Two health care systems

Issue: BCMJ, vol. 51, No. 6, July August 2009, Page 267 Editorials

I enjoy traveling, but there is always part of me that looks forward to returning home. Often the attraction is not much more than sleeping in my own bed and using my own shower! However, sometimes there are extra things to be grateful for: drinking water out of the tap, a sense of security walking along the street, and breathing cleaner air.

Recently I was part of a group who traveled on to Peru after the BCMJ CME cruise to the Galapagos Islands. The tour organizer arranged for us to spend some time talking to a local doctor in Cusco (altitude 3300 metres, or 10 800 feet). This conversation gave us a brief glimpse into medicine in Peru.

Approximately 5% to 7% of the population is cared for under a private, and expensive, health care system; another 30% or so have access to a public system with the premiums being paid by their employer. The remaining two-thirds of the people have theoretical access to the public system, but care appears to be rudimentary at best.

The physician who spoke to us worked in both systems (the private part of his practice centred on tourists with altitude sickness and other ailments). The major diseases dealt with in the public system are tuberculosis and AIDS, the former being driven by the latter. HIV disease has tripled in incidence in the last several years and little care is available. Antiviral therapy costs about US$700 per month and the average income is US$1000. Condoms are not talked about, let alone used, in this predominantly Catholic country. Many rural people do not trust modern medicine and use the local healer instead. Maternal mortality is about 180/1000 births, with many wo­men delivering in remote farms with little help. Medical school is available only to those with the ability to pay, and practice in the private system requires some training overseas, again available only to the well off.

It was sobering conversation that left me appreciating, once again, our health care system and our ability to give care to all regardless of income. It reminded me what a privilege it is to work in such a system and how blessed we all are to live in Canada. 


Lindsay M. Lawson, MD. Two health care systems. BCMJ, Vol. 51, No. 6, July, August, 2009, Page(s) 267 - Editorials.

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