So my 10 goals....let's see how we did shall we....
1. Speak Spanish better.
2.Survive on my Ownin a Foreign Country
3.Understand the Fundamental Differences between the Argentine and American Health Care Systems
4. Be able to Prepare a Traditional Argentine Meal
5.Visit Someplace outside of Buenos Aires
6. Get and Work at a Second Internship
7.Swim in the Rio de la Plata
8. Take at least 100 pictures of my Trip
9.Watch/Participate in some form of Tango Dancing
10.Have an Evita Moment
Let's take a look at them one by one now.....
1. I definitely speak Spanish better than I did when I first arrived. More than being able to speak Spanish thought my understanding has improved exponentially. I read a book and half completely in Spanish while I was here. I can understand medical interviews, presentations, and television. My true test came when I had to call the cab company on the phone and speak Spanish. I didn't even blink and was able to get my point across and understand what they told me. That to me is the true sign of knowing the language better. Being able to speak on the phone in the foreign language means you are relying completely on your language skills, no hand gestures or facial expressions allowed. So yes I would say I accomplished this goal.
2. Did I survive on my own in a foreign country? I would say so. I really began acting like I lived in Buenos Aires and like I was going to be there for a long time. People would stop me to ask for directions, would speak to me in Castellano and get aggravated when I didn't get everything they said the first time until they realized I was a foreigner, and I even became a regular at the café by my house. Not to mention the fact that I had amazing experiences in the city working and traveling. I would call this one accomplished.
3. Well I certainly hope I accomplished this goal. I mean I gave a presentation on it on behalf of the US Embassy so I would say that is a pretty good sign that I had a firm grasp on the differences. But in all honesty, my time here not only highlighted the differences (both positive and negative) but gave me a greater appreciation for the healthcare system that we have in the United States.
4. I would say I can definitely prepare a traditional Argentine meal. I mean the trick really is to make sure that you have absolutely no vegetables except for potatoes, a huge hunk of meat, a delicious glass of wine from Mendoza, and a small dessert (flan or ice cream) with either a coffee or some maté. Yea I think I got that one down.....I won't be cooking this for anyone any time soon, but I could if I wanted to!
5. Did I ever visit someplace outside of Buenos Aires....I went first to Mar del Plata and had tons of fun at the beach. Then I had my Patagonian Peregrination....I won't recap all of that for you, but suffice it to say I made it to the end of the world and back in only 5 days. Oddly enough I didn't go to either of the two places I planned, but I think the trade off was definitely more my style and worth it!
6. So as I have said in the past I definitely did this. I got a second internship, again at some place completely not in my plans, and took advantage of every opportunity possible. I went to an immigration conference, a meeting with the US Embassy, and even other meetings with NGOs in Buenos Aires. Whoever says a co-op is like a normal internship has never met a husky....that't all I'm saying!
7. Okay....this is the one goal I did not accomplish. Quite honestly I am okay with it. I realize that by looking at some of my goals and seeing that they weren't realistic that it is okay to not accomplish everything. I mean I think if I had accomplished this goal then maybe my goal to survive in a foreign country wouldn't have been accomplished because I would have contracted some strange disease from the dirty water of the Rio de la Plata.
8. Yes I have taken far more than 100 pictures while here in Buenos Aires and on my trip. One day I actually took a grand total of 123 pictures.....that is ridiculous! I have never been a picture taker, but I definitely attempted to be better at documenting this trip and I think I succeeded.
9. I did this several times and even got to see an AMAZING tango show. I think just by the virtue of being in Buenos Aires it would have been impossible not to accomplish this goal.
10. What did I do my last full night in Buenos Aires?? I spent it at home cleaning and listening to the Evita soundtrack. I may have ventured onto my balcony once or twice maté in hand....This goal was accomplished time and time again, I assure you!
