While coronavirus was already manifesting itself in Europe, Peru started preparing for its arrival. Every Peruvian region was harshly confronted with the shortcomings of the national healthcare system, among which a big shortage of ICU beds. The Peruvian government has been having conversations at different levels with the private healthcare sector in order to increase the ICU capacity. Below a (maybe rather long) report of my personal experience with such conversations on the regional, and later the national level. Long but (in my opinion) rather interesting.
On March 22, the Governour of Apurímac and the boss of the regional health services (Diresa) came to Diospi Suyana for a surprise visit. After a tour of the hospital they revealed the reason for their visit; the regional government wanted to sign a interinstitutional agreement with Diospi Suyana in order to increase the medical capacity of Apurímac during the corona crisis. In order to help with the preparations, a lot of things were promised, finances, personnel, medication and protective gear for our personnel. The representatives of Diospi who had given the tour explained that the proposal needed some thinking but that we would get back to the regional government soon. That same evening the regional government published on her facebook page: ‘the regional government of Apurímac has signed an interinstitutional agreement with Diospi Suyana!’. Not true.
A couple of days after the visit of the regional government to Diospi Suyana we became aware of a proposed legislation that was drafted by 1 of the 2 members of congress on behalf of Diospi Suyana that worried us. Simply put, the proposed legislation would give the government control over private healthcare institutions such as Diospi Suyana during a state of emergency. Should this proposed legislation be adopted, the Diresa would theoretically be able to take equipment/personnel away from Diospi Suyana. As a missionary hospital naturally we want to help during the corona crisis, with or without a signed agreement. But, such an agreement would mean an extra protection against potential danger posed by the proposed legislation. After internal deliberations it was decided that we would offer 50 of our 100 beds for the treatment of corona patients. 10 beds on the intensive care unit with mechanical ventilation and 40 beds on the ward with oxygen. A couple of days later we received the first version of the agreement from the regional government. To our surprise, not a single one of the promises made by the governour and the boss of the Diresa had found its way into the document. With the help of our lawyers we replied with a severely revised version and at the end of March, the agreement was signed in Abancay by our Director, the Governour and the boss of the Diresa.
Directly after the agreement was signed the Governour assured us that they would transfer a certain amount of money to Diospi Suyana to help with the preparations. In the first days of April I drove to Lima with Klaus for the first time, a drive of over 14 hours. We went to Lima to search for more specialised personnel and ventilation equipment. We had just arrived to Lima when we heard that the Diresa would need a budget specifying the extra costs for Diospi for 3 months related to the signed agreement. Once they would have received this budget, they would be able to transfer the money. We provided the Diresa with the budget the very same day. A couple of days, and phone calls later we were told that in order to receive the money, we should bring the budget hard copy to the Diresa in Abancay, together with a letter asking for the amount to be transferred. We did exactly this. That very same day, the documents were delivered in Abancay, about 1,5 hours aways from Curahuasi, by one of our colleagues. Unfortunately, the money was not transferred.
In the weeks that followed we made several phone calls to the Diresa and everytime we were told, ‘the money will be transferred tomorrow. Mid April Klaus was asked to come to Abancay for the installation of the ‘Comando Covid-19’ and I went along. After a long wait, long conversation and finally the real installation of the new taskforce Klaus and I asked the Governour on the status of the amount that was supposed to be transferred. During the installation of the taskforce some numbers were presented and it turned out that Diospi Suyana would be providing roughly half of the total capacity in the fight against the corona virus, more than 3 big government hospitals combined. You would think that the cooperation with Diospi Suyana would then be high on the priority list. The Governour asked redirected our question to the boss of the Diresa who told us that another document, a contract needed to be signed before they would be able to really transfer the money. So Klaus and I accompanied him to his office elsewhere in Abancay for a short meeting. We were given a contract with the request to just sign it then and there. Then the only thing that would be missing was an inspection of the hospital. Of course we did not sign the document in the meeting itself but we took it back to Curahuasi and would get back to it soon.
