The enthusiastic voice on the phone gave us directions the way people in many parts of Latin America do: “Go past the flower market,” she instructed, as we slowly drove down a street lined with stalls full of buckets of roses, daisies and sunflowers. Once we turned right, then left, then left again at the freshly plastered concrete wall, we would find the unpaved road, she said. “The house at the end of that road, that’s us.”

We arrived at Violeta Chuc Sam’s family home in the mountain town of Quetzaltenango, Guatemala, on a breezy Saturday morning in February. Chuc Sam, whose vivacious personality matched the voice giving directions, greeted us at the door. A few weeks earlier she had agreed to welcome our group of journalists to learn more about her mother Francisca Violeta Sam Colop. We wanted to talk about Sam Colop’s long struggle with skin cancer and her fight to access the medication Keytruda.

This reporting trip was part of the Cancer Calculus, an investigation by the International Consortium of Investigative Journalists and 47 media partners, including the colleagues I was traveling with, reporter Jody García and photographer Laura Garcia from Guatemalan independent outlet Plaza Pública. Our team spent months examining the global consequences of the exorbitant prices of Keytruda, a novel cancer immunotherapy, known generically as pembrolizumab. It is the bestselling drug in the world, and has made around $163 billion in revenue for its maker, Merck & Co., since its U.S. launch in 2014.

Quetzaltenango, Guatemala. Image: Laura Garcia / Plaza Pública

I first came across Sam Colop’s name last August in a 2021 court order granting her access to Keytruda, which she could not afford out-of-pocket. By the time I found her case, I’d already been reviewing numerous similar judicial cases and would go on to find dozens more in the months ahead. But Sam Colop’s case stayed with me. In 2012, she was diagnosed with advanced melanoma, the same illness for which Keytruda was used to put former U.S. President Jimmy Carter in remission. She was an Indigenous Maya K’iche’ educator, a poet and researcher, and an advocate for the preservation of her people’s language and culture. I got excited about the possibility of telling the story of an extraordinary person, beyond what the court records could show. But then, another result appeared in my search: a brief obituary, dated July 5, 2025. Sam Colop was present in the legal document but the possibility of hearing from her was gone.

Months later, I was in her living room, as her daughters Violeta and Marina, and her widower, Juan Chuc Xum, sat below a large framed photo of a stoic Sam Colop reminiscing.  Some of the books she authored — a K’iche’ and Spanish children’s version of the Popol Wuj (the sacred text of the Maya people) and her last collection of poems — were neatly arranged on a table nearby. I listened as they took turns telling her story. She was 65 when she died, but younger at heart, Marina joked. She loved to read, sing and dance, and always had a new project going on, Violeta said. She “always likes to be well put together,” said Chuc Xum, still speaking about his wife in the present tense. In 2021, an oncologist outside her government-run insurance system prescribed Sam Colop Keytruda, which by then was a standard treatment for advanced skin cancer in many countries. But her insurer wouldn’t cover the drug. Like thousands of people across Latin America, she had to go to court to force the insurer to do so.

Juan Chuc Xum (center) with his daughters Marina Chuc Sam (left) and Violeta Chuc Sam (right). Image: Laura Garcia / Plaza Pública

Despite the lack of transparency surrounding prescription drug pricing, our investigation revealed that the cost of Keytruda varies widely by country and even by regions and health systems within a country. A year of treatment can cost anywhere from $29,000 in Indonesia to $130,000 in Colombia, to $208,000 in the United States. In Guatemala, a country with modest income levels, the treatment costs nearly $11,000 per infusion every three weeks, or about $180,000 a year.

“Who could pay for that?” Chuc Xum told us, raising his hands, palms open, before answering his own question. “No one.”

Our reporting began far from the field. For months, we filed and sifted through hundreds of public records, analyzed global data and dug up court documents, to trace the real cost of Keytruda and the corporate maneuvers to maintain its high price and exclusivity. After finding hundreds of cases like Sam Colop’s in Latin America, I learned that a consequence of the high cost is that insurers and hospitals in several countries — with over-stretched healthcare budgets and little negotiation power with Big Pharma — largely won’t provide the medication, unless following court orders. The records quickly raised a broader question: What is it like when a medicine exists, but remains effectively out of reach for those who need it most?

