In Guatemala, an ICIJ reporter witnessed how scarce access to Keytruda shapes life and death decisions

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Outside the crowded ward that serves as one of the only public oncology units in Guatemala, patients wait their turn in blue plastic chairs that line the hallway. In another hospital, in a wealthier country, some would be candidates for treatment with the blockbuster cancer drug Keytruda. 

But here, in Quetzaltenango's regional hospital, access to the expensive treatment is determined by timing, availability and luck.

When ICIJ reporter Brenda Medina and her colleagues from Plaza Pública arrived at the hospital just after sunrise during a recent reporting trip, she met with oncologist Julio Ramírez, the director of the unit where he sees around 40 patients per week.

The public hospital in Quetzaltenango is home to one of only three specialized oncology units in Guatemala. Image: Laura Garcia / Plaza Pública

Dressed in superhero-themed scrubs, Ramírez mentioned how budgetary constraints shaped the list of medications patients could access, including Keytruda, which costs nearly $11,000 per infusion every three weeks.

Months earlier, the reporters had asked Guatemala’s health ministry how many patients received subsidized Keytruda through the public health system. Part of the answer came in a sobering letter written by Ramírez, who said he had only treated one but that funding for two more treatments had been approved.

In person, he insisted that this was an improvement. “But how do you decide who to give it to?” Medina asked. “What’s left for me to do? To play God,” he replied. He gave the medication to the first patient whose diagnosis and test results made them a good candidate.

As part of the Cancer Calculus investigation, ICIJ and its media partners filed hundreds of public record requests as they tried to quantify the true cost of Merck & Co.’s bestselling drug.

In Guatemala, Medina saw what records can’t show: a doctor faced with an impossible choice, patients forced to travel for hours on deteriorating roads, and families left to wonder if they could have had more time with their loved ones. Read her reflections here.

TUNISIA TARGETS ICIJ PARTNER INKYFADA
A three-judge panel will examine a request from Tunisia’s executive office that could shutter one of the country’s leading investigative media outlets, ICIJ partner Inkyfada. The push to dissolve its publisher, Al Khatt, is the culmination of a yearslong government campaign against the organization, free speech activists say. 

US REVOKES VISAS OF COSTA RICAN MEDIA EXECUTIVES
The United States has revoked tourist visas for five board members at La Nación, Costa Rica’s most influential newspaper and an ICIJ media partner, in what critics labeled an “unprecedented” measure that could have a “chilling effect” on free speech in the Central American nation.

ARIZONA GUN SHOP OWNER FACES TERRORISM-RELATED CHARGES
U.S. federal prosecutors charged an Arizona gun dealer with attempting to provide material support to terrorists, signaling a new approach to slowing the deluge of weapons flowing across the border into Mexico. The indictment revolves around the sale of several high-caliber firearms to an undercover agent who posed as a gun runner for a Mexican drug cartel. 

Thanks for reading!

Carmen Molina Acosta
ICIJ's digital editor

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