There you have it a brief overview of the goals I had and my level of achievement on each one. I think its funny that I always tend to have goals in my life or plans for how things are going to work and they always get shot completely to hell. I don't mean I don't accomplish them I just mean it is never in a very orthodox way. Life thinks its mighty funny to see how I'll react in different weird situations and its good to know that even though my experiences might be out of the ordinary they don't necessarily hinder my ultimate goals in anyway at all.
Well hello Everybody.....let me start with saying that I amSOsO So soSOOO sorry for not posting for so long. Life here in BA has gotten a little hectic for me. Good news is that this week I am determined to get up as many blog posts as I can....so be ready.
Today's post is actually about a conference I was able to attend thanks to my co-op at Ciudadanos del Mundo. Buenos Aires hosted a large immigration conference to discuss some of the issues that immigrants here in the city experience. The NGO was asked to go and have a table. Then when I was working they realized I had a camera and might be interested in going to hear the speakers and offered me the chance to go. I figured what would it hurt I really wasn't planning on doing anything crazy that night anyways. So I got in a cab with my boss and headed to one of the private universities here in BA that was hosting the event.
Immediately when I got there I realized that I was invited for more than just my camera. One of the other groups who had been asked to have a table was the International Community of Women Living with HIV/AIDS. I was quickly introduced to their point person who was interested in looking at my women's health curriculum and if it may be of use to their organization. That was sort of exciting and nerve wracking all at the same time. All in all, I gave them my e-mail address and they gave me theirs and apparently I may be asked to a meeting before I leave to discuss some details further.
The actual conference itself was fairly interesting. It was panel style and in about 4 parts. I managed to see and listen to the last two parts. The speakers came from all over South and Central America. Some of the speakers I heard were fromMexico, Brazil, Bolivia, and Argentina. It was very interesting to hear all of the speakers for a number of reasons. One reason is that I loved being able to hear the difference in dialect in an hour span. I got to hear Spanish from Mexico, Bolivia, and Argentina and really contrast the different sounds with certain letters and words. I was actually amazed at how different they all sounded. The other thing that was interesting is that a common point that every speaker made was about the difficulties of immigration in the US.
I was fascinated honestly. The US was the butt of more than one joke at the conference. All of the speakers seemed to have the same opinion that when it came to immigration it was all fine among Latin American countries, but the minute any Latin American tried to immigrate to the US it wasn't possible. It was baffling to hear about the US immigration issues outside of our own country. The speakers were all fantastic and truly believed in a person's right to immigration. But to hear them say that norteamericanos, didn't understand that truly brought home to me just how screwed up our immigration system in the US is.
Here in Argentina immigrants are allowed to move and regardless of their immigrant status receive most of the government benefits of a citizen. This includes a right to healthcare and education. Immigration here is something that the Argentines value. Having a diverse set of people from Lebanon, Pakistan, the Dominican Republic, China, Germany, and the list continues really has provided Argentina with the rich culture they have today.
The most striking thing to me about the immigration conference were the number of people who came up to me to ask me about Herman Cain. Yes, seriously he has become a major point of contingency here in Argentina. More than one person on more than one occasion has come up to me to discuss his ideas and beliefs about immigration. Most of the people I speak with believe he is the Republic nomination for President and I have to explain that he is not. I then further explain that I don't believe he will be the Republican nomination either. Truthfully this is the first time that I realized how American politics really play out internationally.
Here is a video of what they asked me about
The idea that some of Herman Cain's comments about an electrocuted fence to keep out people from Mexico has become a regular talking point about the United States abroad worries me. News and media organizations that choose to take one comment from any candidate and play it repeatedly to create a dialogue or persona really don't think about the implications outside of the US.
I truly feel most people in the US hear something like that and blow it off as some candidate preaching to get votes, but people abroad hear that and think it is something US citizens are taking seriously. It makes me worry about the impression the US gives abroad. If a news or media organization is going to distort a comment or have some sort of values that they choose to let guide their reporting then I think there needs to be more responsibility in terms of the international consequences.
