I'm not sure if any of you remember during that month of Swine Flue hysteria in the US, the experts talked about how the disease might have a serious impact in the Southern Hemisphere because of the upcoming Winter. Well Winter has arrived in Argentina and so has the flu.
The past few weeks have been un poco loco and several events are reminding me why Argentina is not a devoloped nation. June 21 marked the first day of Winter, yet the center was not provided with hand gel, alcohol, or masks until today. These are basic neccesities to prevent the flu. Let you remind you the patients who come in have AIDS (meaning weak immune systems) AND there is a new flu virus H1N1 (aka. Gripe A, aka. Gripe Porcina.) Why wasn't this a priority? The general lack of foresight and plannning is something that really bothers me about the culture here. Having come from a wealthy country where it's reasonable to expect things to function (more or less) as they should, it is very hard for me to accept such a failure in disease prevention and control.
I will admit that even if all the neccesary supplies were procured, cultural practices here in Argentina make it very difficult to control infectious diseases, especially the flu. All Argentines greet one another with a beso (a kiss) whether man or woman and spend lots of time sharing mate with one another (using the same straw). It's also very common for Argentines to travel long distances by bus to visit family in different provinces. All these things make life very easy for viruses. Sometimes I put on my Anthropologist spectacles and find it fascinating to observe the health workers struggling against their own culture in order to prevent disease. Doctors have to remind each other not to kiss each other for a greeting and drink mate solo. Since even they break the rules occasionally, imagine how hard it is for the less educated Argentines. It's also interesting that Gripe A is being blamed on the wealthy Agentines because they were the ones who travelled to the US, Mexico, or Europe and brought the virus back home. Blame and accusation go hand and hand with disease, but besides Gout, I can't think of another affliction associated with the wealthy.
Despite all this madness, I am continuing my project despite some changes that I will talk about soon. It's hard to believe I will be leaving the country in just 2 weeks. As my Spanish has improved and I learn more about Argentine life, I am becoming more aggravated by (what I percevie to be) negative aspects of their culture. Nevertheless, this is a very special place and an experience that will be a part of me forever.
Tuesday, June 30, 2009
Friday, June 19, 2009
Taking Your Medication
It's been two weeks since Yanique visited and I still haven't posted anything about where we went and what we did. I promise, those posts are coming (with plenty of pictures.) Right now I'm back to work at full speed. I only have 2 weeks left and am trying to get as much done as possible. Things have been getting a little crazy at the center with the elections coming (June 28), strikes almost every week, and a mysterious case of missing (and very expensive) HIV medication. So as I get to work, I will leave you with an interesting article I found about a new technology that could reward patients for drug compliance. I think it's a great idea. What do you think?
Monitor: Taken your medicine? | The Economist
Note: Tuberculosis (TB) treatment is called "compliance" because it is a mandatory, supervised program that last a set amount of time. HIV treatment is called "adherency" because it is medication a patient must take the rest of his life.
Monitor: Taken your medicine? | The Economist
Note: Tuberculosis (TB) treatment is called "compliance" because it is a mandatory, supervised program that last a set amount of time. HIV treatment is called "adherency" because it is medication a patient must take the rest of his life.
Thursday, June 18, 2009
San Carlos de Bariloche
Thanks to the kindness of my supervisor, I was able to take a week off from work and travel when Yanique came to visit. We wanted to see the Igauzu waterfalls in the North, but we were told a drought in Brazil made them temporarily less impressive. Plus it's always a good idea to play it safe with Dengue fever, considering all the havoc it wreaked in the Northern provinces just a few months ago.
Bariloche is a ski resort town located in Southwest Argentina, in the area they call Patagonia. While it was not quite ski season (despite the lack of snow, it was suppose to begin in two weeks), we were able to hike the mountains and enjoy the beautiful lake scenery. We traveled in very Argentine fashion, arranging the trip at a travel agent down the block, and going by bus. I think part of the reason we got such a good deal was because most foreigners don't book their trips through small agents in towns like La Plata. And it's no secret foreigners (especially estadounidenses) pay a higher price for everything here in Argentina. As for the bus ride, well, it took 20 hours. Although I really can't compain because they served us decent food, provided movies, blankets, and even alcohol. Also, the seats are comfortable and they recline almost 180 degrees.
