Thirty years ago, a cancer diagnosis was tantamount to a death sentence, worldwide, with mortality rates for breast cancer at 58 percent. Technological advances in diagnosis and treatment have significantly reduced the risk for most cancers … for those who have equitable access to early diagnosis and care. A study released last month showed injustice between U.S. women of different races for breast cancer prognosis. Blacks on average are 40 percent more likely to die from the disease than whites, and this number grows exponentially in some cities: in Los Angeles, it is 70 percent. In Low- and Middle-Income Countries (LMICs), the results are disturbingly similar, but the chasm is between wealthy and poor. The system in many countries does not provide care for those without means to pay for their treatment. For example, in Guatemala, women may have funds to pay for only a portion of their treatment to carry on the fight against their cancer, and then must stop. That amounts to a death sentence.
Breast cancer is the second leading cause of death for women in the world. In Guatemala, over 40 percent of registered cases are a combination of cancer of the female reproductive organs and breast cancer. In the major public hospital in Guatemala, Hospital General San Juan de Dios, an estimate of 25 women are detected per month. Guatemala does not maintain official statistical health records for its citizens, and so there is a lack of official figures on the incidence of cancer in Guatemala. This is even more worrying for rural and indigenous women living in the interior of the Republic.
In order to have appropriate treatment for breast cancer, first there must be accurate and early diagnosis. The most serious limitation to treatment for patients who cannot afford to pay for their care is the lack of public health support. Due to budget constraints at hospitals, support is minimal, focused on a small percentage of women who come to the National Hospital. Moreover, care is inconsistent. The majority of patients do not receive complete treatment, which forces women to pay for their own care. The cost can be more than Q50,000, or approximately $6,500. With a GDP per capita of the equivalent of under $3,400 (that is, the average income is half the cost of treatment/2012 figures), the cost is completely inaccessible to the poor.
The situation is aggravated by inadequate initial diagnosis by some doctors in Guatemala, which result in medical treatments that assume other diseases. This slows appropriate treatment and causes cancer to spread throughout the body, putting women’s lives at risk and the fight for survival even harder. Moreover, even if there were sufficient funds to pay for treatment, there is a lack of adequate staff, medicine, equipment, and public budget to address cancer treatment for the poor, adding to the injustice.
For those living in rural areas, lack of access to care if usually insurmountable: 51 percent of Guatemalans live in rural areas and a large majority of the nation’s poor live outside of the cities. In the 2011 U.N. Human Development Index, Guatemala was number 131 out of 187 countries. The Index measures standards of living, life expectancy, education, and literacy of countries worldwide. The higher the number, the greater the risk.
People living in rural areas are highly vulnerable and indigenous communities (40 percent of the total population) experience the greater portion of poverty within the nation. According to the Guatemalan government, 70 percent of indigenous live in poverty. (See video below.) When women are heads of household, they also lack access to resources and assets.
There is also poverty in the cities, where people often go from rural areas seeking work, finding low-paying jobs or none at all. Without a position, they do not pay into social insurance, which increases the population of patients in public hospitals, overburdening the already underfunded government system.
In order for cancer patients to get adequate health care, they need to get to the capital. Many are referred to two public hospitals: Hospital General San Juan de Dios and Hospital Roosevelt, or to the private hospital Instituto de Cancerología (INCAN). All three are in Guatemala City. The cost of transportation, lodging, food, medicine, and labs renders patients impotent to pay for their comprehensive treatment. Partial treatment has little effect on cancer, meaning that it is likely to recur. Without sufficient funding in public hospitals to subsidize care, many patients return home, having lost hope, ill and destitute.
To combat this paucity of resources for the public, a grassroots advocacy group comprised of breast cancer survivors has formed in Guatemala. Their mission is to influence public policies and budgets there. The
Rebuilding Lives Collective, Colectiva Reconstruyendo Vidas, has petitioned the State of Guatemala to provide comprehensive treatment for women as their constitutional right. Citing The U.N. Universal Declaration of Human Rights, the group refers to the country’s obligation to ensure the health of its citizens.
The group is lobbying Guatemalan Congress and the Ministry of Health to budget and provide resources to Hospital General San Juan de Dios and other public hospitals and to require that they give full, comprehensive treatment, as well as palliative care for patients and psychological support for their families. This means that the hospitals must be adequately staffed and have the equipment needed to provide high-quality care for all cancer patients in Guatemala. In addition, the Collective requests that the Ministry of Health and Education generate campaigns and activities to promote early detection of cancer, to encourage earlier treatment. And, they urge training for medical staff to learn how to detect the disease earlier.
The goal of all of these efforts is to improve the cancer injustice for all citizens of Guatemala who have been or will be touched by the disease. In particular, the outcome for poor and especially rural women would be improved if these measures were followed. The intent of the work is to support those with scarce resources, and to work together in solidarity to fight for the life and health of women.
By Fern Remedi-Brown
Guardian Liberty Voice
Por La Vida de Las Mujeres, Borrador de Boletin de Prensa
International Fund for Agricultural Development (IFAD)
The U.N. Universal Declaration of Human Rights