OKay! Sorry about that....it just was sort of in my head and needed out. I'm better now. So here are some pictures of the conference. ENJOY!!
This is me and one of the social workers Veronica, before I left for the conference.
Since I have the day off Monday because of holiday here I have decided to use the time I would have spent working at the hospital writing a blog about the fundamental differences between the American and the Argentina health care systems. I know I am just so fascinating aren't you jealous?? No well that's okay because I am going to go read and tan in the park when I'm down writing this so.....HA. HA. HA! I also realize some people get scared by a lot of words on a page so I have added two youtube videos with music to break it up...they have nothing to do with the content of the blog.
What is it that is so very different about the two different health care systems? Well first and foremost here in Argentina there is a UNIVERSAL health care system. And when I say universal I mean it. Anyone, man, woman, child, illegal immigrant could go into a hospital and get treated for whatever illness they may be afflicted with on the government. In Argentina, healthcare is a right afforded every person regardless of any other factors. If only everyone in the US would get on this bandwagon. I just don't understand how anyone could think it was okay to deny someone health care simply because of their immigration status or the insurance they had. Seriously as a health care provider didn't you go into thinking you were going to help people and make a difference? [Steps off SoapBox to continue blog post]
Now that I have gone on and on about how wonderful it is that everyone gets care lets talk for a second about quality of care. Much like in the US quality of care if based on the amount of money that you have. The major difference though is in the US, in my opinion, the minimum standards of care seem to be much higher. So while everyone here in Argentina has access to care, I wouldn't necessarily say they have access to high quality care which really does in the grand scheme of things make a HUGE difference in terms of patient outcomes and morbidity and mortality rates.
The next most stunning difference between health care in the US and health care in Argentina is the technology. In the states I feel like every hospital bed has a computer within two maybe three feet of it. All of the diagnostic imaging, blood test results, vital signs, patient history is all located right on the computer, or in some cases the smartphone the doctor is using. Here paper charting is still a way of life. Everything is handwritten. Any sort of diagnostic scans, think MRIs and CAT Scans, or blood analyses are handed to the patient who is then responsible for getting them to the appropriate doctors. I can't even imagine what it would be like in the US if we made patients hang onto their own stuff. It would be a range of ridiculousness from people like me who would forget to bring them to the doctor and people like my mother who would look up stuff on the internet and convince herself she was dying.
Beyond the technology difference there is also a difference in the way the hospital system and patient doctor relationship functions. When I say this I am referring directly to HIPPA. I am amazed at what doctors will say about their patients in front of other patients in the US, but at least they don't use patient names and identifiers when they do it. Having a doctor walk into a consultation of another patient to ask another doctor about new information Joe the construction worker who lost his left foot in the war in the next room just told me XYZ do you think I should change the course of treatment is a regular occurrence here and no one has an issue with it.
The other thing that is greatly different about the doctor-patient relationship in Argentina is sort of a double-edged sword of good and bad. Basically if a doctor is treating a patient the patient's entire family is allowed to be involved in the care. I think from a wellness holistic sense this is a great thing. It is really hard in the United States to communicate personal information about a health topic to family members sometimes who feel because they are not the patient it is not their business. Families here are really involved. I find that family members actually ask more questions of the physicians about the actual diagnosis, what it means, and what the course of treatment is than the patients do. However, all that glitters is not gold. Because the Argentines are so willing to treat an individual patient as a family I have also seen doctors have consultations with patients without the patient there. Literally, a doctor has discussed health care decisions without the patient and only spoken to the loved one of that patient. Then proceeded to give the prescriptions and receipts to that patient. Now I know there are lots of times in the hospital, especially with some geriatric and pediatric populations, that it would be SOOOOOOOO much easier to just talk to the person you know is going to help make the decision anyways, but there is just something about it that doesn't sit quite right with me. I think that no matter if a person is going to undergo some type of treatment or procedure they should be the ones having the conversation with a doctor. The doctor needs to make sure the patient understands what is going to happen regardless of a loved ones feelings. I honestly have not seen this abused here yet, but there is such a high potential for it I can't believe that it is a socially accepted part of medicine here. As I said before it really is a double edge sword. Ultimately you are getting the family oriented care that for a truly holistic approach to healing is necessary for the patient, but sometimes you lose sight of the patient and their actual wants and wishes in doing that.