As you can see from these pictures, we had a great time. The food was more expensive than La Plata or Buenos Aires, but if any low-budget travellers are reading this: the restaurant Lo de Tony was some of the best pizza I've tasted in Argentina and was surprisingly affordable. Our hotel, Hotel Tivoli, was budget (two stars) and was included in the package but it was comfortable and an upgrade from the hostels I've gotten accostomed to. Our excurcions included Cerro Catedral (the large mountain) and Circuito Chico (the view with the lakes.) Both were very pretty. There were many other excurcions such as hiking, rafting, forests, and visiting islands we did not get to. We got a little slowed down by all the delicious chocolates, ice cream, and alfojors sold all over the town. Well worth it.
Bariloche is a ski resort town located in Southwest Argentina, in the area they call Patagonia. While it was not quite ski season (despite the lack of snow, it was suppose to begin in two weeks), we were able to hike the mountains and enjoy the beautiful lake scenery. We traveled in very Argentine fashion, arranging the trip at a travel agent down the block, and going by bus. I think part of the reason we got such a good deal was because most foreigners don't book their trips through small agents in towns like La Plata. And it's no secret foreigners (especially estadounidenses) pay a higher price for everything here in Argentina. As for the bus ride, well, it took 20 hours. Although I really can't compain because they served us decent food, provided movies, blankets, and even alcohol. Also, the seats are comfortable and they recline almost 180 degrees.
As you can see from these pictures, we had a great time. The food was more expensive than La Plata or Buenos Aires, but if any low-budget travellers are reading this: the restaurant Lo de Tony was some of the best pizza I've tasted in Argentina and was surprisingly affordable. Our hotel, Hotel Tivoli, was budget (two stars) and was included in the package but it was comfortable and an upgrade from the hostels I've gotten accostomed to. Our excurcions included Cerro Catedral (the large mountain) and Circuito Chico (the view with the lakes.) Both were very pretty. There were many other excurcions such as hiking, rafting, forests, and visiting islands we did not get to. We got a little slowed down by all the delicious chocolates, ice cream, and alfojors sold all over the town. Well worth it.
Sunday, May 10, 2009
Paro
I apologize for being slow to update my blog. I really don't have any excuses because one of my biggest challenges with my internship right now is actually having too much time on my hands. Besides the large amount of feriados (national holidays) when the center is closed, there have also been several paros (strikes) interrupting the work week. I would like to inform you, the interested reader, all about the unions, labor laws, and worker contracts in Argentina that have set the stage for these work stoppages among healthcare workers. But from what I understand, it just comes down to money. Health workers in the Municipality of La Plata make very little money. The average worker earns about $1000 pesos per month, which is less than $300 USD. Not only is this low for US standards, it's about half of the average wage for healthcare workers in the city of Buenos Aires. (All of the doctors at the center work at private clinics to supplement these meager wages.) However, it's not like the municipality of La Plata is swimming in cash either. Belt tightening is happening all around and it's not clear where the money would come from. The whole situation makes me wonder how much these strikes are really accomplishing. Regardless, they are happening and things are affected, and as it is oftentimes the case, patients are the ones who lose out the most.
Case in point: last week there was a paro on Thursday and Friday. There was no picket line in front of the center and the building was not closed, but all consultations were cancelled. An administrator came in each day to take calls and reschedule appointments. Some doctors came in to the center to take care of paperwork, some (very few) marched in front of the government buildings, while the majority stayed home and enjoyed a long weekend. I came in to the center both days hoping to interview any patients who arrived (before they would be turned away by the administrator.) One patient came in to receive the lab results of his HIV test from his doctor. But since his doctor was unavailable and it was Friday, he was hoping to simply see the results. This man had tested positive for HIV. Clearly, this is a matter that should be handled delicately. The administrator had to call his doctor and have her come in during the paro to bear the bad news as well as discuss how a positive HIV result will effect the rest of his life. Meanwhile the man waited nervously by himself for over an hour as his doctor made this special trip. It's scenes like this that make me loathe the political and economic side of healthcare. Ideally, all the docotors could be paid comfortable salaries, allowing them to continue performing their important jobs. But until Argentina achieves more stability as nation, I'm afraid paros will continue to be a way of life, disrupting those that have already been through too much.
