Diabetes: the problem of inequality in access to medicines and supplies

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Although the law establishes 100% coverage, specialists and patients affirm that in practice it is not fulfilled.

Science advances incessantly around diabetes and this translates into the appearance of therapeutic novelties and technological devices that manage to improve the quality of life of people with this disease, which affects more than 12% of the adult population in Argentina. However, those who have access to state-of-the-art supplies constitute a minimum percentage and there are even serious problems in the delivery of basic medication in public hospitals in different parts of the country; a phenomenon that affects, to varying degrees, all governments, according to specialists and patients consulted by Clarion.

“The right to health and life is the same for everyone, it is a constitutional right. The National Diabetes Law establishes comprehensive coverage for diabetes (100%) according to medical prescription, both in the private and public systems,” he emphasizes lawyer Romina Gali, former director of the Legal Affairs Committee of the Argentine Diabetes Federation. “The unfortunate reality is that sometimes hospitals do not have all the medication or the latest technology that perhaps a patient who has a prepaid can count on. At the same time, it can also happen that before an order, a social work or prepaid says no “.

Currently, there are different types of insulin and needles in Argentina, drugs used for decades and others of the latest generation, insulin pumps, glucose monitoring systems without constant punctures; a diversity of options adapted to different needs. But many people do not even have information about their possibilities and rights, or resources to be able to fight with good results.

“The Clinics is a university hospital, we do not have a pharmacy system, that corresponds to municipal hospitals. In these cases, we give what we have, which are laboratory samples”, explains the doctor Federico Reissig, responsible for the Diabetes and Pregnancy sector of the Diabetes Division at Hospital de Clínicas. And he continues: “The patients have to go to the hospital that corresponds to them to be given the supplies. But many say that they are told there are none, to come back another day. And one has to juggle to change the medication for the one we have at that time. These are people who are in great need. They tell us a reality that cannot be ignored. You try to help them and encourage them to keep pushing. “

“They are mainly from the province of Buenos Aires,” Reissig replies. “One does not know if they ask in the right place or what is really happening, but we have to take them at their word. Obviously, the drug delivery system is not very oiled. There are many who come and ask, “he outlines. And after a pause, he adds:” It is very dramatic. They come and tell you: doctor, give me whatever. Give me what you have, because I have nothing. “

Regarding type 1 diabetes, in which patients are insulin dependent, Reissig explains that there are insulins that can be applied once a day instead of 3 and carry a lower risk of nocturnal hypoglycemia (low blood glucose) . There are also glucose meters that greatly reduce pin pricks for measurements. “The advancement of technology has a great impact on the quality of life, on the way of facing life on a daily basis and on their work performance. But many times there are shortcomings in adequate provision“.

The same happens with type 2 diabetes, which is the one that 90% of people with this disease present. “We continue with old drugs that have the potential to cause hypoglycemia. There are some new ones that allow better glucose control, to which those who have prepaid and only discounted medical coverage have access,” says diabetologist Daniel Abbas, university nutrition specialist, Coordinator of the Obesity and Bariatric Surgery Team of the Obra Social de Drivers de Camiones. And he details: “The old drugs act like a dryer: they try to remove the last drops of insulin from the poor pancreas, which is already bad. They exhaust it. The new ones carry advanced technologies that leave the pancreas alone, they do not require it. They work on other parts of the body and generate great benefit. “

In this sense, the lawyer Romina Gali states that although many of the last supplies that came out were not included in the Mandatory Medical Plan (PMO), “the law is very comprehensive and if there is a medical prescription with a sufficiently strong justification to support the indication, “an amparo can be initiated even if they are not expressly included in the PMO.” Many end up settling for drugs that were already out many years ago. The reality is unfortunate, and I don’t even want to imagine how it is in certain locations far from the big cities, where it is difficult to get to the hospital “.

Mirrors of the federal situation, Clarion He accessed testimonies from patients from multiple provinces who suffer great difficulties in obtaining the supplies they need. In this note, only a few are exposed, which are mere examples of cases that are not isolated.

“The last time I went to pick up supplies they gave me a third of what I need. There were always failures, but the pandemic made everything worse. They are taking away access to treatment little by little, and our life depends on it! “, Cecilia Magalí Gomez, who attends the Evita de Lanús Hospital, in the province of Buenos Aires, goes bankrupt.

“I was left without a job and without mutual insurance. I had to go to the New Hospital Río Cuarto San Antonio de Padua, but there they told me that the treatment I had was like riding in a 4×4 and that they they don’t have the insulin my body needs. Luckily the doctor got me on his own account, and now I resort to donations from patients with social work, “says Claudia Angeletti from Río Cuarto, Córdoba.

“I get half of the medication through donations, the insulins they give me they do not serve me“says Federica Cabrera, a patient at the same hospital.

“I have diabetes 2 and at the José Ramón Vidal Hospital they have not given me plasters to measure glucose for 2 years, they measure me when I have a shift and nothing else. I am a worker, and I buy them only when I can. My dad suffers from diabetes like me, but he has social work and they give him everything for free, “says Antonia Martínez from Corrientes Capital.

Karina Viviana Castro is the mother of an adolescent with diabetes, who receives the medications through the Hospital Enfermeros Argentinos, in General Alvear, Mendoza. Karina denounces that there they tell her that the type of insulin she needs “does not reach them. For a few months, she has taken a long-distance bus and travels 2 hours in order to be assisted at the Chestacow Hospital in San Rafael, where a doctor gets her what she needs thanks to samples she receives but no continuity security. Meanwhile, in Alvear they continue to give her another type of insulin and she donates it to those she can.

“The service of CePSI Eva Perón in Santiago del Estero is unfortunate. There is a lot of protocol but bad care and completely insufficient supplies. Luckily we were able to join a social work, and now they give us everything my 13-year-old son Santino needs”, says Eliana Estrubia.

Diego La Ruffa lives in Tafí Viejo in Tucumán and uses an insulin pump, a treatment that he requires due to the instability of his glucose levels despite having a balanced diet and being an athlete. The system supplies you with medication 24 hours a day, trying to mimic the function of the pancreas. They granted it to him when he had social work in 2014 but in 2016 he began to be treated in the public system, at the Nicolás Avellaneda Hospital. “I have had diabetes for 42 years and this changed my life. They should have changed my pump 2 years ago, but the Ministry of Health told me they can’t. And it no longer works as before, I don’t know how I’ll do when I don’t start anymore“.

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