I went to Guatemala to try to answer that question, where the lack of access to Keytruda for both insured and uninsured people seemed glaring.

Chuc Xum playing with his granddaughter on the rooftop. Image: Laura Garcia / Plaza Pública

When I found Sam Colop’s case, her family had been in mourning for just a month after her death. My colleague Jody García reached out to them and we patiently waited until they were ready to talk. The Saturday we visited Sam Colop’s family, they gathered at her house for the interview, as they used to do almost every weekend for family meals. But in a private moment, Violeta, the youngest daughter, told me that in the months since her mother’s passing, it had become rare for them to meet there. “It feels empty without my mom,” she said, almost in a whisper.

After winning her court case, Sam Colop received Keytruda for two years, though periodic shortages meant she sometimes went without treatment. Had she received the medication as scheduled, or even years earlier, her family wonders, would she still be alive? But as we found in our investigation, geography often shapes who has access to expensive and potentially lifesaving medication.

Marina said she finds comfort in knowing her mother prepared them in anticipation of her death, even leaving instructions in her final book of poems. Violeta said she still feels anger over her mother’s death and knows it will take time to accept it. Chuc Xum went down the list of habitual things he misses (seeing her at home, their conversations, going for a stroll — or for dinner — on a random weeknight) until he arrived at what he mostly longs for: growing old with his life partner.

https://www.icij.org/investigations/cancer-calculus/cancer-patients-legal-battle-keytruda-lifesaving-drug/

INSURERS ‘They deny the medication that is keeping you alive’: Patients wage grueling legal battles for lifesaving cancer drug Apr 13, 2026

https://www.icij.org/investigations/cancer-calculus/merck-keytruda-cancer-drug-price/

OVERVIEW How Merck turned its wonder drug into a blockbuster — and priced out cancer patients worldwide Apr 13, 2026

https://www.icij.org/investigations/caspian-cabals/going-with-the-flow-how-scrapping-our-itinerary-helped-us-land-the-story/

BEHIND THE SCENES Going with the flow: How scrapping our itinerary helped us land the story Dec 17, 2024

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ment altogether because he could no longer afford a previous medication (which costs almost $2,000 every three months). When Ramírez told him that he would be able to get Keytruda, and that he wouldn’t have to pay, Xum said he dropped to his knees.

“A doctor alone does not prescribe that, it has an enormous value,” he told us, convinced there was divine intervention. “This is not human. This comes from above.”

Xum often travels hours from his hometown of Samayac to the public hospital in Quetzaltenango for cancer treatment. Image: Laura Garcia / Plaza Pública

Keytruda has shrunk Xum’s tumors, but he’s not in remission. He lives with side effects like skin rashes and constant diarrhea that sometimes force him to get off the bus to use the bathroom on long journeys, like when he goes to art festivals where he sells his products. Then he has to wait for another bus. But he is grateful to have the cancer under control, he told us.

My reporting in Guatemala was shaped by distance. The physical distance patients like Xum cross every few weeks to reach treatment. The legal distance in cases like Sam Colop’s, where access moves through court systems that can authorize care without guaranteeing its consistency.

In Guatemala, those distances are not abstract. There, we found what doesn’t come through in records: small, crowded oncology wards, hours-long travels on deteriorating roads, and the quiet endurance of families still wondering if they could have had more time with their loved ones.

A three-judge panel is set to examine a request from Tunisia’s executive office that could shutter one of the country’s leading investigative media outlets, ICIJ partner Inkyfada.

The Tunis Court of First Instance will consider Monday whether to dissolve Inkyfada’s publisher, Al Khatt. The dissolution request is not based on a single claim but appears to be the culmination of a yearslong campaign against the organization, according to Reporters Without Borders (RSF).