Case in point: last week there was a paro on Thursday and Friday. There was no picket line in front of the center and the building was not closed, but all consultations were cancelled. An administrator came in each day to take calls and reschedule appointments. Some doctors came in to the center to take care of paperwork, some (very few) marched in front of the government buildings, while the majority stayed home and enjoyed a long weekend. I came in to the center both days hoping to interview any patients who arrived (before they would be turned away by the administrator.) One patient came in to receive the lab results of his HIV test from his doctor. But since his doctor was unavailable and it was Friday, he was hoping to simply see the results. This man had tested positive for HIV. Clearly, this is a matter that should be handled delicately. The administrator had to call his doctor and have her come in during the paro to bear the bad news as well as discuss how a positive HIV result will effect the rest of his life. Meanwhile the man waited nervously by himself for over an hour as his doctor made this special trip. It's scenes like this that make me loathe the political and economic side of healthcare. Ideally, all the docotors could be paid comfortable salaries, allowing them to continue performing their important jobs. But until Argentina achieves more stability as nation, I'm afraid paros will continue to be a way of life, disrupting those that have already been through too much.
Wednesday, April 8, 2009
Health Politics
I've been thinking a lot about the Argentine policy that provides free testing for HIV/AIDS, as well as free medication to anyone with the disease. Specifically, I've been wondering if this is an efficient way to use limited national resources for the betterment of society. Also, should or could this policy be implemented in the US? I don't have a firm answer to these questions, but based on my own limited experiences (and refraining from weighty health statistics), I'd like to share my thoughts.
Free testing for HIV/AIDS is a no-brainer to me. Someone who thinks they may have HIV should have any and all obstacles removed from getting tested so they are fully informed of the risk they pose to others. But I now have a new reason to support free testing. The majority of people who have come into the clinic for an HIV test have been young women of reproductive age. The sad truth is many of these young women were victims of sexual assault and rape. Abortion is not legal in Argentina (a topic I'm not going to touch.) All of this is important because, with proper treatment, a baby born from an HIV positive mother will not get HIV. Women in this situation should be encouraged to get tested as early as possible so that HIV does not pass to the next generation. That's where free testing come in. I believe anyone would agree this is cost-effective way to prevent a deadly disease from taking an innocent life (no matter how you define innocent).
The policy of providing free treatment causes me more internal debate. Argentina is not a fully developed country. While it has tremendous natural resources, decades of political instability have led to higher inflation, lower unemployment, and more poverty than the US and Western European nations. Can it really afford to be giving away expensive anti-retrovirals to HIV patients? More important to me (and to the potential convertibility of this system to the US), does treating the HIV patient really fight the source of the problem or does it merely extend the life of those in poverty. I was leaning towards the latter, until I went to a community prevention meeting last week and realized the logic of Argentina's system.
In Argentina they start off with the realization that the people infected with HIV and AIDS tend to be the poorest citizens. Then they take the moral stance that these people deserve treatment they otherwise cannot afford, so the state offers it for free. By using tax money to pay for AIDS treatment, it means everyone has a stake in the disease. It gives an incentive for all people in a community, both the rich and poor, to work towards prevention. I believe it takes a community effort to fight this disease because only the community has access to many of the root causes: violence at home, teenage drug abuse, dangerous teenage sexual habits, etc.
In the US, people need insurance to afford retrovirals. But the majority of HIV/AIDS patients are poor and the majority of the poor do not have insurance. As Paul Farmer wrote, "[HIV] has spread along the path of least resistance, rapidly becoming a disorder disproportionately striking the poor and vulnerable." I believe when a community fails to invest in treating uninsured HIV victims, there is less incentive for the community to prevent them from passing on the virus. You can think of the US as a big community, or if that's impossible (understandably so), think of the community of New York City. There's certainly no shortage of millionaires in NYC, but there are also over 78,000 people KNOWN to be living with HIV or AIDS in 2008. If citizens had to directly pay to keep these people alive with antiretrovirals, maybe they would care more. Maybe people would use their business contacts to disseminate more AIDS information or pressure schools to provide more rigorous sexual education or even set up free condom vending machines. Who knows? The point is people would do something if they had a stake in the disease.
Am I becoming a socialist now that South America has a hold on me? I doubt it. I just think AIDS is something that concerns us all. And maybe we need stronger action for people to realize this fact.
Free testing for HIV/AIDS is a no-brainer to me. Someone who thinks they may have HIV should have any and all obstacles removed from getting tested so they are fully informed of the risk they pose to others. But I now have a new reason to support free testing. The majority of people who have come into the clinic for an HIV test have been young women of reproductive age. The sad truth is many of these young women were victims of sexual assault and rape. Abortion is not legal in Argentina (a topic I'm not going to touch.) All of this is important because, with proper treatment, a baby born from an HIV positive mother will not get HIV. Women in this situation should be encouraged to get tested as early as possible so that HIV does not pass to the next generation. That's where free testing come in. I believe anyone would agree this is cost-effective way to prevent a deadly disease from taking an innocent life (no matter how you define innocent).
