Dr. Jorge Gronda with a patient.
(CNN Spanish) -
(CNN Spanish) -
Defining Dr. Jorge Gronda as a gynecologist today is insufficient: he is also the founder of a health system accessible to all in Jujuy, a province in northern Argentina with a large indigenous population that suffers from deprivation and discrimination.
And from there it is replicating it in different provinces of the country.
«It was a lot of instinct.
I was only a gynecologist who later turned to rural medicine and I had no knowledge of economics.
It was impossible for me to make a business plan.
It was knowing, discovering that world that was submerged, that I had very close to when I was a child.
The needs they had and from there let the process take me, ”Dr. Gronda begins.
“At that time I was young and felt that I wanted to leave some legacy.
But I realized that as a gynecologist there were 1,000, 2,000, 5,000 gynecologists in Argentina and the world who were equal to or better than me.
And I think I wanted to do something different, to make me feel like the medicine made sense to me.
So I think it was a personal search, ”he continues.
At that time, Dr. Gronda worked at the provincial hospital in the morning, and in his private practice in the afternoon.
But he also went on "rural medical tours" with medical students in which he attended to the women of the area, in addition to learning about the culture and customs.
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“We there in the Puna, half that they did not take us into account and suddenly a 'gringuito' arrived and we had a serious problem at that time, that women were dying and we did not know what it was.
And this doctor, beyond curing illnesses, earned the trust of the people ”, recalls René Calpanchay, a native of the Puna de Atacama and today a user of this service.
“I had to introduce myself to a world with a different worldview, such as Andean cultures, which are 10,000 years old, which come from a system of subjugation where they saw me as the one who subjugated them.
I represented the white world, the world of power, the world of academia ”, Gronda explains.
The determination to promote this work was given in 1996 by a social entrepreneur of these indigenous peoples, but in a context far from medicine.
Gronda wanted to explore other concerns and traveled to the Puna de Atacama to learn about a possible venture with vicuñas.
But there he met Rosario Quispe.
"He said 'Dr. Gronda?'
Yes 'Are you the one who lives in the city and heals women?'
Well, he said, stop bothering me.
He didn't tell me like that, he told me something else.
But he told me 'stop bothering with vicuñas and come and heal us because we are dying of cancer, that you know how to prevent it'.
And there my life changed ”.
With this call, the Center for Gynecological Studies (Cegin), which he had founded in 1988, became the seed of a system of access to health at very low cost.
First it was for indigenous women, but then it became universal.
Today, he says, they have already cared for almost 100,000 people, most of whom had no other health coverage.
“At the beginning, I did it thinking about the women I served and the need we had to increase our flow of clients or patients.
And I did it with a very focused look at gynecology.
The process made the women when they came here to ask me for their son and their husbands.
And that's when I realized that the system had to be comprehensive.
So I spoke with the other colleagues from other specialties, such as the pediatrician or the clinician, and I told them that I had a great demand for people who had nowhere to attend ”.
Thus was born the Ser Card, which today is known as Umana: an annual membership of US $ 5 with which members have access to a wide list of medical providers, pharmacies, laboratories and diagnostic centers at a preferential price that they pay at the time of be attended, but much less than that of a particular query.
“One comes and can be taken care of at the moment like any other person.
Because we indigenous people also want to access first-rate levels of care, health.
In other words, we are Indians, but not stupid, because we want to take care of our health, "says Calpanchay.
Umana serves multiple outpatient specialties that can be treated in one office.
Currently, it has more than 160 doctors in 51 different specialties.
But it does not include hospitalization, which allows you to lower costs compared to traditional health plans that do include it.
“Although it is true that there are hospitals in Jujuy that are of the highest level, it is for serious situations that we go.
For the daily care of the problems that one has, the hospital takes a long time, you have to queue, go at four in the morning.
He is not very human ”, assures Calpanchay.
In that sense, Umana seeks to have a different logic to the public and private health systems, and the pandemic proved it.
“When established health systems enter periods of stress such as the pandemic, Umana is greatly strengthened. Demand increases. It is countercyclical. We do not make coronaviruses, we are not specialists, so we decided to continue caring for our patients who were with cancer, who needed a pregnancy control, who needed an urgent study. And since no one did it because everyone is with the coronavirus, people are increasingly adhering to the system, ”explains Gronda.
“We are coming with my whole family to do the check-up that the boys have to do for secondary school because, due to the pandemic, it could not be done in the hospital.
It is much faster and cheaper for us, mainly because of the transport ”, says Clemente Flores, who came to Cegin from El Moreno, a town 11 kilometers from San Salvador de Jujuy, where he is dedicated to raising llamas and farming. .
How do they do that?
The keys to Umana seem to be those niches that traditional systems fail to cover and eliminate intermediation: they only act as a link between patients and doctors, thereby defining costs and responsibilities.
In general, the price agreed with the professionals is 20% lower than the fee paid by the provincial health insurance, but with the benefit of collecting it at the time, without the bureaucracies or delays of traditional coverage that can delay payment up to 60 days and that in an inflationary context, like the one Argentina is experiencing today, makes it even more attractive.
“I didn't have to convince them.
They fell in love because the process was very convenient for them ”, recalls Gronda, who like his colleagues, benefits from this modality.
Beyond the meager earnings from annual subscriptions, with Umana the influx to its own center, Cegin, has increased considerably.
With this modality, Umana grew as an inclusive health coverage, which already works in the provinces of Jujuy, Salta and Córdoba, while it seeks to consolidate itself in Tucumán.
But not only doctors and patients were involved in the expansion.
Gronda turned to various international organizations focused on Latin America such as Ashoka, which brings together social entrepreneurs, the Incae business school and CAF - Development Bank of Latin America.
"There were many philanthropic organizations that came to help me and said 'well, we put money, but for example, you are not going to do planning with indigenous women.' And the first thing that an indigenous woman of 19, 20 years old, who had already had five children, said to me was 'Doctor, please, do my family planning as you do in your office in the city'. And there I realized that the one who puts the money, sets the conditions. So I decided that to do something transformative for the needs of the person who comes to the office, the system had to be something self-sustaining and have its own budget. If not, I ended up doing what other people wanted and what the patient needed, ”he says.
With these organizations they worked on the needs of the project.
Among other things, they developed a sustainable business plan that can be replicated in other places where there would not be a center like Cegin, which in Jujuy, because it is the place where everything was born, has a preponderant position.
And they succeeded.
“They understood the project.
Generally in my group of belonging or in my country, sometimes they told me that I was crazy, that there were no indigenous people.
I think because they don't know.
I had to connect with people who really love Latin America so that this project begins to fly seriously ”, reflects Gronda.
With the experience of the years and these supports, the project today is ready to be replicated in other places.
“At first my vocation or my goal was to help indigenous women and after this 20-year process, it became so sophisticated, so inexpensive and so simple that today it works for anyone.
I always say that it is like the 'uberization' of medicine because it removes the intermediaries, connects the two parts and that simplifies things so much ”, reflects Gronda.
Thus, Umana reaches more and more people and fulfills its mission: to offer accessible health care for all.
“There are two basic concepts: it has to be universal and of excellence. There cannot be two or three health systems, both in terms of ethics, aesthetics, accessibility and integration. It has to be complete. Today in Umana the businessman's wife sits with the lady who works as a domestic worker at her home. And both come for the same reason: because of the excellence of the system, because it is cheaper and because time is highly respected ”, concludes Dr. Gronda.