Tuesday, March 27, 2012

Unanswered Questions: Baca Ortiz

What is the best thing for an under-funded hospital to do with the little money it receives? This was the question I first asked in 2007, when I was studying abroad in Quito, Ecuador. And I still do not feel that I have a suitable answer. This post is more of a description of my despairing feelings than an offer of solutions. I know that many readers do not like such a lament. But I truly don't have an answer. My hope is that this will at least cause others to ask the same questions, and perhaps it may even inspire a spark of innovation to find an answer.

During the fall of 2007, I had the chance to visit Baca Ortiz Children's Hospital in Quito, the premier children's hospital in the country. It is very difficult to find specific information about the hospital, so I have scraped up what little I could locate to provide a general picture. According to "Volunteers Abroad," Baca Ortiz was founded July 14, 1948. Approximately 140,000 children are treated at the hospital annually. Families come from around the country to the facility, because it offers specialized treatment that is not available in other regions.

The hospital has a paid staff of doctors and nurses, as well as a number of volunteers with a range of skills, from medical professionals, to individuals who visit with the children, to those who help fund raise for the most needy families.

Although Baca Ortiz receives funds from the government, it is significantly under-funded, and families are therefore required to pay for the treatment they receive at the facility.

Based on the accounts of my friend who volunteered at Baca Ortiz regularly and based on the information I received during my time there, the facility itself has so few resources that it cannot stock basic supplies, such as soap, toilet paper, bandages, or medicine to keep on-hand, unless these happen to have been recently donated. If a child is admitted to the facility, his or her family is responsible for providing soap, toilet paper, and other supplies for the child's room. If the child requires any sort of treatment, the family has to go to a local pharmacy and purchase bandages, sterilized surgical instruments, oxygen tubes, anesthetics, sanitizing agents, antibiotics, etc. There is no surplus to have these items readily available.

For many families, this simply means going without sufficient treatment. According to the CIA World Factbook, 33.1% of Ecuadorians live below the poverty line. Many more make enough to be deemed above the line, but are underemployed and still struggle to provide for their families on a daily basis. Additionally, income disparities are extremely pronounced between various regions of the country and between different racial groups.

Families are also provided meal tickets to eat in the hospital's cafeteria a certain number of times per week. For some, these are the only meals they will eat at all due to general poverty or due to the costs of traveling to the hospital and paying for treatment. However, my friend who volunteered handing out meal tickets told me that she frequently ran out before every family had received their share, as the hospital was extremely over-crowded (see the image of children being treated in the hallway on the right due to room shortages) and had a very limited budget to prepare a certain number of meals per week.

Some families have little hope of paying for treatment once they have received a diagnosis, and they go home without assistance. Others may gain funding through organizations that donate specifically for their treatment, such as The Mashi Foundation, which used social workers to identify ten children of highest priority and funded the surgeries for those children in 2010. Assuming that 33.1% of the 140,000 children who visit the hospital in a given year are impoverished, as is the case with the general population, that would be 46,000 impoverished children who come through the doors. Ten funded surgeries is an amazing thing, but it is astonishing to realize that the figure represents only 0.02% of children who are likely too poor to afford treatment at Baca Ortiz. My understanding is that such donated funding is sporadic, at best. Since the need for this type of financial intervention is so overwhelming, the situation is quite desperate and the poorest may never obtain the assistance they need.

After visiting Baca Ortiz, I felt disheartened and confused. Where should the hospital direct its scarce resources? Medicine for those who cannot otherwise purchase it, without which children will suffer from pain or parasites, possibly die from cancer or even treatable infections? Soap to prevent the spread of infection throughout the facility? (It was hard for me to imagine how a hospital functions without having medical supplies on hand, never mind free access to soap? The basic act of washing one's hands is crucial to the prevention of infection, yet some families have to choose between sanitation and medication.) What about meals for those who would not be able to afford a stay without the provision of this sustenance? Without the meal tickets, many families would not only be unable to afford treatment, but could not visit at all due to the extreme hardship it would pose.

I would be interested to hear if you know have ideas about how the hospital can best use its funds. What are ways this conundrum is being addressed in other nations? What has been proven to work? Do you have any novel ideas yourself?

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