The policy of providing free treatment causes me more internal debate. Argentina is not a fully developed country. While it has tremendous natural resources, decades of political instability have led to higher inflation, lower unemployment, and more poverty than the US and Western European nations. Can it really afford to be giving away expensive anti-retrovirals to HIV patients? More important to me (and to the potential convertibility of this system to the US), does treating the HIV patient really fight the source of the problem or does it merely extend the life of those in poverty. I was leaning towards the latter, until I went to a community prevention meeting last week and realized the logic of Argentina's system.
In Argentina they start off with the realization that the people infected with HIV and AIDS tend to be the poorest citizens. Then they take the moral stance that these people deserve treatment they otherwise cannot afford, so the state offers it for free. By using tax money to pay for AIDS treatment, it means everyone has a stake in the disease. It gives an incentive for all people in a community, both the rich and poor, to work towards prevention. I believe it takes a community effort to fight this disease because only the community has access to many of the root causes: violence at home, teenage drug abuse, dangerous teenage sexual habits, etc.
In the US, people need insurance to afford retrovirals. But the majority of HIV/AIDS patients are poor and the majority of the poor do not have insurance. As Paul Farmer wrote, "[HIV] has spread along the path of least resistance, rapidly becoming a disorder disproportionately striking the poor and vulnerable." I believe when a community fails to invest in treating uninsured HIV victims, there is less incentive for the community to prevent them from passing on the virus. You can think of the US as a big community, or if that's impossible (understandably so), think of the community of New York City. There's certainly no shortage of millionaires in NYC, but there are also over 78,000 people KNOWN to be living with HIV or AIDS in 2008. If citizens had to directly pay to keep these people alive with antiretrovirals, maybe they would care more. Maybe people would use their business contacts to disseminate more AIDS information or pressure schools to provide more rigorous sexual education or even set up free condom vending machines. Who knows? The point is people would do something if they had a stake in the disease.
Am I becoming a socialist now that South America has a hold on me? I doubt it. I just think AIDS is something that concerns us all. And maybe we need stronger action for people to realize this fact.
Tuesday, April 7, 2009
Day Trip to Punto Lara
This past weekend, a few of us FSD interns got together for a day trip to Punta Lara. We heard it had a nice Nature Reserve, which seemed like a good way to spend a beautiful Saturday. It's also easily accesible from La Plata, right on the busline. So vamos.
We went to the Nature Reserve, but it was closed. Sometimes things are closed for no real reason in Argentina. Oh well.
So we walked around, but the beaches were pretty dirty. It's a river downstream of Buenos Aires, so I guess that explains why.
Then we sat and thought for a while.
So we did what Argentines would do: drink Quilmes and eat choripans.
We went to the Nature Reserve, but it was closed. Sometimes things are closed for no real reason in Argentina. Oh well.
So we walked around, but the beaches were pretty dirty. It's a river downstream of Buenos Aires, so I guess that explains why.
Then we sat and thought for a while.
So we did what Argentines would do: drink Quilmes and eat choripans.
Sunday, April 5, 2009
Sharing Strategies for HIV Adherency
I've been working with my host organization for two full weeks. I feel like I'm finally starting to get a feel for the place and develop a routine. The clinic is open from 8AM to 8PM, but most of the doctors work 4 hours shifts. I normally arrive a little after 3:30PM . This gives me a chance to chat with some of of the doctors hanging out in the kitchen before they work the last shift of the day. Everyone is very friendly and they LOVE drinking mate. (As a general rule, the easiest way to make friends in Argentina is to drink mate and talk about Futbol.) There are a variety of talented people that work in El Centro de Referencia. Besides the general doctors, there is also a Psychiatrist, a social worker, and an infectious disease researcher.
My supervisor, Dr. Cueto, usually arrives a little after 4 PM and gets started with his patients right away. I shadow him the entire time, occasionally leaving the room when patients want more privacy. I don't get offended when this happens; in fact I'm amazed that most patients are comfortable discussing very personal issues with me around. Shadowing Dr. Cueto for two weeks has helped me get to know a few of the returning patients who come in for HIV treatment. One of the biggest problems I have observed, and something I am becoming interested in, is the problem of adherency.
