SANTA CLARA LA LAGUNA, Guatemala.- When Doña Manuela Tzoc took out a microloan to start a small business more than a decade ago, she had no idea it would lead to a cancer diagnosis. Or to the surgery that would save her life. But throughout Latin America, microcredit networks are a playing an important, if unexpected, role in delivering health services to some of the region's poorest, most isolated and most neglected populations.
Ms. Tzoc, 59, lives in Santa Clara La Laguna, an indigenous Maya village perched over the azure waters of Guatemala's Lake Atitlán. She supports her household of 14 people by embroidering traditional Maya huipiles or blouses and by selling corn. Small loans from the microcredit organization Friendship Bridge allow her to buy her raw materials. prima.
Throughout Latin America, microfinance organizations—institutions that offer loans and other financial services to low-income customers outside of the formal banking sector—have a reach that is difficult for any specialized organization to rival. Microcredit has grown dramatically since the 1970s, and loan organizations penetrate even into remote and rural areas.
“Everybody needs a loan for life somewhere along the way,” Karen Larson, president and CEO of Friendship Bridge, said. “So microcredit is much more pervasive. The opportunity is much larger to touch many, many people.”
In Guatemala, an estimated 200,000 people use microcredit services. In Latin America and the Caribbean, that number jumps to 20 million, according to data from the Inter-American Development Bank.
For healthcare workers trying to reach people who are falling through the cracks of conventional health systems, or who cannot access healthcare at all, microcredit networks can lead them to patients in need.
“It's a way of using the existing infrastructure of a very large organization to take advantage of the relationships between women, so we can offer health services that would be very hard to deliver any other way,” said Dr. Marcela Colom, who runs a preventive health partnership between Friendship Bridge and the nonprofit Maya Health Alliance.
Microfinance organizations vary widely. Some are mission-driven nonprofits concerned with poverty reduction and women's empowerment. Some are simply financial organizations catering to low-income customers. In a crowded marketplace for small loans, offering health services can also benefit the lenders.
“Years ago, it became very clear that microcredit alone did not have the transformational impact on the client that Friendship Bridge wanted” said Larson.
Her organization began offering health services based on evidence that healthcare helped build client loyalty, and the most loyal clients—the ones who stayed in the program longest—became the most successful entrepreneurs, best able to climb out of poverty.
Moreover, a health crisis can cripple a borrower's business. For small entrepreneurs whose families rely on them, it can spell financial ruin when a woman cannot work and pay back her debt.
“A lot of our women don't prioritize their personal health until it gets to the point where they're really affected negatively by poor health status,” said Veronica Valdivieso, Executive Director of Global Health at Pro Mujer, a microfinance organization that works in Bolivia, Mexico, Peru, Nicaragua and Argentina.
For many self-employed women, a day spent waiting to schedule an appointment at a public clinic means a day without income, something many cannot afford.
Pro Mujer, like Friendship Bridge, offers preventive health services to women who otherwise might not seek them. Their brick-and-mortar clinics, attached to Pro Mujer offices and staffed by doctors and nurses, allow women to schedule a loan pickup and a health screening in the same day. That can mean catching an illness before it gets serious.
Pro Mujer also offers mobile clinics in Peru and health-related financial products like cancer insurance, that can help pay the costs of travel and treatments that may only be available in large cities.
Friendship Bridge's program is tailored to Guatemala, where a large number of microcredit clients are indigenous women in rural areas who speak limited Spanish. So the health clinic comes to them in their villages, just like their loans.
Nurse Rebeca González, 26, travels by boat, by tuk-tuk or by foot on any given day, to reach her patients in the villages around Lake Atitlan. As an indigenous Maya woman, she puts others ease when she follows a loan agent into a credit group to explain the medical screenings and family planning services that Friendship Bridge offers.
“Many of these women have never received any health services in their community,” she said. “Many are marginalized simply for wearing their traditional clothing or speaking their language.”
Rebeca speaks their language. She talks frankly in Maya Tz'utujil about topics like birth control and cervical and breast cancer. Some indigenous women shy away public hospitals where doctors tend to be Spanish-speaking and male, so all of the nurses in the Friendship Bridge-Maya Health Alliance partnership are women who speak Maya languages.
When loan recipients from a microcredit group sign up for screenings, Rebeca returns a few days later to set up a mobile health clinic in the home of one of the borrowers. She weighs the women, checks their blood sugar, takes their blood pressure and vital signs, and gives them pap smears and other diagnostic tests.
It was in one of these mobile clinics that Doña Manuela Tzoc decided to have a pap smear. What came back was a diagnosis of cervical cancer, but also the help she needed to navigate Guatemala's health care system.
When a Friendship Bridge client has a serious health problem, the Maya Health Alliance guides her through the healthcare process and covers additional costs. Although Guatemala has a universal public health system, patients often have to pay for medicine and basic medical supplies, on top of travel and accommodation.
“If that poor nurse hadn't come to my house, who knows what I would have done, because I wouldn't know what to look for, or where, or how I would get the money, Ms. Tzoc said.
Doña Manuela's cancer was detected early enough that it could be removed with a hysterectomy. She did not need chemotherapy or radiation treatment.
Two years later, her fingers dart nimbly around an embroidery hoop where figures of flowers and leaves are taking shape. Around her, fruits are ripening on the trees in her yard. Her pigs and chickens rustle around, fighting for kernels of corn.
Doña Manuela still has some savings in the bank. Her daughters have loans of their own. And Doña Manuela is cancer-free.