They call them “oncology families.” Families with a child sick with cancer who arrive in Barcelona from Peru with nothing but despair and oncological reports. Some go directly to a hospital from the airport to access irregularly through the emergency room and get a visit. Others first obtain a health card after registering from a distance or upon arriving at the home of a family member or friend. They are the two most common ways in the middle of an emergency to start a treatment that does not exist in your country. “It is a growing problem in recent years,” admit sources from the Peruvian consulate in Barcelona.
According to data provided by the Department of Health of the Generalitat, some 60 children who recently arrived from the South American country have received in 2023 an “exceptional authorization for humanitarian reasons” to be treated for cancer (mostly leukemia) in Barcelona. They represent around 25% of the new cancers diagnosed in all of Catalonia, about 250, although the percentage is probably higher because it does not include those families who obtain a health card, but who arrive only for treatment. Salud, which is investigating the causes of the increase in patients from this specific community, grants authorizations to irregular patients after receiving a report from the hospital explaining the seriousness of the situation. The health center carries out the treatment and the Catalan Health Service assumes the cost, which can reach 300,000 euros. The phenomenon is reproduced in other areas of Spain, especially in Madrid, according to different sources consulted, although they do not specify the volume of cases.
Eva Bartra landed in Barcelona in December 2019 with her sick 15-year-old daughter. The youngest, who at the age of eight required a bone marrow transplant to combat leukemia, needed treatment for the graft versus host (Eich, the attack of the transplanted cells on the recipient) that she suffered in her lungs. “In Peru there was an agreement with a hospital in the United States for complex cases like my daughter’s, but the Government stopped paying and they stopped treating us,” she explains. With no cure options in her country, she searched through the Internet, she says, for a possible solution. “In Peru they only asked me to seek the best quality of her death and I refused to accept it. I found out where they could treat her and I made the leap to Barcelona. “It is what we would all do to save a daughter,” she explains.
In three weeks in the Catalan capital he obtained the white card that accredited him as an asylum seeker and a NIE to be able to reside in Spain. Initially, they gave her an appointment for 10 months, but after justifying in every way the urgency of her arrival, she obtained a regulated document. At the end of January 2020, she went with her daughter to the Sant Pau hospital to admit the minor. “With the health card they were able to assist me,” she says. After three years of treatment, she has been discharged.
Up to five of the six Peruvian community associations consulted admit that the phenomenon is increasing. “Many of us know of particular cases that come to Barcelona because of their family drama,” explains Pina Quiñones, head of the Peruvian Center Association in Barcelona. “They arrive by plane, go to the Service for Immigrants, Emigrants and Refugees (Saier) in Barcelona and get a registry,” says Quiñones, who assures that the community itself provides education for those seeking to take the leap: “We explain to them that Health care here is very stressed, but this whole situation is very complex because it arises from a vital need.”
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Unlike health tourism, where patients directly pay the thousands of euros that a service offered by any private entity costs, the Peruvian flow has its main origin in poverty. “Oncology families are desperate. They sell all their assets to get here and try to save a life,” understands Jaime Toledo, president of the Ibero-American Cooperation and Integration Association of Barcelona. Families register, many prior to their arrival in the city, and access the system. Sector agents admit that some families have even registered at the Red Cross headquarters or at the hospital itself. “We know families who arrive directly with their suitcases at the hospital because they cannot waste any more time and go straight. They take out loans and mortgages to be able to come to a hospital in Barcelona,” adds Quiñones.
The Generalitat has temporarily given up social services apartments in the area near Sant Joan de Déu over the last two years, according to administration sources. “The problem affects more areas than healthcare because we find that sometimes we don’t know where to put them,” they emphasize. Many families, Bartra explains, end up returning to Peru “because they don’t have the money to settle down for the necessary time.”
The Catalan ministry has held meetings with the Peruvian consulate and the community itself to find solutions over the last two years, but the phenomenon has not only not reduced, but has grown. Counselor Manel Balcells met last week with the embassy in Madrid to find formulas that protect treatment in the place of origin and find “collaboration” agreements. “The same Peruvian consulate has contacted me on occasion to assist the new arrivals,” explains Bartra. “I try to help them out of humanity, but the Government of Peru transfers its obligations to its citizens and it is terrible. What it must do is pay the debts it owes to the hospitals to enable agreements and really help its sick population.”
It does not seem easy to regulate a situation that often arises for the first time in Peruvian consultations themselves. “The same doctors in Peru suggest that cancer patients travel to Barcelona and Spain when they see that they cannot offer alternatives to their situation,” Quiñones and Bartra agree. “They know that it is easy to access the system here and that they will be able to assist them.”
“Almost everyone is served”
The Catalan subsidized hospitals have agreements with governments and foreign entities to care for complex patients. The patients are treated in Catalonia and the service is paid for from the place of origin. The problem is when there is no agreement and the patient also arrives without papers. “So who pays?” asks Jordi Cruz, president of the Metges de Catalunya union. The doctor has experienced the same situation among adults. A few months ago he treated a 70-year-old woman with colon cancer at the Mataró hospital who arrived “directly” from El Prat from an African country. “Her family picked her up at the airport and took her to the emergency room. They made her a medical record, she presented her reports and we visited her because she had a health emergency,” she says. Since the patient had a vital need, the doctors treated her. “At the emergency level, everyone must be treated: they show that they have cancer, you ask the opinion of the medical director and generally they are treated either immediately or through a scheduled circuit.”
The different agents in the sector assure that “oncology families” do not affect waiting lists because “there are none” for minors, but they do pose effects among adults. “It is not a majority problem, but if you add it up, in the end it has an impact,” understands Cruz, who admits the complexity of finding a solution. “We try to have universal and equitable public healthcare, which costs a lot far from the metropolitan area, but we have a gap into which people who do not contribute slip in. It is not a question of not wanting people from abroad: the proof is that almost all foreign patients are treated without having guaranteed remuneration; but to articulate the ways of how to introduce them into the system, how to treat them and how to pay.”
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