Heath Care Delivery In Guatemala and Arguments of Lack of Medical Access in U.S. Immigration Hearings

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Introduction:

The purpose of this article is to examine the health care delivery system in Guatemala and how it impacts repatriated Guatemalans who have ongoing medical issues. In the United States, the level of care for the poor or unemployed exceeds Guatemala’s by several fold. Upon return to Guatemala, most deportees struggle to find employment and fall under the state supported medical care. These state programs are inadequate and could endanger those who have received life-sustaining treatment in the United States but are forced to return to Guatemala. Even lesser medical conditions cannot be adequately treated in Guatemala under state programs. Given the health care delivery issues in Guatemala, arguments can be made in immigration proceedings that a respondent or family member’s life or ability to thrive could be in danger if they are deported and forced to rely on state support for health care.

Health Care Overview:

Guatemala is a country with few resources to spend on health care. Historically, Guatemala has struggled to find a model for health care that is efficient, effective, and available to all people in the country, especially those in underserved and rural areas [1].

Quality healthcare is possible in Guatemala, but at a cost that is prohibitive for half of the Guatemalan population. The Guatemalan public healthcare system is the target of much criticism and has deep issues of corruption. Half of the population do not have formal jobs. Therefore, they are not protected by any type of medical insurance. The only option available is the public healthcare system which is oversubscribed and suffers from poor service [2].

Only Guatemalans who work in the formal sector have access to public healthcare insurance from the Guatemalan Institute for Social Security (IGSS) that is financed through ten percent of their monthly income and a ten percent contribution from the company that hires the employee. This public insurance system is also full of problems. For example, an appointment with a specialist can take more than three years, which forces patients to go outside the medical insurance system to spend large sums to get attention in a private hospital [3].

According to the Guatemalan government, the principal issues in public healthcare system (to include dental care)-- (whether state-supported or through the IGSS) in the country are as follows:

· Excessive waiting times to receive attention even in emergency cases.

· Not enough doctors.

· Inadequate medications. It is very common that patients (mainly the poorest areas) have to buy their own medication because of either wait times or lack of availability.

· Management problems in hospitals and endemic corruption of management and staff at hospitals.

Additionally, the average number of doctors in Guatemala is very low--only 1.6 per 1000 persons, despite the fact that the government has tripled the investment in health care in recent years. The chances of receiving good medical care is better if the patient lives in a major city. However, as noted earlier, care is lacking in small cities and rural areas because specialists are often not present [4].

For people who have medium-high or high income, health care is less of an issue because they are treated in private hospitals. In surveys of upper-class Guatemalans, they see no reason to consider using the deficient public healthcare system sponsored by the Ministry of Health and Social Assistance (MSPAS)[5].

Mental Health Care :

Mental health care is also strained in Guatemala. The government prioritizes basic health maintenance services over mental health. The number of professionals dedicated to mental health care in Guatemala is very low despite the fact that mental disorders are a recognized problem by the government. A report from the Pan American Health Organization (PAHO) found less than ten percent of Guatemalans were able to access national outpatient mental health facilities in an average fiscal year [6].

Private mental health care in Guatemala is expensive. For example, a week of inpatient care in a center specializing in psychiatry can cost $500 U.S., which for most citizens is prohibitive. Immediate treatment from a neuro-pediatric specialist is only possible in private hospitals. In the public sector, due to the high demand of these specialists, it can take many months to just receive an initial consultation. The overall availability of specialists is low and hospitals are always saturated [7].

Several Guatemalan health advocacy organizations have identified that almost 25% of its younger citizens will suffer some sort of learning disability. There is general ignorance in Guatemalan society of these issues. It is common to hear stories of teachers mistreating or punishing children--considering them disobedient or spoiled rather than suffering from a mental health deficiency. In some cases, children have been removed from educational institutions because of their mental health issues [8].

Conclusion:

Repatriated Guatemalans with health care concerns would face severe difficulties with accessing health care in Guatemala because of their medical conditions and difficulty in obtaining employment. Deportees are often hard-pressed to pay for medical care and there is often difficulty in accessing care if they can find a way to pay for it.

This leaves repatriated Guatemalans who have health issues with the possibility of suffering catastrophic medical outcomes. Given these facts, one can argue effectively in immigration proceedings that deportation could prove extremely detrimental to those who are forced to rely on state support for their medical care.

Endnotes:

[1] “Guatemala: Health System Assessment 2015,” U.S. Agency for International Development, August 2015, accessed at: https://www.usaid.gov/sites/default/...APRIL-2016.pdf

[2] “Five Reasons Why the Guatemalan Health Care System is in Deep Crisis,” Mayan Families, February 2, 2016, accessed at: https://www.mayanfamilies.org/blogs/entry/3594

[3] “Guatemala: Health System Assessment 2015,” U.S. Agency for International Development, August 2015.”

[4] Healthcare Access and Conditions in Guatemala, Honduras, and El Salvador,” U.S. Centers for Disease Control and Prevention, January 25, 2017, accessed at: https://www.cdc.gov/immigrantrefugee...iet/index.html

[5] Government Stewardship and primary health care in Guatemala since 1996,” Public Administration and Development, February 2019.

[6] Mental Health, Central American Refugee Health Profile,” Centers of Disease Control and Prevention, January 25, 2017, accessed at: https://www.cdc.gov/immigrantrefugee...lth/index.html

[7] For further discussion on this issue, see: “Mental Health-the situation in Guatemala,” ALAS Pro Salud Mental, https://www.alasprosaludmental.org/the-problem-1

[8]. Niños especiales enfrenta falta de atención educative,” Prensa Libre (Guatemala), May 10, 2017, accessed at: https://www.prensalibre.com/ciudades...cion-educativa


About The Author

Robert Kirkland is a retired U.S. Army lieutenant colonel and operational Latin American Foreign Area Officer. He has a B.S. from the United States Military Academy, West Point and a M.A. and Ph.D. in Latin American history from the University of Pittsburgh. He also has a graduate certificate in Latin American Studies from the Center for Latin American Studies at the University of Pittsburgh. He has provided expert testimony on drug cartel and gang violence in Mexico and Central America since his retirement from the Army in 2014. He can be reached at info@robertkirklandconsulting.com

The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.


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