Kathleen Rees ‘10 is a double major in Health: Science, Society, and Policy and in psychology, and a 2009 Sorensen Fellow of the International Center for Ethics, Justice, and Public Life. Kathleen is interning this summer in the town of Urubamba, Peru through the organizations ProWorld and ProPeru.
One of the harshest realities I have experienced in Peru is the difficulty of getting the most needy peoples the medical attention that they need. The system is not structured to help these individuals and in many ways the medical system here is “every man for himself.”
If you are a Peruvian with money, with a good income and a good job, you can afford to be apart of the ESalud system and receive the best medical treatment. For those with some money but not much money, there is the MINSA (Ministry of Health) system. If you pay for your social security and register with MINSA you can receive treatment in any MINSA facility as long as you have enough money to pay a fee for consultations and for your medicines. If, however, you are a worker in the fields with little to no money or an elderly indigenous adult with no family support, you will not be accepted in the Esalud or the MINSA facilities. There are no free governmental programs for these individuals. Yet, ironically, if individuals who are very ill, with a variety of state determined chronic illnesses, are able to get a written diagnosis from a MINSA facility, the state of Peru has a law stating that they will pay for their medical treatment for free. The catch here is that the patients will have to find their own means of transportation to and from Cusco, many on a regular basis for medical attention. But how do you get a medical diagnosis if you have no social security and the MINSA doctors will not see you? Unfortunately, the majority of those in Peru who are in this situation never get the medical treatment that they need specficially for this reason. There are very few avenues for poor individuals, who are predominately the indigenous Peruvian population, to receive free consulations by any doctor.
It is only through the aid of organizations and non-profit clinics, such as Clinica Kausay Wasi in Coya, that these individuals are able to get the medical documentation for the procedures and treatments they need in Cusco. Even then, in the little time I have been volunteering at Clinica Kausay Wasi in Coya, I have seen two patients, both elderly adult males, who were diagnosed with colon cancer leave the clinic without paying and without their documentation because they were afraid they would not be able to pay for the medical attention they would need. Although the clinic helped them to get the documentation, and would have most likely allowed the entire consultation processes to be free of charge, these men still had to find their own way to the specialized cancer facilties in Cusco to receive treatment.
Imagine, as much as you possibly can, that you are an elderly, indigenous male that speaks very little Spanish and has a family to support. You are told that you have to go to Cusco immediately because you potentially have a life threatening disease that will need months of expensive medical attention. You are told that the treatment is free and that all you need to do is pay for transporation, but you already don´t have enough money to pay for the current doctor´s visit and you were told this visit would be free and now you are being told to pay as much as you can to the clinic. Would you go? Why would you think the treatment in Cusco would be any different than the medical treatment you had known all your life?
The irony in all of this is the presence of images of indigenous peoples in all of the MINSA and state health materials. Many of the pamphlets and informational posters feature happy indigenous couples in traditional dress entering health clinics or undergoing medical procedures. Yet, these are the very people that are not receiving the medical treatment that they need. These are the women that make up one of the highest maternal mortality rates in the world. Where is the disconnect? Why is the medical system not reaching this population? These peoples are obviously identified as prominent citizens of Peruvian culture. Why then is the medical system not more concerned with their needs? These are questions that I am still trying to investigate but for which I do not have answers at this time. The more I see the more questions I have…Hopefully I can post soon with some more answers. If not, these are at least some more ideas and observations for thought.
Posted by Kathleen Rees ‘10
krees@brandeis.edu
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It’s really sad how some countries medical systems are so bureocratic and useless. I was just in Peru doing volunteer works at a small medical center and I witness everything that you said.
Regarding the Peruvian medical system’s lack of care for impoversihed people, I was under the impresion that citizens had an opportunity to apply for free medical care. They conditions were simple: if you had little money and assets, you got insurance. When we went to asses their homes, they didn’t seem to live far from the medical center. Then again, I was in Chupaca. It might of been different where you were.