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Stories - Lines

In Ecuador, the lines to receive health-care services started the night before our clinic. Lines of hundreds of people that were not a thousand only because the organizers turned people away once a set number of “tickets” were given out.

The lines would snake through the street around to the side of the clinic. There were never any chairs, not until you got right up to the clinic, which were in schools. And the people had been there since 4:00 AM, or 3:00 AM, or even the evening before.

And these people didn’t just bundle the kids into the mini-van and cruise down to the clinic. Whenever the doctor was occupied with chasing down what medicines we had for particular symptoms, I would fill the dead time with questions. Are you from this town? I would ask, finding that a lot of the patients said no. They would point vaguely at the hills and say they live up on one of the nearby hills. So I would ask how long it took them to get here. And it would be hours. One hour. Two hours. Three hours. Sometimes they walked for a while to get to the main road, then took a bus, or truck to this town, then walked the rest of the way in.

If you factor in a two hour travel time, to being in line at 3:00 AM, these people were leaving home in the middle of the night. And you also have to consider that since one of our policies is that only people who are in the clinic can be treated, parents with three and four children, some of them too small to walk, some too sick to walk, and elderly people with sticks for canes, all had to come in to be seen. And several people came from other towns that were even further away, having heard about the clinic through friends or family.
So, why do these people come to the clinics in droves? Ecuador has an under funded socialized medical program similar to that found in the rest of Latin America. Where doctor’s visits cost co-pays of $5, and medicines are not covered at all.

But to make things worse, and the lines longer, when we were in Ecuador, the doctors were on strike. In the entire country, the doctors were on strike due to a contractual dispute with the government. Again, since it’s socialized medicine, the government pays their salaries. They would only treat emergencies. There are some private doctors, and private hospitals, but those are only for the rich, as the patients have to pay for all of their care in a private facility.

At our clinic the medicines were free. We often gave out three and four and five prescriptions to each patient. We would see about 200 people a day, and the pharmacy would give out over 500 prescriptions a day.  Socialized medicine, when it is underfunded, as it generally is in Latin America, is often no better than having no medical program at all.