Monday, July 02, 2012

Health care in a poor country

I'm still getting used to living in a really poor country. I know all the stats. I've been doing research for the last six days for a project, so I really know them now. But the reality still surprises.
I'm in Tegucigalpa, the capital, working on a project. At breakfast in the hotel today - tipico, which means eggs, cheese, beans and toast (tortillas for most people) - I was reading the paper and there was a story about 430 doctors who want to work for free. (It was a slightly eerie breakfast, as I think I'm the only guest today.)
They're Hondurans who went to medical school in Cuba. They need to be certified in Honduras and do two years of service before they're allowed to practise. (Their counterparts from Honduran universities only need to do six month of service.)
But there's a catch. The government pays new doctors $310 a month during their period of service. And it doesn't have enough money to pay the 430 new Cuban grads. So for the lack of $133,000 a month, desperately needed medical care isn't available. (That's an oversimplification, because the government is also worried about the future, higher costs of paying those doctors when they're certified.)
On one level, it's not really a choice, at least in the short-term. The Honduras government has a budget of about $3.2 billion, for the army and education and police and health care and everything for 8.2 million people. The B.C. government spends $5.2 billion on elementary and high schools for a population barely half the size. (The reasons that Honduras has so little money rates another post.)
And, in fairness, B.C. takes the same approach, limiting residency placements to save money even though more foreign-trained doctors are keen to practise and need a residency to qualify.
But the system is much worse here. And the problems are much broader. Nursing assistants have been on strike in recent weeks because promised payments have not been made. Interns staged a long strike. Last week, the main hospital in Tegucigalpa cancelled surgeries because it didn't have the chemicals needed to test blood for safety before it was used. Doctors said the problem was that the hospital hasn't been paying suppliers, who won't deliver any more reagents.
It's a mixed public-private system here, and doctors can practise in both. Good luck if you're entirely dependent on the public system. (Which explains the widespread use of plants and herbs for healing in Copan, even in town. When my partner fell and made a mess of her knee, she was offered mango bark to make a antibiotic healing poultice. It seemed to help.)
And good luck if those who are so keen to slash health care spending in Canada get their way. The World Health Organization reports Canada spends 9.2 per cent of GDP on health care. Honduras spends 6.2 per cent.
President Porfirio Lobo criticized the health system Saturday, blamed administrative problems and vowed to sort things out. But with 17 months to go until the next election, he's already a lame duck. Presidents can only serve one four-year term in Honduras, and attention has shifted to this fall's primaries to pick candidates for the parties.
What should happen? Who knows. That's the first lesson from life in a poor country - there are no easy, quick fixes.