medical care or vaccinations.”239 Regarding access to health-care services, “only those who work on ranches [could] access the [Health Insurance Institute], and even [then], the use of this insurance is not possible because the cards are not delivered or [the Community members] do not have the resources to travel to and stay in the Loma Plata Hospital, which is the closest one.”240 Also, “a 1993 health census conducted by the National Health Service (SENASA) […] confirmed that a large percentage of the current Xákmok Kásek population carried the Chagas disease virus.”241 206. Regarding current conditions, the Court has verified that an indigenous community health care promoter was hired on November 2, 2009.242 Also, following the issue of Decree No. 1830 on April 17, 2009, the State has organized nine healthcare workshops with the Community,243 during which it attended 474 consultations, providing treatment and medicines in some cases.244 In addition, the State forwarded documentation on a project to build a health clinic for the Community, at an estimated cost of Gs. 120,000,000 (one hundred and twenty million guaranís).245 207. Nevertheless, according to Marcelino Lopez, Community leader, and Gerardo Larrosa, the Community’s health-care promoter, the health situation is fairly critical. They indicated that “indigenous people die owing to lack of transportation [or] medicine,”246 and their perception is that, in the case of “most of the indigenous people concerned, this is because of the […] Government.”247 Specifically, Gerardo Larrosa indicated that “the health brigades almost never provide assistance, except on a few occasions,” and “[t]here is no stock of basic medicines for primary care, or even an adequate place to store them.”248 208. The Court acknowledges the progress made by the State. However, the measures taken following Decree No. 1830 (2009) are characterized by being temporary and transitory. In addition, the State has not guaranteed members of the Community physical or geographical access to health-care establishments and, from the evidence provided, there is no indication that positive measures were taken to guarantee that the medical supplies and services provided would be acceptable, or that any educational measures were taken on health matters that respected traditional customs and practices. 239 Cf. CEADUC Anthropological Report, supra note 55, folio 1742. 240 Cf. CEADUC Anthropological Report, supra note 55, folio 1742. 241 Cf. CEADUC Anthropological Report, supra note 55, folio 1742. 242 Cf. Communication MSPyBS/DGAPS No. 865/2009 of December 18, 2009 (file of attachments to the answer to the application, attachment 1.4, folio 3306). 243 Cf. Report of the General Directorate for Assistance to Vulnerable Groups of December 16, 2009, supra note 237. 244 Cf. Information presented by the Ministry of Public Health and Social Welfare on December 16, 2009, with data on medical attention provided between May 1 and November 4, 2009, and data from the lists forwarded by the General Directorate for Assistance to Vulnerable Groups to the Ministry of Public Health and Welfare (file of attachments to the answer to the application, tome VIII, attachment 4, folios 3292 to 3305), and records of attention provided in January and February 2010 (file of attachments to the final arguments of the State, folios 4423 to 4435). 245 Cf. Report on the “medical clinic – for the indigenous settlement of the XV sanitary region of President Hayes” (file of attachments to the answer to the application, attachment 4, folios 3315 to 3321). 246 Testimony of Marcelino López, supra note 63, folio 587. 247 Testimony of Marcelino López, supra note 63, folio 587. 248 Testimony of Gerardo Larrosa, supra note 75, folio 606. 48