“What is clear is that the procedure fits a broader pattern of institutional censorship: using administrative and judicial tools to eliminate,” Oussama Bouagila, director of RSF’s North Africa office, told ICIJ in a message.

Al Khatt is a nongovernmental organization founded in 2013 to foster independent journalism and media literacy in Tunisia. It also publishes and partly funds Inkyfada, a longtime ICIJ partner that has contributed to several cross-border investigations, including the Panama Papers, the Pandora Papers and the Implant Files.

https://www.icij.org/news/2026/05/us-bars-executives-of-costa-ricas-leading-newspaper-la-nacion-from-entry/

PRESS FREEDOM US bars executives of Costa Rica’s leading newspaper La Nación from entry May 06, 2026

https://www.icij.org/news/2024/11/many-journalists-have-left-how-post-election-repression-compounded-press-freedom-fears-in-venezuela/

PRESS FREEDOM ‘Many journalists have left’: How post-election repression compounded press freedom fears in Venezuela Nov 15, 2024

https://www.icij.org/news/2026/01/im-on-the-right-side-of-history-icij-member-roman-anin-stripped-of-his-russian-citizenship/

PRESS FREEDOM ‘I’m on the right side of history’: ICIJ member Roman Anin stripped of his Russian citizenship Jan 22, 2026

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The United States has revoked tourist visas for five board members at La Nación, Costa Rica’s most influential newspaper, in what critics are calling an “unprecedented” measure that could have a “chilling effect” on free speech in the Central American nation.

Over the weekend, Pedro Abreu, CEO and chairman of the board of Grupo Nación, the holding company that owns the newspaper, started getting messages from friends with links to local media reports. Three outlets claimed that he, along with four other board members, had had their U.S. tourist visas revoked.

“One of the media outlets even stated our names, our dates of birth, and the expiration dates of our visas,” Abreu told the International Consortium of Investigative Journalists, adding that he was in disbelief. “I checked my email, looked to see if I had any calls or anything, but I had no official communication. After a while, I searched on a U.S. government website, I put in my visa information and there I saw. It came up as revoked.”

Under President Donald Trump, the U.S. State Department has revoked visas of lawmakers, government officials and judges from Mexico, Colombia, Brazil and Costa Rica over a range of accusations from organized criminal activities to “witch hunts” of Trump’s political allies. Costa Rica is the only country where the U.S. government has targeted owners and executives at media outlets. (In October, the U.S. revoked the tourist visa of the owner of a digital outlet who was under investigation for money laundering.)

The State Department did not respond to questions sent by ICIJ.

Costa Ricans are required to apply for tourist visas to enter the U.S., which grants them entry for years at a time. Five of Grupo Nación’s seven board members had their visas revoked; the other two hold passports from countries that allow them to enter the U.S. without one, said Fabrice Le Lous, La Nación’s editor in chief. “And there is one common denominator among them: that they were given absolutely no reason or explanation,” he said.

The Trump administration has used visas as a reward and a punishment in its efforts to persuade nations to accept U.S. deportees from other countries. In September, after Ghana agreed to take deportees, the U.S. lifted visa restrictions on the country. It is not clear whether the visa revocations in Costa Rica are connected to the April agreement outgoing President Rodrigo Chaves signed with the U.S. to accept up to 25 deportees a week.

https://www.icij.org/investigations/china-targets/escalating-efforts-a-year-after-china-targets-beijings-global-campaign-against-dissenters-continues/

CHINA TARGETS ‘Escalating efforts’: A year after China Targets, Beijing’s global campaign against dissenters continues Apr 28, 2026

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PRESS FREEDOM ‘I’m on the right side of history’: ICIJ member Roman Anin stripped of his Russian citizenship Jan 22, 2026

https://www.icij.org/news/2025/11/censorship-disguised-as-law-investigative-journalists-in-peru-push-back-against-government-crackdown/

PRESS FREEDOM ‘Censorship disguised as law’: Investigative journalists in Peru push back against government crackdown Nov 12, 2025

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