, because yes, it is an enemy that we must fight against and that does not tire when we are fatigued,” he said.
“We know that the economy is bad and that there are people who are suffering. But being at this moment saying “I want a job” is because you have life and health. The economy is very necessary, this is not a pulse of health or economy, it is to achieve a balance ”, he added.
For this reason, he indicated, in Costa Rica it was known from the beginning that the country could not be turned off completely: the economy and subsistence is necessary.
To the future
His management at the head of the Ministry of Health will end, but he is clear about what is next in his life. That, in turn, has been clear to him since he decided to study Medicine to help people.
“My aspiration has always been to contribute, wherever I am. I have no aspirations to leave the country or to something different. Obviously one has to assess the options or alternatives when they arise and see what is best for oneself and for the family. One has to reconcile one’s aspirations with those of the family,” he assured.
He added: “As long as I able to do my job and feel that I am contributing and doing my bit to improve health, wherever I am, that is what I want to do. And see later and say ‘it was worth the effort’ “.
“Always asking God for a lot of wisdom to do the best things. Either in my position as Director of Health Surveillance or wherever I am. May He give me wisdom to do what is best for me and my family,” Salas concluded.