Maybe the next difference I have seen is because my true hospital experience has really only been in Boston, but it's a difference that stands out either way. Medical research here has NOTHING on the United States. When I say medical research I mean the research doctors do, the research they present, and the research that they read. When I was Singapore I really didn't notice this difference because the university in Singapore emphasized research. But that is not the case here in Argentina. Research takes a major back seat to actual patient care. Honestly there is a huge potential for all kinds of research here in Argentina because of the access to care for all people, but it is not something that is exploited because the country has not yet invested in the idea of research. There are really no hospital research facilities. Publications are read by physicians, but only the very good ones and even they, I think, struggle with understanding many of them because they are not written in Spanish but rather in English. Research is definitely a daunting part of the medical field in the United States. There is the old motto that seems all to true with doctors, especially in Boston, of "Publish or Perish" which just simply does not exist here in Argentina. The oncologists I work for actually held a symposium about kidney cancer last month. It was the first and only type of presentation of a disease, new line treatment options, and other educational materials I have seen to another group of physicians. Working in Boston it seems like every week someone or some team of doctors or nurses is pitching some meeting they're having to discuss their research about [insert weird medical topic here]. I think the lack of research is honestly part of the reason why you see such a difference in the quality of care. Because there is no research in this country about how to carry out treatments for successful patient outcomes there is a gap in the knowledge as to how to make every physician successful at curing patients.
The next thing I am going to talk about is only because I LOVE public health so much, so a lot of you probably won't care about it. Here in Argentina they have social program that work as incentives to get your kids vaccinated. The government actually has mini vaccine clinics in every neighborhood where any vaccine you could think of is available for patients. Patients who are children and follow the government checklist for yearly vaccines and attend school actually are given I think its almost $200 by the government. Not a bad deal for protecting your own health. I do find that there is a great misunderstand about what a vaccine is in this country and therefore in some of the more vulnerable populations, that actually could use certain vaccines, a fear to get vaccinated or get their kids vaccinated. To me though this really isn't any different from the people on the Jenny McCarthy train who don't want to vaccinate their kids from terrible diseases.
I thought a long time about how to end this blog. It just seemed like I could go on forever and ever and ever.....but I won't. Instead I thought I would end with a story that I think illustrates the struggles and benefits of the Argentine health care system perfectly.
The doctor always gives me a quick run down of the patient’s history before they enter the room and what exactly he will be discussing with them today. Well he began telling me the patient’s story and I was preparing myself for the worst, I won’t lie. ”Well she had polio as a child and now she has a weird gait, she’s 45 and this was a diagnosis of stage 2 breast cancer so…” This was my warning. I was expecting the absolute worst to walk through the door. A young woman, tired, worn down, hobbling on some old Tiny Tim crutch, to come through the door. I could not have been more misguided. This woman walked through the door on what looked to be new crutches, dressed nicely, with a decided polio weakness, but her nails were painted and she required absolutely no help sitting down and taking out all of her necessary medical documents. On top of how great she looked, she was the most pleasant patient I think I had seen all day.
I couldn’t do anything but smile. This was the perfect example of how a system can work. How someone with a devastating diagnosis like polio as a child can grow up and be successful. How someone with a complicated medical history is not completely devastated by a cancer diagnosis. This woman was amazing to me. Clearly she had a physical therapist, access to assistive devices, and she was able to catch Stage 2 breast cancer at the age of 45 because of a routine mammogram. I am still blown away. This is what I want for the United States, well without the polio diagnosis (as a future public health nurse I would like to not have that any where in the world).
