Medicine in Argentina by Kyle Lakatos
The doctor indicated in the direction of the infant resting on the bed; a young girl, who had only experienced breathing for herself a mere two months and was now fixed to assisted oxygen. La medicina (doctor in Spanish) extended her arm towards me; in her hand was a pink stethoscope. While keeping her head still, she used her eyes to motion me to towards the baby. It was my second day in the ICU. Dr. G only spoke Spanish, but by that point, I had already learned a few things; that day, in particular, she was wearing her favourite pink scrubs to match her stethoscope, the upcoming weekend she had a trip planned to go to another province, and her calling to become a doctor happened at 14 when her father passed away. I looked at the young girl; she looked at me, calm and quiet before giving me a smile. Gently pressing the stethoscope against her chest, she initially winced at the cold metal. "Thump-thump, pause, thump-thump."
Her pulse was rapid firing at over 100 bpm, a perfectly healthy rate for her age; whereas mine had suddenly dropped, to what could have been declared as medically dead. The endorphins had coursed throughout my blood and a feeling of lightness surged across my body. It was in that moment I knew. This was my calling.
Why I chose Medicine in Argentina
Three months before I stepped foot into the clinic, I made two defined goals to decide the destination of my medical volunteer experience abroad. The first, to put myself into an exclusively Spanish-speaking environment thus forcing a swim or sink response to bolster my competence with the language. The second, to commit serious time and energy into a clinical environment to see if the growing voice inside my head had reason to be there. After thorough perusal of various programmes, I settled on Projects Aboard in Argentina. In addition to my goals, the organisation would provide room and board with a host family, traveller’s insurance, and work in a paediatric hospital.
In short, my two goals have been met with exceedingly positive results; furthermore, I have had so many additional opportunities and experiences thrust upon me as part of this personal quest. My time here has been spent between a few different roles. During the day, I volunteer, observe, and assist doctors in two different public (free) hospitals; and in the evenings, I spend my free time reaching out to the community and participating in health outreach initiatives. For me, there has been a natural synergy between the community and the clinic; each providing a different perspective towards the health needs of the individual.
Clinic: man meets medicine
Two weeks after my rotation through ICU, I found myself entering a door that read "Ecographía" ("Ultrasound" in English). I was greeted by the shrill screech of a toddler, squirming and screaming as his mother simultaneously attempted to comfort and constrain him. The doctor gestured at me to join him as to better see the screen and position of the probe. By this time, the child had admitted defeat for screaming and resorted to sobbing softly. Pointing at the monitor, the doctor flatly stated "Riñón izquierda." With the expression of a dear in headlights, I stared at the pixilated, greyscale picture attempting to see the left kidney. Amongst the striations and dark spots, an ovular form could be made out in the haze. It pulsed and gyrated ever so slightly, matching to the boy’s short and rapid respirations. Part astonishment and part bewilderment, I was looking inside the human body. This exchange continued throughout the day. Organ after organ we discussed the name and structure of the entire thoracic cavity. Diego, as I came to know him, became a close friend of mine during the remainder of my time in Argentina.
Although my primary commitment was to children’s hospital, Diego invited me to join him during his shifts at the adult emergency hospital to see some advanced cases. Perhaps the most gruesome is worth sharing. A female, late 30s was admitted to the emergency room after a bullet had passed through her midsection, hitting many organs along the way; it had entered from back right and exited front left. As the ultrasound team, we came in after the surgery to monitor post-op progress. An internal look showed her right kidney had been removed, blood was loose in the body, and some organs were severely damaged. It was a miracle she was still alive.
Fortunately, not every case ended in such a sad state, sometimes even a happy ending. In radiology, we saw a girl who had three bones in each thumb (normally we only have two). In Dermatology, doctors eased people’s fears of cancer by marking their skin tags as non-malignant. And surgery… phew! Needless to say, it is amazing what can go in and out of the human body and still have it function near seamlessly. My time in the clinic and throughout the various rotations has given me a different perspective on the hospital.
Diseases thrive on ignorance
You see there exists two very different worlds within the hospital; the more familiar (and easily less popular) side inhabited by patients and diseases. Then there is the upside-down, the world only seen by the staff; an intricate network of people, each with their own expertise, working [somewhat] harmoniously as one unit to provide for their patients. Much like the various organs of the human body, each with their own specialised function. On a few occasions, doctors hop between departments to consult their colleagues on tough cases, each new perspective providing new insight to the patient’s wellbeing. I too consulted with the doctors, interviewing each of them on their experiences. With medical education, the medical system, and the role of the community in public health. Although there is no shortage of information available it seems the conversations between family, friends, and communities are not often had. From the cultural taboos of talking sex, to lack of information on proper hygiene, the populace puts itself at risk by remaining silent.
Community: man is medicine
I. Happy teeth
We arrived at the south side of town by bus. I continually repeated the word "caries" (cavities) repeatedly to ensure I would not forget. Looking out the window, I noticed the well-paved streets had disappeared, what replaced them were patch worked roads covered in dirt. We were to meet with a group of 20 girls from the local neighbourhood, providing them a short education on dental hygiene. The week prior, we prepared presentations, games, posters, and an interactive teeth-brushing activity all with the goal of getting them excited to brush their teeth. To my luck, I have worked with kids before. In fact, I enjoy it. I got them excited, made them laugh, and asked them questions about why we brush our teeth and how often we need to visit the dentist. My fellow volunteers led a "how-to" session for brushing your teeth properly; this involved the giant mouth (pictured above) and a makeshift giant toothbrush for the girls to demonstrate. Finally, we ended in a group brushing activity, were everyone showed us their best techniques and best smiles.
