Wednesday, January 15, 2014

Disparities in Health Care. . .some observations. . .

I need to preface this blog post by admitting that I am still very ignorant and have a great deal to learn about health care here in Nicaragua (you will notice that I throw out many facts and opinions with no references—I have done my best to represent reality but please don’t use this to write a paper or anything), but I would love to share some of my observations and thoughts so far. 

Nicaragua has a government-run healthcare system, so most people have “access” to free health care at government-run and funded hospitals and clinics. I use the word “access” very hesitantly, because in order for the people of Nicaragua to benefit from these services, they have to be able to get there, which means having the means to pay for transportation and also the ability to take time off work or away from the responsibilities of their families.  It is especially difficult for the many people living in the rural areas of Nicaragua to get to hospitals and clinics when they are in need of medical attention. 

There is also much skepticism about the quality of care that is received at these hospitals and clinics.  Marlene, the woman who works in our home and takes care of Charlotte while I volunteer at clinic 2 days a week, has a niece, Isabella, who is 5 who was diagnosed with leukemia about a year ago.  “She’s just like Mae,” she often tells me.  The family was told recently that she doesn’t have much longer to live.  She has been receiving chemotherapy at a public hospital here in Managua, and my mom, who is a physician, guesses that the treatment she is receiving is what someone in the US would have received 20 years ago.  A 5-year old diagnosed with leukemia in the US has a 80 % survival rate, but a child the same age with the same diagnosis in a developing country, like Nicaragua, only has a 30% chance of survival.  I got to meet Isabella recently, and spending time with her made my mind and heart race… but mostly my heart.  I have a 5-year old daughter, and if she was diagnosed with leukemia, I would do everything I possibly could to give her the best chance of survival—and I would have the means too.  How is that fair? What if I were Isabella’s mom and she were me?

Mae fell off the trampoline and hurt her elbow over Christmas break, and we were for the first time faced with the decision of where to take her for medical attention.  There is no such thing as 911 here in Nicaragua (Mae just tried calling it recently).  There is a number that you can call to request an ambulance, but they cannot guarantee that one will be available to come.  And I can guarantee that there is no way I would be able to tell them how to get to our house.  So, we won’t be relying on that service. One of our options were the public hospitals and clinics that I have already talked about.  There are also many little private clinics and diagnostic centers that you can go to and pay to have whatever test—x-ray, EKG, ultrasound, lab work—done that you want for fairly cheap (to have an x-ray done costs about $15).  The clinic that I volunteer at, Clinica El Samaritano, is a small private clinic where you can get quality health care for less than $5/visit (which unfortunately is too expensive for many Nicaraguans). 

The place we ended up taking Mae is called Metropolitano, which is JACHO accredited (held to the same standards as hospitals in the US), and by far the nicest hospital in the country.  I have heard that the president had this hospital built so that his family could have a place to go for quality health care. This hospital is interesting because it also does “Medical Tourism,” which I had not heard of until recently.  Basically the hospital offers packages to foreigners who want to travel to Nicaragua to have procedures done at a much cheaper rate than in the developed world.  They make it sound all cushy by offering to plan a Nicaraguan vacation for you while you are here getting your knee replaced or whatever.  I’m not sure yet if I recommend it or not, but just in case you’re curious, here is the link to their website: http://www.metropolitano.com.ni/internationalpatients/

As you can see, there are a wide variety of health care options available here is Nicaragua, which unfortunately translates into a huge disparity in the care people have access to and receive.  As my eyes are being opened to the different ways that people live, I am experiencing a mix of emotions.  Selfishly, I am so thankful for the many blessings and options that I and my family have (we even have evacuation insurance that would pay for us to travel back to the States should there be a problem that can’t be dealt well with here in Nicaragua), but the injustice of it all makes my stomach sour.  I don’t understand why in our world the presence or absence of money has so much power, and especially the power to dictate the quality of health care that we receive.  So, for now I look for ways to get involved with offering quality care to those who might not otherwise get it, and I pray.  I pray that God will find a way to redeem this broken and unjust world.  And I usually have faith that He will do it…. but it isn't always easy.

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