“¡¿Qué le damos?!”, shouts the woman who, with her hoarse voice, cuts out the noise of the other sellers. He runs from side to side, with a tight scarf around his waist and a black hat that barely covers the sweat on his front. She offers her products as something hopeful: “Water, insulin, paracetamol, syringes, gloves? ”, lists around the Hospital del Guasmo, the largest in Guayaquil, in response to patient demand that the health system does not provide basic.
“Give me a bottle of water,” asks a woman from across the river. His face is marked by anguish. At the hospital, there is no water to give medicine to your teenager, who gave birth to 24 weeks premature twins and is struggling to survive. “I was asked for very expensive special probes, which cost around $115 each, and which are used for children suffering from malnutrition,” says Abuela, full of uncertainty because she does not know where to find the money to buy them. The long list of supplies needed includes surgical attire for the medical team performing the C-section, as well as medications during the operation.
The scene repeats itself with other family members entering and leaving the hospital. “There’s nothing!” a man shouts while waiting for one of the salesmen at the door. For Santiago Carrasco, president of the Ecuadorian Medical Federation, the country’s health system is in agony. It is attributed to two factors: lack of management and corruption. “Five ministers passed through the Ministry of Health, all without skills or experience, with political values, and we warn that this should not succeed in the field of Health,” complains Carrasco.
The last minister spent only four months in power. After the defeat in the consultation and referendum on November 16, Representative Daniel Noboa entrusted Vice President María José Pinto with the functions of maximum authority of the Ministry of Public Health, without specifying what this position entailed. Pinto, a textile businesswoman with a background in a well-known family business, heads a commission created by the president in August to assess the health sector’s problems, although the commission’s results remain unknown.
Meanwhile, people die waiting for a medical appointment, treatment that never arrives or leaves on hospital beds where doctors, helpless, cannot save lives.
At the Macas hospital in the Ecuadorian Amazon, a mother from an indigenous Achuar pueblo huddled against a cardboard box. Inside was the lifeless body of her daughter, barely a month old. This is how they kept their promises: without respect, without modesty, without the dignity of a minimum protocol. Members of their community said the girl joined them because of their children. And they returned it to his mother as if it were an object, in a cardboard box closed with a belt. “Without drugs, without inputs. Our doctors transform us into signatories of death certificates,” denounces Carrasco. In the midst of this disaster, the Ministry of Health gave vague answers: it announced an “internal audit” and promised sanctions for the staff involved in this “irregularity”.
The government knows the seriousness of the crisis. According to a report from the Ministry of Health, the supply in hospitals throughout Ecuador reached an average of 61%, which “testifies to a critical situation that compromises the operational continuity of health services at the national level.” But in hospitals like del Guasmo, the supply only reaches 41%, and at the Monte Sinaí Hospital, in Guayaquil, it does not exceed 18%. In September, President Noboa declared a state of emergency to expedite the procurement of medicines and supplies.
The situation is worsening due to the reduction in missions expected since 2023. The ministerial report highlights that there is “a progressive reduction in annual missions to meet operational, institutional needs and accumulated obligations”.
When Noboa assumed the presidency, in November 2023, the Ministry of Health had one of the highest assumptions in its history: $4.3 billion was planned in the presumed health investment plan for the following year. However, a few months later this assumption is reduced to 2.959 million dollars and, in 2025, the drop will be even greater, up to 2.798 million. And on the ground, this is the case: even with a bad hypothesis, at the end of November, the institution alone had ejected 45% of the allocated funds.
This is because the Ministry does not directly report the assigned assumption. That is to say: the hypothesis is on paper, but the funds are not actually available to the institution. This same situation could repeat itself next year. The Executive and the Assembly approved an allocation of $5.136 million for health, but without specifying where the funds will come from to finance it.
Alejandro Solano takes his head, holding it with the palm of his hand as if he wants to contain the pain. “It must be the prison, which I have raised a little these days,” he says, remaining important for what, in reality, is the beginning of a chain of self-importance. For five years now, he has been living with kidney failure, an illness that developed without controlling his hypertension in time. The consequences were not long in coming: three dialysis sessions per week, four hours each. It’s the only way to save your life. This is the time needed to purify your blood. So he began his ordeal to stay alive.
The country’s public hospitals do not have the capacity to treat around 20,000 kidney disease patients, so many of them come from private clinics with which the government maintains millions. “It was painful to arrive at the clinic and find it closed because they hadn’t paid,” recalls Alejandro, who once again walked through the closed doors of a clinic without knowing how to pay the $1,500 cost of private dialysis. “The government is condemning us to die,” he says with satisfied anger, having spent years fighting a system that seems to provide no answers.
Kidney patients have become the most visible face of the health crisis in Ecuador. They took to the streets forcefully to protest, even though no one within the health authorities had heard their complaints. Each week they face the anxiety of being informed that this could be their last day of treatment or, even worse, that in the middle of dialysis, they suspend their attention when the power company cuts off the supply for non-payment, as they have done in the past. According to Alejandro, who also chairs a patients’ association in his own situation, at least 300 people died last year in Guayaquil due to lack of adequate care. “It’s hard to remember it, but to live it more. We know that we can pass at any moment,” he says with resignation.
About The Author
