Overview
In Peru, we have EsSalud and MINSA (Ministry of Health) hospitals for public health, and a long list of choices for private health care. If you are employed, you are covered by EsSalud, but the public health system here is really bureaucratic. Bloodwork, medicines and exams are covered by the public system, but one of the problems is getting those appointments. There are more than 6 million people under public care, and resources are very limited. For 2016 there was an average of 1.07 doctors for every thousand users. Sadly, our public health system is not enough.

Some employers give you the chance to get private insurance too, and then you can choose from different clinics to attend. In that case you always pay a copayment (or deductible) for appointments, and the costs of your exams and medicines are partially covered, It is estimated that only 20% of formal workers use this option. There are also private insurance companies that provide similar coverage.

What happens if you need to see a doctor?
In the public system, getting an appointment for a general practitioner can take a couple of months. After that, it might take other couple of months to get to see a specialist. You need to do all these steps to finally get to the endocrinologist. It is almost impossible to get quick attention under this system.

In private health care it is easier to get an appointment, depending on the doctor and clinic you chose. You can always get an appointment for the next couple of days, and often you can see the specialist directly after that. People sometimes prefer this if they can afford it, but it means paying between 30-100 US dollars for it.

Who decides what doctors can prescribe?
The General Direction of Medicines, Supplies and Drugs (DIGEMID) is in charge of what medicines are allowed and sold in the country. This agency is part of the Health Ministry and it decides what medicines in the public system the doctors can choose from. In the private system, doctors are also guided by insurance companies.

Practically, what is it like to live with type 1 diabetes in Peru?
Living with type 1 diabetes in Peru, a country where there is very poor information and options, is hard. The diagnosis is always a shock for anyone, and there are very few diabetes educators. There are not many people or resources to guide you in the first steps of how to manage diabetes. There are also very few nutritionists specialized in diabetes, and I have learned how to count carbs by my own, doing my own research because the endocrinologist didn’t help with it.

We only have glucometers for controlling sugars and no access to other technology. Test strips are expensive, costing around $30 for 50 strips. They are not usually covered by private insurances. Medtronic insulin pumps have just entered the market and is the only one offering Continuous Glucose Monitoring (CGM) and pumps. Their prices seem almost like a joke because it costs around $7500 for a pump and CGM, and at least $600 in monthly supplies, when the minimum wage here is around $300. Only very wealthy people can afford that. There is no Free Style Libre, and we do not have ketone test strips, or glucagon. I learned about them reading foreign pages online. Again, only people with some extra money can get them by purchasing from abroad.

Living with this condition in Peru is very frustrating sometimes because diabetes can be hard, and not having the resources to have a better life is sad.

What about getting admitted to hospital?
Going to the emergency room in the public system can be a nightmare because if you are not really in bad shape you can be waiting for hours to get medical attention. Getting a bed in a hospital if you need to get admitted can take days because there are not enough beds in public hospitals.

Getting admitted in a private clinic is easier. If you have insurance they allow you in, but if you don’t have insurance you have to sign a warranty because of the high costs associated with treatment and hospital stay. In both private or public hospitals you need to highlight that you have diabetes. In an emergency testing blood sugar is not the first option, so it is a good idea to have some sort of ID that lets them know your condition in case you are unconscious.

How does diabetes care vary throughout Peru?
In Lima (the capital city), you can get the care you need with the things that are available. However, Peru has very little towns that are far apart from the center. Those locations do not even have basic health care. I do not think there can even be adequate diagnosis there, considering they do not have the tools needed.

There is also a lot of ignorance about diabetes. People always relate diabetes to what they know about type 2, and they think it is just a matter of not eating sweets or doing some diet. Many people do not understand that people with type 1 diabetes need insulin to live. Many people believe that with natural medicines like homeopathy, cinnamon, baking soda, or some kind of plants they can be cured. This is dangerous and it leads to more complications related to diabetes.

A big thank you to Milagros de Quesada who lives in Peru. She provided this information for our map tool.