Cancer Care and Health Care “Delivery” in Guatemala

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Peter_Rohloff
Peter Rohloff has training in parasitology, internal medicine and pediatrics. He practices in Boston, MA at Brigham and Women's Hospital and Boston Children's Hospital. Since 2003, Peter has been working in Guatemala, where he serves as the medical director for a health systems NGO – Wuqu’ Kawoq | Maya Health Alliance. Peter’s interests include the management of chronic diseases of children and adults in resource poor settings and how indigeneity, cultural, and language barriers impact access to and utilization of health care. @wuqukawoq

It has been a busy couple of months for us in Guatemala. For more than a year now, we’ve been working closely with INCAN to improve care for the rural patients with cancer diagnoses that we encounter in our practice area.

INCAN is an interesting organization. It’s a private, lower-cost entity that provides a mix of services, including cancer screening, public health campaigns, and definitive cancer treatment. It is sort of like a cross between a traditional cancer hospital and the American Cancer Society, in Guatemala. And it’s the only place here that offers anything close to definitive treatment for patients with cancer diagnoses.

But there’s a major catch. Although INCAN does a good job of diagnosing patients and prescribing chemotherapy regimens, they remain an isolated institution in Guatemala City, far removed from the majority of the patients who need their services.

Many cancer patients live in small, isolated rural communities many hours by bus from Guatemala City. Many of them have never travelled before, and most do not have a good command of Spanish, the only language they will hear when they arrive in the city for their cancer treatments.

It turns out that in a country like Guatemala the major barriers to quality treatment for cancer are not really the things that most people think about, like access to chemotherapy medicines, or the skill of surgeons or oncologists. Rather, they’re things like the logistics of arranging bus rides or overnight stays far away from home. Or accompaniment by someone who is more literate or more fluent in Spanish than the patient, who can help navigate the confusing maze of the urban hospital environment.

The vast majority of indigenous cancer patients in Guatemala never return for follow-up after their first appointment and never receive definitive treatment. There’s been a lot of literature in Guatemala that has tried to explain this as having to do with the particular cosmological outlook of the Maya. We think that is basically untrue. It’s not necessary to invoke world-views when logistics, poverty, and structural injustice are staring you in the face.

So that’s where we at Wuqu’ Kawoq—and others like us, committed to improving health delivery—come in. We do the eminently unsexy working of providing reminders about appointments; driving patients around the countryside; subsidizing bus fare, meals and lodging; providing interpreters and advocates. This, we think, is how you improve cancer care. Its not rocket science by any means, but it works.