It’s 8am in Cusco, Peru. I’m starting my shift at the general health clinic in San Sebastian, a suburb that’s a 20-minute bus ride from the centre. Yesterday was a sweaty day in the city; today though, my breath hangs in front of my face and I shiver in my raincoat.
Intermittent rain quickly creates icy rivers out of the main streets, which require some serious long-jump skills. People weave across the six-lane road through the breaks in traffic, scaling the overflowing gutters, babies tied posteriorly onto the women using handwoven cloth typical of Cusco. The women don’t use prams here, partially because of the design of the narrow cobblestone streets and the topography, rendering them unergonomic and dangerous. You will typically see a woman with a little sack tied around her shoulders, the little lump most likely a newborn.
At the clinic, the line to the front desk that usually flies out the door is absent. The lack of patients on a rainy day is one of the only things that this clinic and the department I work in at home have in common. On a normal day, the clinic is full of ladies with their baby sacks and snotty kids running around dressed head to toe in wool.
This week I’m working in Tópico, a room for people needing injections, wound dressings or their vitals taken. There is no running water today. It’s the second time this week this has happened.
Procedures are vastly different here, and I find myself checking medications against a barely legible handwritten note that the patient pulls from their bag, along with the required medication bought from the pharmacy. A patient buys all the medication, syringes and needles they require prior to attending the clinic, and mixing medications in the same syringe for intramuscular injection is the norm. The doctor’s note must be accompanied by a statement of health insurance, otherwise treatment cannot be commenced.
Any real emergencies here, and there most likely won’t be a doctor available, like the other day, when a man had a seizure outside as he was out walking past.
I know in the past when I’ve had the flu, I feel like I’m dying, but never literally. But this is actually the reality for people living near or below the poverty line in Peru, with the leading causes of death in the country being influenza and pneumonia. There is also a high rate of HIV and AIDS due to a lack of sexual education and treatment options. Peru spends 5.5 percent of its gross national product on healthcare, whereas in Australia, we spend 10.3 percent.
What does this mean? While there is some shit going down in rural Australian hospitals at the moment, we’re pretty much assured protection from various causes of certain death if the need arises, free of charge, and many other benefits such as free GP visits or specialist consultations. We even have a free ambulance service in Queensland! Everyone aboard the chariot!
Peru, on the other hand, does not have the same liberties as us. There are a few key determinants that change the game dramatically, one being that the water is unsuitable for drinking pretty much everywhere, giving rise to water-borne diseases and parasites that would barely touch the health demographic in Australia. The good news is that after a cholera outbreak in the 1990s, Peru started to organise its health system so that everyone could receive free health care regardless of income status, and the health ministry continues to tick boxes that progress towards universal access to standard healthcare.
The bad news is that a lot of people, particularly Peru’s indigenous population, can’t afford the transport to the hospital, and if they can, they might have to wait days to see a doctor. When they finally get to the consultation, they either won’t receive the treatment they need, can’t afford the out-of-pocket drug expenses or are mistreated by medical staff. To add some more llama crap to the lawn that is the Peruvian healthcare system, a lot of the people only speak Quechua, particularly the older generation, and doctors will speak only Spanish, rendering communication extremely difficult. I attended a wound on a tiny little indigenous lady who could only say “muchas gracias”; fortunately, she had the support of her Spanish-speaking daughters, who were there with her.
The aforementioned man who had a seizure out the front of the clinic is just an example of the gaps in the system. After we got him inside, I went to give him oxygen as indicated. The nurse that I was working with then told me that oxygen can only be administered with a doctor present. The doctor didn’t come for 40 minutes. When he finally sauntered in, he barely came within two metres of the patient. The only sense of urgency in his manner was leaving as quickly as he arrived. As soon as the family was in attendance, the nurse chased them to the front to procure the papers for the man’s health insurance for the treatment and the oxygen already supplied.
The man managed to walk out of the clinic shortly after, and I guess he was one of the lucky ones. In Australia, a patient once called me an assortment of names after I told him there were no sandwiches left (which are free to patients). This man had nearly died the day before after a drug overdose, which required expensive medicine and procedures to preserve his life, all costs that are covered by the state.
It is not like this in all of South America. Here is a hot travel tip: if you are going to get sick, make sure you are in Colombia, which is luckily where I came down with a very bad case of tonsillitis, requiring a trip to the emergency room for antibiotics and analgesia. The journey from front door to bed was less than 30 minutes. I can attribute this to the fact that there was barely anyone waiting for treatment. Colombia is ranked as having the some of the best hospitals in Latin America, and from my bedside perspective, the system is quite efficient. Aside from a small side business of corruption, where some funds are diverted according to the desires of the appointed governor, the implemented system is stratified according to earnings and all citizens have access to a health plan.
After receiving a shot of penicillin in the butt, aptly called rompiendo burro (literally breaking ass) and a prescription for painkillers, I was cast on a voyage back to perfect health with a newfound faith in Colombia.
If you’re reading this I can most likely assume that you live in or are from an economically stable country such as Australia. Good for you. I could go on recommending places to donate to or organisations to volunteer for, but of course I know how unrealistic it is to suggest these things to busy people. Our privilege, free healthcare and access to all levels of education enables us to carve out lives for ourselves based on our own choices as independent young adults (except for the alcohol abusers who show up frequently at the hospital covered in vomit like it’s their 18th birthday every weekend, always called Kevin). While it sometimes feels as though our country is run by a bunch of real-like racist caricatures from the Herald Sun, and despite all of our Peter Duttons and Tony Abbotts, when it comes to health, our government truly does advocate for it’s citizens.
After such a profound, firsthand experience with the healthcare system of Peru, I think we are doing alright.
Photos provided by the author