Whither equity in health? The state of the poor in Latin America

Abstract

A waiting room in a charity clinic in rural Haiti. It is a humid afternoon, and huge drops of warm rain are starting to fall. A young woman is watching as her ten-year-old son, Dominique, clutches miserably at his abdomen; he is staring at the roof, not saying anything. A Haitian colleague says to me, His temp is 104, it's been up for over a week, his belly pain began three days ago. I'm getting the films and labs now. He pauses, looks darkly at the mother: It's late. I say nothing, but look at the woman as I reach for the boy's abdomen, praying that it's not yet rigid (it is not). Though she is no doubt younger than I, she appears weathered, for Haiti has been no kinder to her than to her son. She looks at me, sighs, and wordlessly makes a weary gesture. I know it well: What can I do?, she asks with her hands. It's beyond my control. And so it is. Well beyond her control. Her boy probably has typhoid fever, and the severe abdominal pain is ominous: one of the worst complications of typhoid is intestinal perforation, which usually leads to peritonitis and death in rural Haiti. Typhoid, a classic public health problem, is caused when drinking water is polluted by human feces. Not her fault. Ours perhaps, I think immediately. We could have worked harder on water protection efforts, even though another, more conventional voice in my head reminds me that Dominique and his mother live well outside of our catchment area, the region in which we-Partners In Health, a Harvard-affiliated public charity-work closely with community health

The Neglected Tropical Diseases of Latin America and the Caribbean: A Review of Disease Burden and Distribution and a Roadmap for Control and Elimination

“…In terms of income distribution, LAC exhibits the highest inequality anywhere [6], with the richest one-tenth of the population earning 48% of total income and the poorest tenth earning only 1.6% [7]. Of LAC's estimated 213 million impoverished people, approximately one-third live in rural poverty as subsistence farmers, ranchers, and fishermen [8], typically in communities of indigenous and African descent where they face a high level of social exclusion and social inequity [9], including lack of access to safe water and health care services [10],[11]. Two-thirds of the region's poor live in favelas , asentamientos pobres , barrios pobres , turgurias , and áreas periféricas , i.e., urban and peri-urban communities where poverty combines with the conditions of unsafe water, poor sanitation, and the proliferation of rodent animal reservoirs and vectors [8],[12].…”

Ethics for International Medicine : a Practical Guide for Aid Workers in Developing Countries

“…Many patients in developing countries have diseases such as tuberculosis, malaria, and intestinal parasites, which are infrequently seen in developed countries (Cappello, Gainer, and Adkisson 1995). Even when patients have familiar illnesses, they are often at more advanced stages of disease because they have little or no access to health care in the absence of medical aid workers (Cappello, Gainer, and Adkisson 1995;Farmer 2007;Rinsky 2002). Moreover, malnutrition and poor general health often compound the primary diseases of patients in developing countries (Dupuis 2004;Farmer 2007).…”

“…Medical aid workers commonly encounter patients with medical conditions that they are unfamiliar with or that are more advanced than what they see in the developed world (Farmer 2003;Graf 2003;Hennessy 2003;Leo 2003). Diseases that have been virtually eliminated in developed countries, such as malaria, tuberculosis, and dysentery, are rampant in developing countries (Tan-Alora and Lumitao 2001).…”

“…For example, Partners in Health employs community health workers to visit the homes of patients with aIDS and tB, bringing them their medications so as to ensure compliance (Lyon and Farmer 2005). In addition, this organization has shown that providing food aid along with medication is correlated with a high rate of patient compliance (Farmer 2005;Mukherjee et al 2006). When medical aid workers encounter patients who require long-term treatments, it is important that they are aware of the barriers to adherence and that they work with patients and communities to minimize these barriers.…”

The Context of Ethical Problems in Medical Volunteer Work

“…Many patients in developing countries have diseases such as tuberculosis, malaria, and intestinal parasites, which are rarely seen in developed countries (Cappello et al 1995). Even when patients have familiar illnesses, they are often at more advanced stages of disease because they have little or no access to health care in the absence of medical volunteers (Cappello et al 1995;Farmer 2007;Rinsky 2002). Moreover, malnutrition and poor general health often compound the primary diseases of patients in developing countries (Dupuis 2004;Farmer 2007).…”