Between getting a filling replaced at the dentist, working with pharmacists to treat any number of parasites, and spraining my ankle, I have been able to get quite the “insider’s look” at the health care system in Guatemala.
Health care is delivered by a public system, a private nonprofit system, and a private for profit system. Most of what I experienced was in the private system. Besides a few noticeable differences, the care is generally ok in private clinics or hospitals and costs FAR less than we are used to in the US.
For example, I was able to go directly to a dentist when my filling broke, get a free consult on the spot, and get the entire filling replaced the following day for a mere $20 (which I am sure was the slightly marked up “gringa” price). While the dental work seemed all too familiar, the equipment was about 20 years older and the “patient chair” was in the waiting room (there were no patient rooms or curtains). Throughout the filling replacement, people would ring the front doorbell, the dental assistant would answer it, and they would come in to talk to the dentist (sometimes just stopping by to gossip). She continued working on my teeth as though it was completely normal. My dentists were a husband and wife team who told me they had trained in Guatemala city. The husband was especially proud to tell me that he was also an architect….hopefully just as a hobby?
Me with my dentist.
She's one of the few female dentists in Guatemala.
My sprained ankle (from a fall hiking in the jungle up north) was another story. We were not near any big cities when it happened. However, I was able to go to a pharmacy (every pueblo has a pharmacy) and get 800mg ibuprophen tablets (and anything else I might have needed) without any prescription. This is how most locals treat themselves – direct to the pharmacy with a request for some medication their friend or neighbor recommended.
After a day or so, we decided it might be good to get some crutches (and possibly an X-Ray?). When we arrived at the public health clinic in the village where we were staying (Fronteras), there was a line of about 30 women waiting to see the doctor. Several pregnant women were smoking outside and other patients were waiting, eating and talking by a fried chicken stand right next to the clinic. As you might have guessed, this clinic did not have any crutches (or equipment to X-Ray or diagnose my condition).
About an hour and a half drive away, we found a recommended private “hospital”. It was only two years old and looked like a cross between a nursing home and a church. The clinic was virtually empty, however, the doctor on staff assured us that he had some crutches. For about $12, I had a consult with the doctor who sat behind his desk and asked me to wiggle my foot. During the $25 X Ray, I had to ASK to wear that heavy apron to protect me from the 1970’s equipment and radiation. After running to fetch the protective apron, the doctor assured me that they always provide it when someone asks.
After my experiences in “private” health care here, you can imagine how interested I was to learn about the public system. I informally “interviewed” a variety of locals…
Public health care in Guatemala (called IGGS or Instituto Guatemalteco de Seguridad Social) is not “free health care”. Similar to the United States, big companies pay into a healthcare insurance pool. Employees from those companies pay a small portion, and they are allowed use the public hospitals. Those who are not employed by big companies (which is most of the population of Guatemala) can pay 4% of their income (whatever it may be) to access the public hospitals. However, according to those we spoke with, very few people choose to pay for this access, as it is really only coverage for catastrophic care.
Our host father shared a story about how he went to the public hospital for a chronic hearing loss problem. Not only did they still want him to pay for regular visits with the doctor to assess the problem, but they told him the first visit with the specialist wasn’t available for six months (keep in mind that his hearing was getting worse by the day). He went down the street to a private provider and paid only slightly more for a visit the following day. Insurance options (sold through banks) are only just starting to creep up to help people offset the costs of private medical care.
Poor families, however, cannot afford to pay for care in either the private or the public facilities. In addition, the public hospital (which also includes all of the clinics, from dentists to behavioral health) requires LOTS of waiting, which takes away from time that could be spent working. We heard from our Spanish teachers and host family that sometimes, people will line up outside the hospital the night before and sleep there so they are near the front of the line. Otherwise, going to see the doctor, even for something minor, might take all day (only to hear that you have to come back in six months). Apparently everyone gets in the same line – whether they need dental care, acute care or chronic care. One doctor’s full time job is to assess the line, both for critical patients, and to direct patients to another area where they wait for their specific issue (e.g., dentist, internist, etc.). You can see while people might try to find an alternative for their medical issues.
Between one quarter and one half of Guatemalans do not have any access to health care services (both because of poverty and the rural nature of certain areas). Guatemala is among the worst performers in terms of health outcomes in all of Latin America, with one of the highest infant mortality rate and one of the lowest life expectancy at birth. The CIA World Factbook ranks Guatemala #143 for life expectancy (granted the US only ranks #49…but that’s another discussion).
Major causes of death in Guatemala still include treatable and communicable diseases, such as diarrhea, pneumonia, cholera, malnutrition, and tuberculosis. Outside the public health clinic that we went to in Fronteras, a small sign with pictures said, “if you’ve had a cough for more than ten days, tell the doctor, you might have tuburculosis.”
A paper I read on this topic (Health and Poverty in Guatemala, Marini, Michele & Marini, 2003), suggested that the following factors limit the ability of public health workers to improve the situation: (i) widespread poverty due to limited household resource availability; (ii) poor environmental conditions; (iii) the limited availability of private sector providers of an adequate quality; and (iv) a general lack of knowledge about the benefits of modern medicine, especially among the indigenous population.
We have personally witnessed all of these in action during our time here. One NGO we worked with that provides nutritional education to mothers and urgent care to children who are dying from malnutrition said that when they first began their project two years ago, women from rural pueblos (e.g., Santa Maria de Jesus where we spent some time) refused to let their dying children be admitted to the clinic for fear that the doctors would eat them. After several children died anyway from malnutrition, one family decided to “chance it”. Their son was saved after being admitted. This has helped the project grow in this community, but others continue to be plagued by a lack of knowledge about modern medicine.
Woman begging on the street with a Goiter.
Goiter's are commonly caused by a lack of Iodine.
In conclusion, health care in this country, if it is delivered at all, comes from a broken public system and several NGOs who work in health. We learned from NGOs and locals that we spoke with that people are more likely to go to the pharmacist, dentist or eye doctor because of cost. Unfortunately, preventive care has a long way to go in Guatemala - and preventive care is what's needed most. From basic nutrition and health education to maternal/child care, ample work remains.
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