In normal circumstances, Guatemala's healthcare system in rural areas is "appalling", said a doctor in the Guatemalan Department of Alta Verapaz, but in the time of the coronavirus pandemic, it is even worse.

Rural and Indigenous communities across Guatemala are increasingly concerned about the spread of coronavirus, questioning whether the country's already fragile healthcare system could adequately respond.

"The Guatemalan health care system is not prepared to attend to a pandemic of this magnitude," said Diego Petzey, currently a community leader in Santiago Atitlan, another rural area.

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Most of Guatemala's 196 confirmed COVID-19 cases and five deaths have appeared in the country's urban centres, including Guatemala City and Quetzaltenango, but earlier this month, the government reported the first case of community transmission in the Maya Kaqchikel town of Patzun, some 80km (50 miles) west of Guatemala City.

"There is a false sense of confidence that the virus will only affect urban areas," said Lucrecia Hernandez Mack, the former health minister from 2016 to 2017 and current congressional representative with the centrist Semilla party.

Guatemala remains a largely rural country, with 46 percent of the population living in rural communities, according to the 2018 census. The majority of these rural residents are members of the Indigenous Xinca, Garifuna and 22 different Maya groups.

In rural areas, the government launched a prevention campaign about washing hands and social distancing in Indigenous languages on local radio and television. But both Hernandez Mack and Petzey said it is not enough, saying many communities still lack daily information in their languages about the crisis.

"They have not taken sufficient necessary measures to attend the Indigenous populations that are more dispersed outside urban centres," Hernandez Mack said.

The Guatemalan health ministry and the presidency did not respond to Al Jazeera's requests for comment.

Historical discrimination

Indigenous populations have historically faced discrimination in Guatemala. More than 80 percent of the victims of human rights abuses during the country's 36-year-long internal armed conflict were Indigenous.

Indigenous groups in Guatemala continue to suffer disproportionately from poverty, which pushes many to either migrate to the United States or to neighbouring Mexico or Honduras for the coffee harvests. According to a 2014 report from the Guatemalan National Institute of Statistics, 79.2 percent of Indigenous people in Guatemala suffer from poverty, compared with 46.6 percent of non-Indigenous populations.

Children sit on a rock in Yalambojoch, Guatemala [Oliver de Ros/AP Photo]

Indigenous residents also suffer from high rates of the factors that are considered by the World Health Organization to increase vulnerability to the novel coronavirus. More than 11 percent of Indigenous groups in Guatemala are above the age of 50-years-old and living in rural communities.

According to data from the Guatemalan Health Ministry from 2015, 45 percent of adults over 45-years old suffer from diabetes, and over 70 percent of the adult population suffers from some level of obesity.

Rural Indigenous communities also continue to suffer from extreme levels of malnutrition.

The effects of deep-seated discrimination are felt in the healthcare system, as well.

Unprepared health centres

Guatemala has 44 public hospitals and nearly 1,500 health centres across the country that serve a population of 14.9 million people, according to the 2018 census. But according to Hernandez Mack, the country needs about 5,000 health centres to meet residents' needs.

"We have conditions of inequalities in healthcare services," Hernandez Mack said. "Departments that have larger populations of Indigenous peoples, like Alta Verapaz or Huehuetenango, have less coverage of health services."

A study by the Guatemalan Health Ministry in 2017 found that the Guatemalan government was spending less per capita on health services in largely Indigenous departments than departments with a majority of non-Indigenous communities.

Mayor Florencio Carrascoza Gamez, wears a protective mask, as he poses for photos at his office in the largely Indigenous town of Joyabaj, Guatemala [Moises Castillo/AP Photo]

Faced with the pandemic, the Guatemalan government is constructing field hospitals in five parts of the country to respond to coronavirus cases. The government confirmed that there are only 676 respirators, with only 56 designated for coronavirus patients, and another 200 arriving.

Front-line doctors and health professionals working in rural health centres often lack required equipment and medicines.

The doctor in the department of Alta Verapaz said that medics there are working double shifts in the health centre because of the government imposed-curfew, which lasts from 4:00pm-4:00am. She said that when they have had a suspected case, health professionals are required to walk two or three hours into the mountains to check in on suspected cases.

"We are not prepared," she said. "We don't have protection equipment, so every doctor is purchasing their own equipment. More than likely, we will be forced to reuse disposable equipment, and that is not good."