The municipality of Buenos Aires has a law that demands all HIV and AIDS medication to be administered free of charge. Unfortunately, this doesn't mean everyone who needs these medications will take them properly, or at all. For most Americans (myself included), it's hard to believe that free, life-sustaining medication would be willfully rejected with such frequency. But here in Argentina, a country accustomed to political and economic crisis, uncertainty is a way of life. In just the time I've been here, inflation has caused a 50 cent increase in the price of a bus ticket. Also, the Government recently decided to move up their October Senatorial election to June (much more on that in a later post.) This instability most affects those in or near poverty (like the majority of HIV patients), and it becomes a mindset they cannot escape from. If nothing is stable in your life, how do you learn dependability? Many do not and often fail to commit to a job, a family, or taking medication that will keep them alive.
The idea for my project is to identify patients who do not fit this trend. There must be several patients that manage, despite hard circumstances, to take their medications every single day. I want to know how these few patients do it, and then I want to help them share this information with others. My first task is to create a list of questions that will identify patients who successful adhere to their treatment. I need to keep in mind that many will not be truthful, so the questions should be detailed but not so detailed they become confusing. Then I will conduct the interviews. I will probably need to study vocabulary related to the questions and bring a a tape-recorder. Finally, I will hold a follow up session for patients who show strong adherency. I will have them discuss strategies for success and organize their responses into a pamphlet that I can publish and distribute. This will allow other patients to learn from their peers instead of doctors. It may even inspire them to work harder once they see that success brings positive attention.
I think this is a fairly manageable project, but as I said before, it is Argentina and I should expect the unexpected. One final point: last Friday confirmed how important the topic of adherency is, not just to the individual, but to public health. There was an AIDS patient who said he was taking his medications regularly, but was not responding to them. The doctors at the clinic ordered a genotyping analysis that was sent all the way to Stanford University. As it turns out, this patient developed a form of AIDS resistant to several drugs. Dr. Cueto is convinced this happened because he stopped taking his medication for a long periods of time. These expensive tests and the risk of unleashing drug resistant forms of the AIDS virus into the population would be unnecessary if this man simply took his medication everyday. But then again, it's never really that simple here.
My supervisor, Dr. Cueto, usually arrives a little after 4 PM and gets started with his patients right away. I shadow him the entire time, occasionally leaving the room when patients want more privacy. I don't get offended when this happens; in fact I'm amazed that most patients are comfortable discussing very personal issues with me around. Shadowing Dr. Cueto for two weeks has helped me get to know a few of the returning patients who come in for HIV treatment. One of the biggest problems I have observed, and something I am becoming interested in, is the problem of adherency.
The municipality of Buenos Aires has a law that demands all HIV and AIDS medication to be administered free of charge. Unfortunately, this doesn't mean everyone who needs these medications will take them properly, or at all. For most Americans (myself included), it's hard to believe that free, life-sustaining medication would be willfully rejected with such frequency. But here in Argentina, a country accustomed to political and economic crisis, uncertainty is a way of life. In just the time I've been here, inflation has caused a 50 cent increase in the price of a bus ticket. Also, the Government recently decided to move up their October Senatorial election to June (much more on that in a later post.) This instability most affects those in or near poverty (like the majority of HIV patients), and it becomes a mindset they cannot escape from. If nothing is stable in your life, how do you learn dependability? Many do not and often fail to commit to a job, a family, or taking medication that will keep them alive.
The idea for my project is to identify patients who do not fit this trend. There must be several patients that manage, despite hard circumstances, to take their medications every single day. I want to know how these few patients do it, and then I want to help them share this information with others. My first task is to create a list of questions that will identify patients who successful adhere to their treatment. I need to keep in mind that many will not be truthful, so the questions should be detailed but not so detailed they become confusing. Then I will conduct the interviews. I will probably need to study vocabulary related to the questions and bring a a tape-recorder. Finally, I will hold a follow up session for patients who show strong adherency. I will have them discuss strategies for success and organize their responses into a pamphlet that I can publish and distribute. This will allow other patients to learn from their peers instead of doctors. It may even inspire them to work harder once they see that success brings positive attention.
I think this is a fairly manageable project, but as I said before, it is Argentina and I should expect the unexpected. One final point: last Friday confirmed how important the topic of adherency is, not just to the individual, but to public health. There was an AIDS patient who said he was taking his medications regularly, but was not responding to them. The doctors at the clinic ordered a genotyping analysis that was sent all the way to Stanford University. As it turns out, this patient developed a form of AIDS resistant to several drugs. Dr. Cueto is convinced this happened because he stopped taking his medication for a long periods of time. These expensive tests and the risk of unleashing drug resistant forms of the AIDS virus into the population would be unnecessary if this man simply took his medication everyday. But then again, it's never really that simple here.
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