The poorest wait the longest before seeking health care. They wait until they are sick, often very sick. Feeling well is not the same as being well. People die because they don’t get care for risk factors, early chronic illnesses, and pre-cancer and early cancer when diseases are silent and don’t produce symptoms. Siempre Salud wants to solve that problem by bringing health care to people, not people to health care.
We don’t wait for people to seek health care. We make a census that enrolls all community residents in order to know them before they know they are sick. We try to prevent illness by identifying and addressing risk factors. We detect serious illnesses when they are silent and then we offer the highest quality of primary care based on the best evidence. And we deliver that care in the clinic and in patients’ homes. We eliminate exposures that cause cancer and we identify pre-cancers in time to easily eliminate them. Because we bring care to residents’ front doors, we are mobile. Because of the need for mobility, we intentionally don’t build permanent structures. That saves money. We don’t take care of everyone. We prioritize. We focus on illnesses that contribute the most to early deaths and severe disability. In these ways we keep costs low while bringing the best care based on the best evidence directly to the residents of the communities we serve.
Many diseases have risk factors that are silent but function like early warning systems. Risk factor recognition allows time for preventive measures to take effect. Diabetes and high blood pressure are silent for years before they maim and kill. Early detection of diabetes and high blood pressure at the silent stage followed by good basic health care prevents early death and complications like heart attacks and strokes and, in the case of diabetes, kidney failure, gangrene leading to leg amputation, and blindness. Many cancers are preventable (cervical, colon, lung, stomach, liver, and skin). Preventing two of them (cervical and colon cancer) requires recognition and treatment of a silent pre-cancerous stage. The methods to recognize and treat cervical and colon pre-cancers are easy, safe and effective. Other cancers, for example lung and skin cancer, are preventable by eliminating harmful exposures. Infections cause three cancers (hepatitis B and C cause liver cancer, Helicobacter pylori causes stomach cancer and human papilloma virus causes cervical cancer). There are effective vaccines that prevent hepatitis B and human papilloma virus. Helicobacter pylori (H. pylori) infection is preventable by access to clean drinking water. H. pylori infection occurs in the very young and then is chronic and silent or perhaps silently abating and relapsing. Eventually H. pylori infection leads to stomach ulcers and cancer. Helicobacter pylori infection is easily treated by a simple cocktail of drugs taken for two weeks.
We intend for people to receive this kind of care on time at their front doors in the poorest communities in Latin America.