Argentina's health system devastated but health workers rally
The financial crisis of the past year has had a devastating impact on health care in Argentina.
With an unemployment rate of about 20% and an estimated 19 million of the population of 37 million living below the national poverty line, public clinics and hospitals have been swamped with patients who can no longer participate in private insurance systems sponsored by unions and employers.
Speakers at the Fifth Argentine Health Congress, held in August in Mendoza, painted a stark picture. An estimated 18 million Argentines now have no medical coverage and must depend on the overburdened public health system.
The Argentine peso had been on a par with the US dollar for a decade but with the devaluation it is now worth little more than 25 US cents. This has caused the price of imported drugs and medical supplies to skyrocket and supplies to fall.
"Practically 80% of the supplies we use are imported, from a simple glove to the latest antibiotics," Francisco Díaz, president of the Association of Private Clinics Sanatoriums and Hospitals, told the newspaper La Nación.
Rubén Torres, director of Health Services in the Health Ministry, announced that annual per capita spending on health care in Argentina had dropped from US$ 650 to US$ 184 because of the devaluation, a drop from one of the highest rates in Latin America to one of the lowest.
Dr Horacio Mingrone of the F.J. Muñiz Hospital in Buenos Aires said in an interview that patients are waiting longer to seek medical treatment because of their economic situation. "Their first priority is to find a way to live, to eat, the care for their families," he said. "Health comes second."
Dr Mingrone, whose hospital specializes in infectious and respiratory diseases, said that the patients who come to the hospital now are sicker than they were in the past. For example, 40% of the HIV- positive patients he sees for the first time already have AIDS. He added that patients who could have been managed as outpatients with highly active retroviral therapy (HAART) if they had gone to a doctor earlier, now often are admitted with opportunistic infections, such as hepatitis C and lung diseases.
He also noted that doctors in the Buenos Aires province and the capital itself are seeing more cases of diseases associated with poverty and poor hygienic conditions, such as hantavirus and leptospirosis, which formerly occurred primarily in areas outside the capital region.
People suffering from chronic illnesses such as diabetes and AIDS have had great difficulty obtaining the imported drugs they need to maintain their health. In May, the Argentine Society of Nephrology said medical care of the approximately 17 000 Argentines with chronic kidney disease was seriously compromised because of the increase in costs for dialysis supplies.
Recipients of transplanted organs have reported that it has become much more difficult to obtain the immunosuppressant drugs they need to prevent their bodies from rejecting the new organs. And new transplant surgery is often postponed.
Other types of non-emergency surgery have been postponed as well. The construction workers' union insurance plan put 20 pacemaker operations on hold in May. In April, the newspaper Clarín reported that Posadas National Hospital in Buenos Aires province had to suspend scheduled operations.
In several provinces, an increase in low-weight births has been reported, an indication that the mothers were undernourished. In Mar de Plata, 13% of the babies born in public hospitals in 2001 weighed less than 2.5 kilos, La Nación newspaper reported in July. It quoted Dr. Liliana Racciati, an obstetrician in charge of the high-risk ward at the Inter-zonal Specialized Maternal-Child Hospital there, as predicting that the percentage would be higher this year.
And psychiatrists in Buenos Aires told Inter Press Services of an increase in the number of people seeking psychiatric help because of stress related to nemployment and an inability to support their families. The number of calls to suicide hotlines has also increased, the news service reported.
Juan Pedro Sapene, a psychiatrist in Santa Fe, told the newspaper El Litoral that he was seeing more patients suffering from depression than before. "We see the impact of the crisis on people's emotional and family lives ... Many couples begin to have problems blaming each other for things that in reality have other causes," he said.
The elderly are particularly hard hit. A government social security system, called PAMI insures 3.5 million Argentines, of whom 2.4 million are over 65. The system has been plagued by mismanagement and overspending and is deeply in debt to its suppliers. According to the Pan American Health Organization, the lack of influenza vaccine alone could cause 850 to 4200 deaths among people over 65.