II. On Wednesdays parent’s eat free!
Imagine: A typical Thursday, you go to work, make dinner, and spend time with your family, a normal rinse and repeat sort of night; however today your child has a cough. Friday, suddenly they have a fever, are sweating, and you cannot change their diaper fast enough! Your child has contracted Shigella and needs to be admitted for treatment for at least a week in the hospital. While in the ICU, your child is fed as a patient; however, as a visitor, your meal is not free. The following Wednesday arrives, it’s been four days since you’ve been to work, as a result, you haven’t been able to buy dinner. It is the unfortunate truth: families go without dinner because they choose to be by their child’s side.
Wednesday 10:00pm, a stranger comes knocking on the hospital door,
"Te gustaría a cenar?" ("Would you like some dinner?").
This is the work of a small unnamed group of 10 community members, who every Wednesday travel through the hallways of the hospital providing food to parents of admitted children. The family’s expressions and sentiments have spoken volumes. Hearing the kind words and stories from the parents warmed, and subsequently melted my heart. A mother of a four-month-old had been there for three weeks. Some patients had their entire family join them, up to four members sitting in a stale, clinic room, filling it with their love and prayers for the child. Working with this group has been a beautiful demonstration of the impact small groups and community members can have. Portraying a subtle balancing act to augment the support within the context of the healthcare system.
III. Not your dad’s sex-ed
I have long been an advocate of sexual health and education, particularly around the pesky parasites that can be easily exchanged. Furthermore, I spent four years working as a vaccine scientist, gaining advanced perspective on the pathogenicity of viruses and other pesky bugs. Word got out to my coordinator, and after some discussion, we agreed it would be beneficial to provide another workshop, this time about Sex [Education]. This came in two parts.
First I would prepare a presentation describing STIs; from how you get them vs. how to prevent them, following with how to treat/cure them. Later, it was requested I add in additional information on birth control options. You see, in Argentina (and many other countries) sex is a taboo discussion topic. Even when providing the initial training to my fellow adult volunteers they snickered and giggled at the mention of sexual organs. Therefore, my approach is simple; make it fun to learn about. This workshop was targeted towards adolescents and adults, as Sexual Education is not a standard part of the curriculum in Argentinean schools.
Following the sexual education workshop, we added another outreach, this time collaborating with the AIDS Health Foundation Argentina. Taking this talk into the streets, informing people about HIV, asking them if they wanted to receive a free test and if need be providing counselling and support systems. Midway through the public outreach, I was asked to increase my recruitment levels by passing out condoms to any random passersby on the street. Earning the nickname ‘condom fairy’ I proudly walked up and down the main square asking people if they knew the difference between HIV and AIDS. My cheerful approach seemed to work, more and more people gathered to get tested; soon the line was longer than the tester could accommodate. The best problem we could ask for.
IV. Sticks and stones may break my bones… but this many will crush me!
Straight out a scene from Mad Max, a wasteland lay before us. Two tons of rocks, under those a rotted wood pallet, scattered rusted-metals splayed across the ground, and bags of used diapers stacked like leaves in the fall. Not hard to imagine, when you enter a trash dump. Yet, here we were in the backyard of a preschool. Our task? To remove it all!
We arrive at 9am. Scattered across the yard were trash, glass, old electronics, and play structures that had been destroyed by time. The centrepiece of this spread was a patient’s bed with accompanying stirrups. Turning back to the group, I put on my gloves, gave a nod, and exclaimed, "Let’s get started!"
I knew the pile of rocks would take the longest so I made sure to get multiple people started there. Meanwhile, another team focused on the garden, removing stray bits of glass and the random artefacts. This lasted for a few hours until we took lunch at noon. The day grew hotter, I found myself reminding everyone to stay hydrated and apply a generous amount of sunscreen every thirty minutes. At about the 1pm mark, we had finished all but half the rocks. The plan wrote itself; ease the burden and share the load. We formed a production line even Toyota would be proud of. Bigger rocks, which were easier to handle, were passed along a conveyer of people, while the smaller ones were shovelled into a wheelbarrow. Within two hours, the rocks were gone! The wooden pallet, complete with its exuberant ecosystem of crawlers, pinchers, and nails was ‘delicately’ torn. It had been six hours of physical labour coupled with blistering sun. I felt amazing! Here is to hoping a day of work will leave months of impact; one where children can play safely, and minimise their risk of disease and injury.
The hard work does not end in the hospital; healthcare does not belong solely in the hands of doctors and nurses, everyone has a role. Coming to and working with people in Argentina is an experience I will not soon forget. As an aspiring physician, the perspective I have gained has exceeded my expectations. I know being a doctor is my vocation. Helping people. Thinking through the combination of internal and external factors affecting health. I know one person alone cannot change the world, but a community can. I will find that community; I will foster and grow with that community. I know there are many challenges scattered ahead of me to reach my goal, but each will provide an opportunity for growth and reflection. For now, I will continue seeking out opportunities to build upon connecting communities with their wellbeing. My quality of life will be measured by the stories I share, the people I meet, and the impact I impart.
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