Once we got back to Curahuasi we discussed the new contract with our lawyers and it turned out to be a very good decision not to sign the document inmediately as we were asked to do. The contract was drafted in a way that we would become a provider of the state with all connected requirements. Also, the Diresa would get a certain level of control over internal processes of Diospi Suyana. We would not and could not agree to these terms and we communicated this to the Diresa. Without the contract, the Diresa said that they could not transfer the amount. So our lawyers drafted another document, and appendix to the original agreement. In this new document our rates for the treatment of corona patients were included among several other things. By now we know that the rates we offered to the regional government are the best rates in Peru. Prices in private clinics in Lima are easily 5 times higher. The Peruvian government recently also announced the rates that the national social health insurance will pay to private healthcare institutions and these were roughly twice as high as our rates. This shows conclusively that Diospi Suyana is not seeking to gain anything from the current crisis. The goal was and is to save lifes.
After having canceled a number of times, a delegation from the Diresa finally came to inspect the hospital in the last week of April. They were very content with the preparations that Diospi Suyana had made and they confirmed that everything was in place for the treatment of corona patients. The rates we offered were also deemed very favourable so nothing wrong there. A couple of days later we received a reply to the appendix that we sent to the Diresa earlier. ‘Just a couple of small changes, nothing with major impact’ they assured us. Hearing that made me inmediately distrust the new version and our lawyers confirmed that with these ‘small changes’, the Diresa had tried to put us back into the position of a provider of the state and to the legal regime applicable for providers of the state. Our lawyers called it a trap and legal contraband. This was a position that we would not and could not accept. A big disappointment. The next day, Klaus and I drove to Abancay once again where we met with the Governour and other staff of the regional government and the Diresa. At the beginning of the meeting we inmediately indicated that we were very disappointed in the attempt to put us in a legal position that we did not want to be in, something we communicated before very clearly. Klaus said: ‘either we sign the apendix as prepared by our lawyers today, or we will start negotiations about an agreement with other parties’. We were assured that we had completely misinterpreted what had happened, everybody only had the best intentions and we all wanted the same thing they just worded it differently. I am quite sure they did not even believe themselves but later that morning the appendix as prepared by our lawyers was signed. Now the money would really be transferred. Many phone calls and messages later I received a message on May 20th from the second in command of the Diresa stating that all documentation was now ready and that the money, after the OK of the boss of the Diresa, would now in fact be transferred. But surprise surprise, nothing happened. The next week the Diresa phoned me saying that in fact we would need to sign an additional contract. The contract they sent us once again contained clauses that would put us in the legal situation of a provider of the state and that would give the Diresa far-reaching influence in our internal processes. On Friday May 30th Klaus and I drove to Abancay again with a very clear message; either you transfer the money today, or Diospi Suyana will issue a statement explaining that the regional government was not keeping her promises, in spite of the signed agreement and appendix. The money was not transferred so our directors Klaus & Martina John issued a statement live on our radio station. The statement was also filmed and published on our social media platforms. We could not yet imagine how God would greatly use this statement to open many doors for Diospi Suyana.
Within 24 hours, the published statement had roughly 100.000 views which was an absolute record high for Diospi Suyana social media. When Klaus and I left for the third time for Lima on Monday monring, the statement had been viewed over 1.000.000 (one million!) times. Many Peruvians left comments and they were brutally honest. Next to overwhelming support for Diospi Suyana, the comments show that many Peruvians are deeply tired of the corruption and incompetence among their politicians. A couple of days earlier, the Diresa had given a press conference ‘explaining’ the situation and spreading several lies about Diospi Suyana and the negotiations. For example they claimed that Diospi Suyana was trying to benefit financially from the crisis which is quite special with rates that do not even cover the costs. This press conference was published on the social media of the regional government and even on their own pages almost all commentaries were supportive of Diospi Suyana. With all this attention online there were more and more phone calls from radio and TV. On the way to Lima, Klaus was phoned so often that the drive did not take 14 but almost 17 hours!
Our days in Lima were filled from morning to evening with meetings with politicians and interviews for TV, radio and written articles. On Tuesday morning we were welcomed in the building of congress by Lenin Checco, a Member of Congress on behalf of Apurímac. He had seen the statement and wanted to hear more about what happened the months prior. He told us that he had asked the Governour some tough questions on Apurímac’s medical capacity a couple of weeks earlier. The Governour told him not to worry because…the agreement with Diospi Suyana was signed which meant 50 beds extra for Apurímac. The Member of Congress also shared with us that of the ICU beds that the regional government of Apurímac had available on paper, only 3 were fully operational. The manner in which Diospi Suyana had been treated for over 2 months was cause for concern for the Member of Congress. Afterwards, we went on for an appointment with the president of congress and Member of Congress Checco accompanied us. Klaus was given the opportunity to share the story of Diospi Suyana and afterwards also the President of Congress took the time to hear about what had happened during April and May. After taking a nice photo, the Peruvian congress issued a short statement on the ongoing situation and voiced support for Diospi Suyana.