In February, Health Minister Ginés González García declared a national health emergency to last through the end of this year. Congress quickly passed a law eliminating tariffs on imported medicines and medical supplies.
In March, the government issued a formal decree announcing a National Health Emergency, in effect until the end of this year. Under the decree, the government would reestablish supplies of medicine and other materials in public hospitals, guarantee supplies of medicine for vulnerable outpatients, guarantee access to medicines and supplies to prevent and treat infectious diseases and ensure access to medical services for recipients of social security benefits.
Experts in diagnostic imaging - and improvization
Gabrielle Lofthouse is a half-Argentine fifth year medical student at Guy's, King's and St Thomas's School of Medicine, Kings College, London. She was shocked by the summer she spent this year, after the economic collapse, at the Department of Endocrinological Medicine in a major hospital in Buenos Aires. She told the Bulletin:
The greatest contrast is between the very basic facilities that the doctors here are forced to work with and their very high level of clinical knowledge.
Doctors here have no easy access to hi-tech imaging or diagnostic methods, and due to the very weak peso they can no longer afford to maintain what equipment they do have, as it is mostly imported. So they have been forced back upon basic clinical history and examination techniques - and they are quickly becoming extremely skilful at it.
I too had to become an expert, in the matter of the 'Obra Social', the health insurance system of Argentina, which is extremely important in determining what treatment each patient is entitled to receive.
Argentinians, if they are lucky, are members of a health insurance scheme or 'Obra Social' supported by their employers; for example there is an Obra Social for teachers, another for government employees etc. But membership relies on personal contributions to the scheme, and due to the severe economic problems here at the moment, many people are no longer able to pay their membership and so no longer have health cover.
This results in patients being unable to pay for adequate diagnostic methods or treatments. This is a very frustrating situation for both patients and doctors. For example, all drugs here, including generics, are charged at different amounts depending on their quality. So now some patients are unable to pay for the proper prescribed drug - so they buy a poorer quality version which will not have the same effect or may even be detrimental to their health.
I was also shocked, when I was observing biopsies of the thyroid gland, to discover that patients here are now required to buy their own needles and syringes to bring to the hospital to be used for this procedure. One lady was unable to afford all the necessary equipment and as a result was unable to have the procedure. This to me is in such marked contrast to my experience as a student in London, where equipment such as syringes and needles are considered to be throw-away items and are used in large quantities without a second thought being given to whether supplies will run out or not.
Gabrielle Lofthouse was interviewed by Robert Walgate, Bulletin.
Under the emergency decree, the government has required doctors to prescribe drugs by their generic name as a cost-cutting measure. After a heated controversy, with the drug companies and groups allied to them opposing the move, the Congress voted at 2 a.m. on 28 August to make the measure law.
The government also set up an agency called Remediar to provide a selection of basic medications to clinics throughout the country. The medicines are to be given to people whose income is below the poverty line or who are not covered by any insurance plan. The programme is financed in part by US$ 110 million in redirected loans from the Inter- American Development Bank.
The agency is also charged with monitoring the sale of drugs to make sure that drug companies and pharmacists do not gouge customers. To this end, it has set up a toll-free telephone number to report overpricing and has requested the assistance of local chapters of Caritas International and the Red Cross.
Dr Mingrone said that under the emergency plan, committees have been set up in all hospitals to monitor the effect of the financial crisis on each illness they treat.
Argentina has a large number of well-educated health professionals who, despite the lack of resources are managing well, Mingrone said, and many are going the extra mile to help their patients.
The nurses in the maternity ward at Sáenz Peña Hospital in Chaco are now making cotton diapers by hand for new mothers who cannot afford to buy them. Other Argentines have devised creative ways to deal with the crisis.
In July, volunteer doctors and pharmacists set up a street clinic for people without health coverage, the news agency EFE reported. In Mendoza, a special medical insurance system was established that allowed patients to pay with vouchers that doctors could use to "buy" other professional services through a national barter network called Red Global de Trueque. A supermarket chain in Santiago del Estero is allowing its customers to use points earned with its discount card to pay for medical appointments. 
Terri Shaw, Washington