Insulin for Kids in Oaxaca
I recently traveled to Oaxaca for Life for a Child, the Australia-based charity that supplies insulin and blood glucose testing supplies to some 46,000 children in 45 countries, mostly living in lower or - in a smaller number of cases, like Mexico - middle-income nations.
Mexico created, in theory, a universal health care system over twenty years ago in the form of Seguro Popular, a public health insurance scheme that was supposed to cover the 50% of the population that is not enrolled in one of the workplace-based health systems, the largest of which is IMSS.
Seguro Popular was never perfect or fully funded, but one of the good things it did do was provide free insulin to children and youth who could not access the life-saving drug through the other Mexican health care systems. Kids with Type 1 diabetes don't make their own insulin due to an auto-immune condition, and without multiple injections per day, will soon die in an agonizing manner, essentially starving to death (insulin helps carbohydrates enter the body's cells).
Seguro Popular is now being phased out in favor of another system, the realities of which have yet to be fully understood. The supply of insulin in Seguro Popular-affiliated clinics and hospitals should be continuing, however.
In Oaxaca, however, we discovered to our horror that Seguro Popular had never provided insulin to pediatric patients. Oaxaca is Mexico's fourth-poorest state, and the main government hospital, we learned, does not have the funds to hire a pediatric endocrinologist. As a result, there is no one to authorize requests for insulin for pediatric patients from the central distribution system in Mexico City.
There are pediatric endocrinologists in Oaxaca, to be sure; it's just that they are not employed by the public hospital. And without that, there is no insulin for pediatric patients who don't have access to the other healthcare systems.
It was frustrating to sit with the public health ministry people and to hear that for want of a staffing slot, the state's poorest and most vulnerable children were being forced to buy their insulin on the open market, rather than receiving the life-saving drug directly from the state, as is their right under Mexican law.
Life for a Child hasn't been sending insulin to Mexico, because it thought the government had that covered. Now, we realize that in at least one state, there are gaps.
Our partners in the Mexican Diabetes Federation, and in particular in the Jalisco Diabetes Association - which is very active on this issue - will be investigating over the next year. If other Mexican states are in a similar situation, perhaps Life for a Child can start shipping insulin in from its US-based partner, Eli Lilly.
It's a huge endeavor, of course, as insulin requires a cold chain from start to finish. It also demands a lot of the healthcare providers and distributors, all of whom have to safeguard the cold chain, track the drug's delivery to individual patients, and consistently collect accurate data on patients' well-being.