Social Security

This is a translation of my previous post, in which I quoted the text of Alfredo Molano's latest column in the Colombian newspaper El Espectador. Molano is an exiled Colombian journalist who writes on social issues. I have translated the text because I believe it should have wider redearship among non-Spanish-speaking readers who are interested in Colombia. The translation is my own, is very literal, and is unendorsed either by the author or the newspaper.

War Hospital
by Alfredo Molano Bravo

I have received the following mail of which, I think, my readers should be aware.

"The ISS [Instituto de Seguros Sociales, Colombia's Social Security Institute, which manages public hospitals] is at its end. Bad for the country and worse for the patients who are forced to use its services and for their family members who must watch in horror as their loved ones agonize in a hallway, in a basement, on the stairs. The San Predro Claver Clinic, the one I am suffering, is a war hospital, or, as they were called during wars, a blood hospital. To begin with, patients must wait in neverending lines, not to be seen, examined, and diagnosed by a doctor, but to stand in a new line. Many faint and fall, and even then they are not seen to. The remaining patients simply avoid stepping on them, until some compassionate nurse puts alcohol on their noses to wake them up. Some people sleep at the clinic to not lose their turn, and turns pile up day after day. As a result, new arrivals have 400 patients before them, many of which, if they get to see a doctor, it is to be sent to intesive care.

Those who survive receive, finally, a prescription, have to pay for the medecine out of their own pocket. What's more, for scheduled surgeries, the patient must bring with him blood, pay for the anaesthesia and, of course, everything that is necessary to save his life, which doesn't always happen. Clinical or radiological tests are rarely practiced because the machines are down, or because the drugs in the "essential" drugs list prescribed by the doctor are never available.

The crisis and bankruptcy of the Social Security system seem planned in favor of private health companies. When a worker needs a service or an authorization for a service at a private EPS [HMO, health maintenance organization], the attendant checks the computer, where it says that his employer is up-to-date with the payments and the payment form is scanned in, so it can be printed anytime. Instead, ISS patients must carry under their arms a folder with all payment receipts and proof-of-membership for 15 or 20 years back. Without the dog-eared folder there is no chance to receive help at any Ambulatory Attention Center or at any Emergency Service.

Through the basement of the San Pedro Claver Clinic pass the patients that come in through Emergency; they are called Observation Rooms. There men and women wait — often on the edge of death — in hallways filled with stretchers. It smells of chloroform, alcohol, band aids, and all the humours that concentrate in closed spaces. It must be added that the patient has to pay for the stretcher rental, in which he lives, eats, performs bodily functions and awaits death. It is forbidden to walk down the hallways. The walls are full of hooks and nails on which to hang serum and blood. I must add, too, that the famous and quite useful CAT exam at San Pedro is unthinkable: the wait lasts months.

A retired nurse who worked for 20 years in the terrifying San José Hospital remarked, 'I have never seen anything like this; in the rooms, even when we had ten beds with people picked up off the street, the hospital had curtains to separate them.' Exams and diagnoses are made in public, violating the patient's right to privacy. There is total promiscuity in the halls and, especially, in the basement.

And the worst: not a day goes by in which someone doesn't die in front of the other patients; sometimes, two or three die. Not even one's right to agony is respected. I suspect some die of fright at the death of their neighbor.

The only good things about San Pedro are the doctors, the nurses, and in general, all the paramedic team. They are true apostoles who work without even gloves. They are specialists forced by the system to work in the most deplorable conditions. The only advantage is they must improvise, invent, discover, innovate, eschew technology and return to the time of the integral doctor and the clinical eye."

Inés de Arenas