Él Hopsital Bernardino Rivadavia—Hospital Rivadavia for short—is Argentina’s oldest hospital still in full operation. Located on Avenida Las Heras, in the Recoleta district of Buenos Aires, the hospital serves not only as a treasured landmark, but also as the startling image of public health care in Argentina today.
Rivadavia, which occupies an area of around five blocks, has managed to retain the neoclassical flavor from which its structures—strong pillars, extensive gardens, stone pavilions—were inspired. Although founded in 1774, the hospital was not relocated to its current address until 1887. The design, based both on modern architectural concepts and convictions of European health care, emphasized greater integration between health and nature—an approach that supposedly lent itself to safer attention and swifter recoveries.
Despite its honored and entrenched history, exemplified by its own museum of medicine, Rivadavia is not merely a monument. Its structural deterioration and financial neglect demonstrate—if only part of the reason—why, for me, this hospital functions as the face of Argentinean public health.
The Argentinean health care system can be broken down into three main providers: the private sector, which covers about 5 percent of the population; mutuals or social plans, which cover approximately 45 percent; and the public sector, which covers roughly 50 percent.
Private health care in Argentina is much like that of the United States—patients must meet their own individual health care costs, primarily through private insurance schemes. The social security sector, characterized by “mutuals” and social plans, is funded and operated by “Las Obras Sociales,” or the trade unions. Employers and employees each pay a fixed rate from which the mutual covers part of the cost of care and medicines. Patients then pay the difference between the actual treatment cost and fixed rate.
The public sector, however, is financed through taxes and utilized by thousands each day, and is the most exhausted branch of the health care system. This is firstly because in Argentina, health care is a universal human right granted to everyone regardless of income, nationality or status. Both citizens and non-citizens (legal and illegal) are able to make use of the nation’s public system. Yet, an increase in immigration alongside a sharp rise in unemployment over the last 10 years has led to system overuse and new structural challenges.
Argentina was a relatively rich nation when its current health care system was first instituted. During these initial years, buses full of patients from neighboring countries and poor outskirts would arrive at public hospitals ready to receive treatment. Today, however, many believe that Argentina can no longer afford to subsidize the treatment of foreigners because care for its own citizens has also begun to suffer.
Having spent the last four months in rotations at Hospital Rivadavia, I can only begin to elucidate the complexity of this health care reality—a reality that doctors, nurses, patients and fellow interns collectively and openly recognize. Many of the patients I have seen have been poor foreigners or immigrants, mostly from the neighboring countries of Peru, Bolivia and Paraguay. Although doctors and nurses try their best to deliver exceptional care, their tools, technology and machines are, in every case, extraordinarily outdated.
Despite these realities, everyone simply shrugs their shoulders. “Well,” they say, “Rivadavia is a public hospital,” as if that categorization sufficiently justifies the deep-seated problems of the Argentinean public health system—and there are more.
One of the first issues to draw my attention was the obvious lack of supplies, from the complete nonexistence of toilet paper and soap in the bathrooms to the sparing use of cotton balls and alcohol. The majority of hospital beds are not covered with any kind of sanitary paper, and if they are, the sheets are rarely replaced. Broken chairs and squeaky doors line the hospital hallways, concealed by the crowds of patients who wait hours each day for treatment.
Most Argentines will blame the government for the state of its public hospitals. Simply put, growth in public health care capacity has not been met with an analogous increase in funding. Government attention to spending has begun to focus on other areas of health—specifically, drugs and pharmaceuticals. This sort of redirected spending in conjunction with competition from the private sector has largely contributed to the dwindling amount of resources available to the nation’s public health facilities.
Systemic glitches aside, however, most patients appear thankful and satisfied with the public health care they receive. Hospital employees, too, rarely complain about the supply shortages or sub-par conditions. Like any hospital, physicians and nurses participate in weekly seminars and talks, and as a teaching institution, Rivadavia offers hundreds of medical students opportunities to learn about both medicine and the realities of public health in Buenos Aires.
Being an American, the image of public health care in Buenos Aires certainly took me by surprise, forcing me to think deeper for answers to our own ongoing debate. Yet, for the people of Argentina, the gift of universal health care is a cherished and unchallenged right of which they are proud and have no shame in sharing with the rest of the world.
Sonia Havele is a Trinity junior and is currently studying abroad in Buenos Aires, Argentina. This is her final column of the semester.
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