Wednesday, November 7, 2007

Back from Peru...

My wife and I are back from our Peru mission trip: And a couple of things struck me from this experience...

There is a "national health care system" in Peru. That is, each of the graduates from the medical schools of Peru serve in a national system as primary care providers. Sort of like our "National Health Service Corps", but with an important difference - the patient is expected to pay for this care, and the poorest of the population simply go without care.

Or, maybe that's not really different at all. I have many patients who have deferred care until they have advanced disease due to cost, and they certainly do NOT have access to primary health care without cost here in the US. Many patients do not qualify for Medicare or Medicaid, and even our "safety net" of Community Health Centers expects payment of a nominal fee.

We did a lot of traveling during our trip - Lima, Trujillo, Chao, Cascas, Iquitos. We saw the coastal desert, the foothills of the Andes, and the Amazon jungle. During that time, we saw very few Americans. But, while waiting to leave the country at the Lima Airport, we saw two different medical teams as well. We shared the American Airlines flight back to Miami with one team, a surgical team who'd spent two weeks in Northern Peru, and were looking forward to their first hot shower! It struck me that mission teams must be a fairly common sight, arriving and departing from Lima's Jorge Chavez airport.

We also had the chance to meet three medical students while in Peru. I have some mixed feelings about their professional goals. Two of the three intend to come to the US for residency training after finishing their seven years of medical school. The US can certainly use the help; 3700 of the 10,000 physicians-in-training in US family practice residencies are International Medical Graduates, according to the American Academy of Family Physicians. We just can't find enough US-trained physicians to take care of our own.

But, what about Peru? These three medical students represent the concern of many "developing" countries - the talent that is needed to move the country forward is leaving for the US or other "developed" countries, which offer their own version of the American Dream.

While the US struggles with what has been called "expensive medioctrity", the Peruvian government has pledged to provide access to primary healthcare services for all citizens, regardless of income. This is seen in this article, published in the Spring. I'm not sure what progress has been made since that time... but I do know that there are still many Peruvians who are suffering. I've met them. And the language of suffering if universal. I've met them here, too. We are spending way too much for a system that doesn't work. And, Peru is movnig forward with a national health plan to cover everyone.

So, who's really "Third World?"