Brett Friedler - Medicine & Healthcare in Argentina
Once the patient was prepped for surgery, the operating room fell silent. Dr. Catallo, the chief of surgery, was silently praying in the corner. ‘This won’t be good,’ I thought to myself.
Twenty minutes prior to this realization, Dr. Catallo told me to go to the surgery room. However, his Spanish accent was particularly difficult for me to understand, so I must have missed the word “amputation” in his description.
The patient was an elderly woman with advanced type II diabetes. Unfortunately this is not an uncommon finding in Argentina, where the typical diet has a very high sugar content. In this particular case, blackened, necrotic tissue had spread upward from her toes to cover the foot and shin of her right leg. The doctors believed they needed to amputate the limb to save her life.
The procedure was completed in 12 minutes, but during the operation I had no concept of time. Instead I stared fixedly as the sharp blade effortlessly cut through several layers of skin, fascia, connective tissue, muscle, fat, and a pool of edema spilled out of the incision. In the grand finale, Dr. Catallo literally took a saw to the femur. Whilst the surgeons stitched her up, all I could ask myself was how the patient was not bleeding to death. Indeed, the patient was alive and well a week later when I helped to change her bandage. I left behind in the OR that day both my innocence, as well as any doubts about the difficulties of pursuing a career in medicine.
My Medical Placement
I am a 24-year-old aspiring doctor. After completing my M.S. degree in Physiology and Neurobiology, I was interested in pursuing a cultural immersion experience that would also help me decide if medicine was the right career path for me. In retrospect, Projects Abroad helped me achieve both of these goals.
My volunteer placement landed me with an incredible host family in the small, rural town of Jesus Maria, a little over an hour north of the city of Cordoba (easily accessible by bus). Located twelve blocks up the road was the public, free services clinic I worked at called Hospital Vicente Aguero. The hospital contains a pediatric, OB/GYN, internal medicine, surgical, and intensive care wards, as well as a laboratory. I had the option of rotating between wards, but instead opted to stick with internal medicine for the two-month duration of my stay.
A typical day in the clinic consisted of morning rounds and afternoon general assistant duties. I would shadow doctors representing various specialties, listen closely, and simply wait to be told what to do. Some of my responsibilities included fetching a medical prescription, setting up an ECG, or shuttling various patients medical history files to and from the doctor’s office. In the afternoon we cleaned and bandaged the wounds sustained by patients in automobile accidents. If a patient needed to be taken from the clinic to surgery or radiology, I would help transport them. Occasionally I would record patient blood pressure, change their saline solution, or remove a catheter.
While I had the opportunity to practice important clinical skills on my placement, I also observed some rather disturbing trends. Argentina is a developing country in South America. Neither the technology, nor the systems of healthcare delivery are on par with what is observed in the United States. Patients spend more time than is necessary in recovery due to a combination of a lack of resources and poor communication amongst medical staff. Additionally, the ubiquitous diabetes tends to slow the healing process dramatically.
Sterile practice is not adhered to with any meaningful consistency (with the exception of the OR). I was shocked when the doctor I was assisting one day asked me to grab the trash bin from the bathroom to dispose of bio hazardous bandages. On more than one occasion I witnessed doctors or nursing staff applying antiseptic or changing bandages without wearing gloves. While these aspects of Argentinean healthcare are preventable and frustrating, the tireless work ethic of the understaffed medical personnel for marginal pay is nothing short of inspiring.
Advice for future volunteers
Finally, if you are considering a trip to Argentina with Projects Abroad, bear in mind a couple of points.
Firstly, very few people speak English in this country. If you don’t have at least a rudimentary understanding of the Spanish language, I strongly recommend you pick up a Spanish-English dictionary, a Rosetta Stone program, or maybe enroll in a Spanish course at your institution. Mastering the basics will dramatically improve your experience at work and add color to your social life. Many of the volunteers I shared time with in Argentina did not have a handle on the Spanish language and were frustrated with the language barrier. The wrong thing to do is expect others to cater to your needs. You will find that simply being surrounded by Spanish-speaking people will improve your understanding tremendously as you take things in context.
Secondly, if you are doing a medicine program, you will need to take initiative at work. Ask intelligent questions and take advantage of rare opportunities. Introduce yourself to everyone and explain your interests. Within a week of working I had already seen an autopsy, a hysterectomy, and two C-sections simply because I expressed interest in surgery to the right doctor. As you build relationships with the medical staff, you will be trusted to handle more important tasks. However, there are things you will not be able to do without medical credentials, so don’t expect to operate on a patient or administer medication.
Thirdly, make time to see some of the country. There are mountains, waterfalls, glaciers, cities, wine, and tango to explore. On a long weekend, my roommate and I would take a bus out to Puerto Iguazu/Cataratas, Mendoza, Buenos Aires, Quebrada del Condorcito, or any of the neighboring towns in the province of Cordoba. The bus system is very easy to figure out and (relatively) cheap. Your Spanish will also improve by interacting with others, especially when a taxi driver is charging you 300 pesos for a one-hour ride. The correct thing to do in this case is to say that you’ll spend a night in a nearby hostel for 40 pesos, and walk away. Watch how they come back with a better price that is still a rip-off. The lesson here is that the least interested party always wins in business and love.
As I move forward with my career in medicine, this authentic experience in Argentina will always hold a special significance for me. Two months of volunteer work with the in-patient clinic has granted me perspective of how lopsided the comparison between healthcare delivery in my home country versus other countries, truly is. As a matter of moral integrity, I intend to participate in various international healthcare relief efforts throughout medical school and beyond.