May 27, 2017: Visit to a local clinic in San Salvador

Today, we visited the ISSS (Instituto Salvadoreño del Seguro Social) CLINICAL CUMUNAL CIUDAD MERLIOT, which is a semi-private first level clinic located in San Salvador.

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We were greeted by Cecilia Torres, the Health Administrator of the clinic, who holds a Master’s Degree in Public Health. She spent a majority of time explaining the purpose of the clinic and describing El Salvador’s Health Care system.

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Clinic administrator, Cecilia Torres, and our guide, Joaquin

The clinic caters to patients that are part of the El Salvador’s health social security insurance system or ISSS. In order to qualify for the Social Security insurance, the patient must be employed. Immediate family members are covered including children until the age of 12 y.o. The clinic also serves the community where it is located. Patients must make an appointment. Two patients are scheduled per hour, but there is allowance for two additional appointments for patients, who drop in.

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Clinic reception area.

Lab services, preventative dental care, preventive health care, Obstetrics and Gynecology examinations and mental health screening are just some of the services are available at this site. The clinic is open from 7:00 am to 7:00 pm. If care is needed after hours, patients are instructed to go to a Level 2 facility, where emergency care is available.

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Clinic pharmacy.

El Salvador’s health system is composed of a three-tiered system. There is the private out-of-pocket system for the wealthy; the insurance based system called ISSS (Instituto Salvadoreño del Seguro Social); and the National Health Service for those who are unable to pay or are unemployed.  ISSS is a semi-private system that the employee and employer both contribute. Approximately 15% of the population qualities for this type of insurance coverage. 80% of the population will seek assistance through the National Health Service, which is vastly underfunded and underdeveloped, and 5% comprise the private health care system. The El Salvadoran Military has its own health care system that is free to members and their families. It is the best health system in El Salvador. Urban dwellers have far better access to health care, then their rural counterparts. In fact, very few rural communities have sufficient health care, with most relying on shamans, midwives, and home remedies. In general, Health care workers and physicians are in short supply throughout the country.

Ms. Torres mentioned that respiratory diseases, particularly pneumonia and TB; gastrointestinal diseases; heart disease and stroke; and violence are the main health problems confronting her country. The number of Salvadorians diagnosed with diabetes is also increasing.  Zika virus and Dengue Fever are also a concern in both rural and urban populations, as well as tourists.

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