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La Mujer del Chatarrero (Bosnia, 2013) -

La Mujer del Chatarrero” es un documental dramatizado que desnuda las diferencias sociales y étnicas de la actual Bosnia. Una familia de gitanos humildes, que rayan la línea de estado de pobreza extrema, se enfrentan a un evento adverso que trae aparejado una debacle de la estructura familiar y consecutivamente van horadando en la vida de la familia.

El hombre de la casa trabaja de manera precaria con el solo fin de vivir al día literalmente.  Senada, la mujer, confinada a las tareas de un hogar hacinado con sus dos hijas pequeñas que avizoran un destino similar sin educación y perspectivas de crecimiento. El nudo de la película ocurre alrededor de un aborto retenido que evoluciona desfavorablemente ante la falta de atención medica.  El marido descuida sus tareas diarias, el hogar queda a la deriva y las niñas boyando en un mar de incertidumbre.

Educación

La educación es uno de los pilares de la prevención y cuidado de la salud.  Si bien no está explicito el nivel educativo de la familia, todo sugiere que han tenido pocas o nulas posibilidades de adquirir educación en todos sus niveles. En el hogar se destacan múltiples factores de riesgo para la salud, tales como la exposición al humo del tabaco y de calefacción a leña en ambientes cerrados, la malnutrición e higiene limitada.

El déficit de educación y previsión lleva a la familia a nuevo embarazo que queda trunco por lo que se asume como un aborto espontaneo con feto retenido.  Los síntomas son subestimados hasta que el estado clínico de la mujer se torna insostenible y cae rendida en un cuadro de sepsis progresiva.

Problemáticas en Salud

A) Accesibilidad geográfica

La primera dificultad que queda en evidencia es la problemática de accesibilidad física a la atención medica.  La familia reside en los suburbios marginales del poblado, que cursa un cruel invierno, lo que complica los múltiples traslados de la familia para la consulta, y que eventualmente hasta se quedaría sin vehículo que fue desmantelado para comprar remedios insuficientes, agigantando las distancias para la accesibilidad geográfica a la atención medica.

B) Accesibilidad de Cobertura

En un modelo de atención sanitaria regulado por la prestación mediante aseguradoras, la familia queda excluida de terapéuticas mas complejas como lo es un legrado quirúrgico.  La medicina da la espalda a una situación de emergencia con la frialdad de una navaja, avalados por un sistema con reglas claras e intransigentes.  Si bien las primeras consultas se concretan y el diagnóstico es certero, el tratamiento traslada el costo al paciente directamente o a su seguro de salud, el cual la familia no posee.

C) Desigualdad e inequidad

Ambos conceptos tienen significados diferentes, en esta oportunidad quedan fusionados en una situación totalmente desbalanceada en la que la mujer de un chatarrero, claramente en situación de desventaja, no tiene las mismas posibilidades de recibir atención medica que el resto de la sociedad, pero además con inequidad evidente de un núcleo familiar que claramente requiere de un apoyo mayor para el caso que se presenta.

D) Sin derecho a la Salud

La negativa a la atención, por parte del plantel médico, a pesar de ser conscientes de la gravedad del cuadro y de su mortalidad, es una manifestación conceptual de no percibir el acceso a la salud como un derecho per se.  La familia queda literalmente librada a su suerte prescindiendo, de lo que en gran parte del mundo, es un derecho de todo ser humano.

E) Corrupción del sistema

El marido busca incansablemente una salida para la situación y finalmente consigue que se le realice el tratamiento pidiendo una tarjeta de seguro social prestada y mintiendo sobre la identidad de su esposa para que puedan tratarla. Afortunadamente para la paciente el sistema además denota errores en los mecanismos de control que dejan pasar el hecho de que la tarjeta del seguro no es acompañada por su identificación personal, por lo que avanza con el legrado.

La incertidumbre continuará

Finalmente, la esposa se repone parcialmente del cuadro, regresan a su hogar en donde, además de lidiar con el corte de electricidad por falta de pago, los cuidados y medicamentos ya serán de hecho insuficientes, por lo que el estado de vida en incertidumbre permanente continuará, y probablemente esta suerte será trasladada a las criaturas que sobrevivirán o no, en un sistema desigual y sin equidad, por su código genético atormentado permanentemente por su código postal. (La película dura un poco más de una hora).

Lejos de la Telemedicina

En este escenario es impensado la implementación de servicios de telemedicina.  SI bien, la tendencia mundial pretende resolver los problemas de conectividad y accesibilidad a la salud, aún hay otras prioridades de urgente resolución para poder avanzar en la aplicación de tecnología en la práctica médica.

Dr. Ramiro Vaca Narvaja

Coordinador del Departamento de Telesalud en la Clínica Pasteur Neuquen, Argentina. Co-fundador y Director Médico T-MAIDER.

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