Friday, 2 January 2009

A thumbs up for Peruvian (public) healthcare

I've been extremely lucky so far on my trip in that I did not have to seek any medical help whatsoever until this week (about 108 days in, for any statisticians out there). As some of you will know, the cause was a spider bite I picked up on my elbow in Lima a couple of days before Christmas.

The bite was merely annoying for the first few days but began to swell and get more painful by about Sunday. My first stop was a pharmacy in Lima, where I was given two anti-histamines (I might have been a medical journalist previously but I will apologise in advance for some spellings here). These drugs at first lessened the pain, but then it came back with a vengeance by Monday, at which point I was by the beach.

I sought out the only local clinic - a very clean, very upmarket affair in a westernised shopping centre 5km down the Pan American highway. I was seen immediately by a doctor who spoke perfect English and he set about removing the pus that had built up in my elbow. An excruciating half an hour later, all that remained was for me to pick up my drugs and pay the bill.

Eighty-three pounds sterling.

When, two days later in Cuzco, I made my way to the public hospital to have my wound cleaned again, it transpired I had been given the wrong antibiotics for my elbow and made to pay through the nose for them.

At the public hospital I was seen almost immediately and referred from one doctor to another before being given some (correct) antibiotics and having the wound cleaned. (A mere five excruciating minutes this time). The cost of all that?

Five pounds sixty.

Yesterday I needed to go back to have the wound cleaned (the first time in my life I've been to hospital on New Years' Eve and New Years' Day, and hopefully the last) and whilst the staff were under considerable strain, and I did my best to let people in front of me in the queue (everyone had something worse than me) I was still seen inside 45 minutes by polite staff who never seemed to take a moment's rest. The antibiotics I had been given were clearly working, as the actual cleaning of the wound barely hurt and barely took three minutes. Two pounds twenty.

Part of this impressive service, I think, is that a public hospital is one of the few places in Latin America where gringos may get genuinely preferencial treatment without paying a penny more than an ordinary latino. The thought process I imagine to be something like this: "What the hell is that white man doing here? Does he realise there are private clinics all over the city? I bet in Spain or the USA, or wherever he's from, he would be seen by three doctors inside two minutes! We'd better show him that Peruvian healthcare is nothing to be ashamed of."

If any of the doctors had not been run off their feet I would have loved to discuss with them what the NHS is actually like. Personally I am a huge defender of the National Health Service but I had already formulated a Spanish phrase in my mind to explain why I instinctively brought a book with me to the hospital: nunca se paga; siempre se espera - you never pay; you always wait.

Of course, I'm not going to be naive enough to give total endorsement to a third-world health system. Waiting in line yesterday I saw a woman in considerable pain and distress being treated in the waiting room. Another man was brought in unconscious and seriously injured by a pick-up truck - presumably because that was better than waiting for an ambulance. And I'm sure a city of Cuzco's size could use a more modern building with larger wards. But, as far as I have seen, the professionalism of the staff cannot be faulted (in the public hospital, that is, not the private clinic. Cost differential: roughly 1500%).

As a backpacker, I do consider myself lucky to have avoided the doctor's surgery until this far into my trip, but I also consider myself lucky now to have had a genuine cultural experience in Peru: one that you don't see in the guidebooks or the tour offices. (Who needs Machu Picchu?)

So now it is January 2 and I'm off to spend my morning at... the hospital. The wound needs to be cleaned up again. Bloody spiders.


Richard Smith said...

Good to get the whole story at last, and you give the "man bitten by spider" story an interesting twist by turning it into a story of the superiority of pubic versus private healthcare in Peru. And are you sure it was a spider? They get the blame for many things they don't do. It could just have been an infected wound caused by anything.

James Smith said...

It may have been some other kind of creepy crawly - but the doctors I spoke to thought it most likely a spider. I am happy to blame them. And, in fact, as Claire will atest, an unrelated spider in Cuzco ended up paying a stiff penalty for his paisano's aggression.

Jamie said...

Out of interest, do you have any information on the breed of spider? I hope, for your sake, that it was something big and impressive.

You should read The Kiss of the Spider Woman by Manuel Puig. Its about gays not spiders by the way.

James Smith said...

I beleive it is known as the Peruvian Dog Spider, so called for its size. Enormous. Imagine a chihuahua with eight legs.

No seriously, I was asleep and have no idea. But, in related news, the Bolivian healthcare team I saw today were loving my denigration of Peruvian spiders, after the doctor said he was surprised I wasn't robbed in two weeks in Peru.