After spending the morning in congress and after having something to eat we went back to the guest house (base of Diospi Suyana in Lima) for a bit of rest and to get some material ready for a TV report on Canal 5, Panamericana. Later on we delivered the material at the studios and Klaus was interviewed together with one of our lawyers.
Leaving Canal 5 we went to the Ministry of Health for a meeting with the Minister. Again, Klaus was given the time to tell the story of Diospi Suyana. Afterwards we spoke about the problems surrounding the agreement signed with the regional government. After the Minister had left we had further conversation with people from the national social health care insurance. They suggested that we would forget about the agreement signed with the regional government and that we would sign a new agreement with them. We agreed to discuss the matter further and explore option later that week in a Zoom meeting. In Peru, strict lockdown measures are still in place and when we were done at the Ministry of Health there were no taxis on the street because of the curfew. Thankfully a driver of the Ministry could take us home, even with flashing lights. What a day.
The next day we got up early again because Klaus had a live interview on national TV and afterwards we went to the First Minister in the presidential palace. The second in command in Peru took over half an hour to speak to us and hear our story. Both our lawyer and the legal advisor of the First Minister were present as well. When we shared what had happened throughout the past months, the legal advisor was quite surprised. She had already been in touch with the team of the Governour and she had been told that the regional government itself had not really been involved and that it was the Diresa that had messed things up. Of course we had brought a copy of the original agreement that was also signed by the Governour himself showing that the regional government had been involved from the very beginning. After the First Minister had received a signed book from Klaus (and one more for the President) he had to leave and we discussed the possibility of signing a new agreement with the mediation of ‘the palace’.
After the meeting in the presidential palace we quickly went on to the next. The other Member of Congress for Apurímac, Omar Merino, had kindly invited us. Omar Merino was the same Member of Congress that had submitted that proposed legislation that we saw as a potential danger for Diospi Suyana. This proposed legislation had in the mean time been almost unanimously accepted by congress. Furthermore, this Member of Congress is the president of the health care committee of congress. So, for various reasons an interesting man to speak to. We were warmly received by Omar Merino who had also invited 4 of his colleagues. Once more, Klaus told the story of Diospi Suyana. After the presentation we explained to Omar Merino wat had been going on in Apurímac. He had heard heard about the matter but he had been told that we simply wanted to receive money without signing any document. He was very surprised to hear (and see) that we had actually signed an agreement the end of March and an appendix the end of April. ‘From now on you have a friend in congress’ he assured us. Who knows, we will see.
After all this attention from politicians, now came the press. That and the following day several journalists came to the guest house to interview Klaus. On Thursday we also had an elaborate Zoom meeting with the representative of the national social health insurance.
Friday was our last day in Lima. In the reception area of a residential flat we met the previous First Minister and later that day we had a Zoom meeting with the Minister of Economy and Finance and her team. Every member of the Peruvian cabinet is assigned to one of the regions in Peru. So next to specific content, every Minister is also supposed to have special attention for his/her assigned region. This meeting was especially important because of the fact that the region assigned to the Minister of Economy and Finance is Apurímac.
Saturday morning at a bit after 04.00 we left Lima, heading for Curahuasi. The car full of new, non-invasive ventilators for the hospital and our heads full of the experiences of the past days. Klaus said: ‘Steven, I have made several hundreds trips to Lima but I have never had a week like this’. We started every day with a prayer and at the end of every day we could thank God for opening doors.
The topic is still ongoing, as are negotiations. The number of confirmed corona cases in the mountains of Apurímac are rising every day and by now, the first patients have been admitted to the ICU in Abancay. We expect to be called upon soon to admit corona patients and we hope to have a functioning agreement soon. Very recently, a delegation came from the government hospital of Abancay to see if we would sign an agreement directly with them. We want to help no matter what but an agreement with the government (on any level) does offer us a certain protection against possible government interference in our hospital. Our lawyers are working very hard on the matter. When I mention our lawyers, I mean the oldest law firm in Peru, Olaechea. They have been helping Diospi Suyana for years already, completely free of charge and they are of huge importance to the Diospi Suyana project. But even the best legal help cannot equal the help of God.
Ah, Lord GOD! It is you who have made the heavens and the earth by your great power and by your outstreched arm! Nothing is too hard for you.