COVID-19: Health inequity in Guatemala and the pandemic

By Aaliyah Sayed, Megha Thomas, Thomas Bocian, and Riley Felsher

The novel coronavirus has altered our reality, and health systems all around the world are being put to the test. In New Jersey, an hour away from New York, marginalized communities and those with preexisting health problems are suffering disproportionately compared to the rest of the state. Due to complicated social factors in the US, including residential segregation, the mortality rate of African and Latin-Americans is 100% higher than that of Caucasian-Americans. In addition to overwhelming the health system, the virus reveals deep-rooted social problems in America.

Protecting citizens and flattening the curve of the virus is imperative, and this requires a robust and organized health system. COVID-19 has reached Guatemala, but the country is ill prepared. As we have seen in New Jersey and New York, Guatemala has social vulnerability, aside from health inequity, that can destroy efforts to contain an outbreak.

This social vulnerability- malnutrition in the west, scarcity of resources in rural areas, and lack of water and universal coverage, creates a system full of holes. Dr. Carmen Alvarado, the medical director of the Guatemalan NGO 32 Volcanes, says, “In reality, we’re talking about coronavirus, but we first need to acknowledge that vulnerability exists due to other factors. And basically due to impoverishment, the population, above all rural indigenous people, is displaced and lacks food security, which has exacerbated the vulnerability problem.”

The Guatemalan health system has not earned the trust of the people- and for good reason. With the lack of medicine, clean water, hospitals, and coverage, Guatemala is ill prepared for a pandemic as contagious as COVID-19. Congress has given 100,000,000 quetzales ($13 million USD) to the Ministry of Health to create more laboratories for COVID-19 examinations and for hospitals. There are only five provincial hospitals with 96 total beds for intensive care (roughly 5.65 for every million people). In comparison, El Salvador has 16.67 for every million. In addition, there are only 56 respirators in the entire country. There is not clear information about how many tests of 24 COVID-19 tests are being realized per day, but according the number provided for the official government announcements, there have been just a few for the total of population in Guatemala.

The government recognizes the need to strengthen its health system, and has promised to help with the costs of medicine, surgical equipment, and medical supplies. On March 25, the government approved the Emergency Law to protect Guatemalans from the effects caused by the covid-19 coronavirus pandemic, which allotted $480 million quetzales to cover programs for health, employment, security, the economy, and elderly. It also ordered health authorities to provide funds for hospitals and health centers, and to spread information on the pandemic in the various languages of the country. However, until a few days ago, this budget continued without being executed and medical personnel working for the hospitals -specifically destined to attend the pandemic- have recently and publicly complained about poor working conditions.

Those who suffer from malnutrition have higher risks of various diseases, including cholera, diabetes, and heart disease, which increase the risk of dying from the virus. Lila Álvarez of the Center of Permanent Attention in Cotzal indicates that the rates of malnutrition vary widely by region, with the west having the highest rates. This implies that the west will need more resources than the rest of the country. Ultimately, Guatemalan citizens may have to pay for medical equipment in their taxes to compensate for the inability of the government to guarantee nutrition.

Regardless, the community has taken matters into its own hands: for example, the University of San Carlos in Guatemala has been making and distributing respirators.

Alvarez also pointed out, “Our health system is best characterized as curative and not preventative, and we need to increase the preventative part. If the mortality rate of coronavirus is so high, the most vulnerable populations will be impacted the most negatively.” The ministry promotes hand washing, but following this recommendation will be difficult for communities without access to clean water. As of today, Guatemala does not have a law that guarantees universal access to clean water. If the government does not tackle the water problem at its roots, it will not be able to solve hygiene problems to combat COVID-19.

The system simply does not have sufficient coverage, especially for rural and indigenous areas. Public facilities serving these populations are poorly financed and lack human resources and medicine. Alvarado confirms, “There is fragmentation between the ministry of health and non-governmental organizations. The ministry, what it has is social reach because it has more coverage than an NGO, but what NGOs have are human resources… It is a collaboration that should exist.” The Comprehensive Health Care System is an organization that has made agreements with NGOs to reform the health system, and expanded coverage to approximately 3.2 million inhabitants in rural and indigenous communities.

If the government can implement new policies focused on the community, their work will lead to effective change. Until then, Guatemalans are vulnerable to the virus due to existing structural weaknesses. The government has the responsibility to protect all of its citizens equally, but at the moment, this goal seems unattainable.

Cover photo: A police officer delivers boxes containing food aid to low-income people by Luis Echeverria.