Guatemalan Health System: An Ongoing Humanitarian Crisis Esteban Marquez Office of International Programs 2017 International Educational Experience Presentation

Introduction Located in Central America, Guatemala is one many countries with some of the worst health outcomes globally. It has the fourth highest rate of chronic malnutrition. Other alarming ranks include high maternal and child mortality and prevalence of chronic illnesses such as diabetes and heart disease. While many of these issues stem from lower socioeconomic backgrounds, slow modernization and a deficient infrastructure country-wide have hindered the prosperous development of quality healthcare outcomes for the past several decades.

Barriers to Accessible Healthcare After visiting Guatemala for a few weeks and having absorbed rich cultural and social information from my experiences, I was able to identify five main barriers to healthcare development in Guatemala. These are: Language diversity Poor state and local funding Privatization of health systems Lack of specialists and advanced resources Cultural limitations

Language Diversity The population of Guatemala is predominantly of Mayan descent. This means that there are over 22 indigenous languages spoken across the country. A diminished educational system prevents most of the population to learn Spanish adequately. Spanish is the official language in the country.

Language Diversity Healthcare professionals in Guatemala speak mostly Spanish, therefore making it difficult to authentically communicate with their patients. The basic needs of healthcare are thus difficult to assess and discuss given this gap in communication. This also represents a barrier for medical interprofessionals that come from other countries, who assume all Guatemalans speak Spanish.

State and Local Funding While healthcare in Guatemala is free to everyone, it has it’s limitations. Resources are vastly scarce, and healthcare professionals tend to be selective in their approach to treatment. In 2008, the state government spent an average of $97 per person on public healthcare. This compares to an average of well over $7,500 per person in the United States. Some of the established local clinics and health centers, examples being Patanatic and Godinez (the two clinics we worked with in Sololá), often do not have the necessary supplies, vaccines, or medications to adequately care for the community’s needs.

State and Local Funding According to Petrovick (2016), “this has the greatest impact on families with low resources who cannot afford to go to expensive private clinics”. This barrier was very evident throughout our entire journey in Guatemala. Resources are often outdated and futile when available.

Privatization of Health Systems Private healthcare companies have taken over complex health services, including imaging services, surgical procedures, and critical care nursing. These secondary services are thus difficult to access by the general Guatemalan population despite healthcare being free for all citizens. These secondary services have become very expensive for families, given the public health posts being contracted by foreign and private healthcare firms that seek to optimize profits in the region.

Lack of Specialists and Resources Perhaps the most difficult barrier that Guatemalans confront regarding healthcare services is the lack of specialists and impaired access to services. Over 80% of healthcare specialists are located in Guatemala City, meaning that any complex or chronic health issues must be assessed in the capital city. To many Guatemalans, this is simply a non-budgeted expense; this represents taking a day off work, without pay; paying a hefty price for a long bus ride to the capital city; and not being guaranteed that they will be seen or acquire prompt results after their visit.

Cultural Limitations There is a notion in the Guatemalan culture that exposes a gap between healthcare and the patient’s beliefs. Guatemalan’s feel that their visits to health clinics or local hospitals are often stagnated by the lack of sensibility and respect from healthcare professionals in regards to the patient’s own preferences and beliefs. This was something that was noted during our visit, as many community members felt skeptical about our presence and our purpose in their community.

Cultural Limitations The bridging of this notion relies on transparent and active communication between community leaders and healthcare professionals. Understanding and being open to other cultures can immensely impact communities in countries like Guatemala, where healthcare needs are at an all-time high and immediate change is needed.

Suggested Interventions Invest in local social work agencies that can help advocate for patients and their causes and facilitate their visits to any clinic or healthcare agency. Eliminate corruptive and political affiliates from any healthcare institution, whether at the local or state levels. Adequately educate providers in all areas of the healthcare spectrum to optimize communication efforts and reduce ambiguity, while increasing transparency and accountability on both ends.

Closing Thoughts The people of Guatemala continue to struggle with an unsustainable healthcare system that attempts to facilitate free healthcare to all its citizens, yet lacks adequate leadership efforts to mobilize the structural changes needed to make this happen. With continuous privatization of basic and secondary healthcare services, the people of Guatemala will continue to struggle with illness prevention and health promotion. It is up to local and foreign health management organizations to fix the micro and macrosystemic structures to best implement patient-centered care and produce positive health outcomes for the vulnerable citizens of Guatemala.

References Guatemala Demographics Profile. (2016). Retrieved January 30, 2017, from http://www.indexmundi.com/guatemala/demographics_profile.html Institute for Health Metrics and Evaluation. (2015). Retrieved January 30, 2017, from http://www.healthdata.org/guatemala Instituto Nacional de Estadísticas Guatemala. (2017). Retrieved February 01, 2017, from http://www.ine.gob.gt/ Leading Causes of Death. (2016, October 07). Retrieved February 13, 2017, from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm Petrovick, T. (2016, February 2). Five Reasons Why the Guatemalan Health System is in Deep Crisis. Retrieved March 30, 2017, from https://www.mayanfamilies.org/blogs/entry/3594