A Peso for Your Thoughts: Lessons learned from Argentina

“Permiso Permiso Permiso”

And then we’re off the crowded bus and onto a narrow side street, picking our way single-file across the sidewalk; old cobblestones covered here and there with makeshift planks where they’d fallen into disrepair. Horns honk to tell you that their intention is to pass through the intersection regardless of whatever human-shaped road-bump you dream up for them, people go about their shopping in small street-side markets, a stray dog laps water from the hose of a man cleaning his storefront sidewalk. On some streets the buildings are not tall enough to block out the midday South American sun, and we make a thorough test of our scrub’s sweat-wicking abilities; as we near our hostel, located centrally  on the Avenida de Mayo, the buildings grow taller and offer a welcome reprieve.

We’ve just finished another morning of practice at Hospital Roffo, or – more properly – the Angel H. Roffo Insitute of Oncology, located an hour’s bus-ride away within the sprawling city of Buenos Aires. To our eyes it does not immediately resemble a hospital; the grounds are full of trees and park benches, with outdoor pathways between buildings fashioned from tile, concrete, or even simple trod-upon earth. Windows are thrown open to the elements, and the outward aesthetics of their buildings’ architecture here at Roffo would rival our houses of parliament. The inside tells a different story, without the technological and financial resources afforded to Canadian hospitals, the buildings here are comparatively out of date – even still, vaulted ceilings perhaps double the size of more modern hospitals in Canada contribute further to the open-air quality, and I will say for myself that I felt less stifled and comparatively at ease in this kind of physical environment. These differences are perhaps more influenced by climate than culture, and certainly not transposable to a Canadian winter, but the focus on physical environments bears some thought. Here in Canada, we recognize this important feature in areas such as palliative care, where a certain ‘homieness’ is privileged, but the idea can perhaps been taken further.

Our group photo after the first day at Hospital Roffo.

Above the chalkboard in the hospital’s primary classroom are inscribed the words ‘La vida que no se consagra a la investigacion no merece ser vivida,’ a famous quote from Plato which translates to ‘The unexamined life is not worth living,’ a fitting inscription for any place of learning. In this classroom we learn about the differences between Argentinean and Canadian Healthcare Systems, and the challenges particular to the former. The Roffo Hospital has only eighty beds but receives over 100,000 visits a year – these are not always patients from Buenos Aires or even Argentina, but because of the oncology speciality at Roffo patients from nearby countries, such as Paraguay, are also treated there. We cannot however speak of Buenos Aires and extend the situation to Argentina as a whole – to do so would be like conflating Toronto with all of Canada. In Buenos Aires there is somewhere between three and four doctors for every 100 people, a luxury hard to imagine in Cape Breton, but the availability of services and personnel differs across the 23 provinces and one autonomous city (Buenos Aires is both a province and an autonomous city, but that’s for another time). Argentina has a three-tier healthcare system, consisting of – in broad strokes – public (universal), social security (insured through occupations, dependent on salary), and private (paid plans and services); healthcare is publicly accessible, then, but the full picture is more complicated than that. For example, people with social security often purchase additional private plans at monthly premiums to ensure better and timelier access to services.

Other differences we note as students are not as academic or sociopolitical. When visiting patients on our first day at Roffo there were only a few currently on one particular unit – we walked by several empty rooms on the way to the end of the hall, and were surprised to find two patients rooming together; later we found out that the two men had roomed together previously when they had been receiving another cycle of chemotherapy. With the more individualistic values of North American society, as nurses here we tend to utilize every empty room available before doubling-up on patients – but here the opposite was practiced. Whether this was for the nurse’s convenience, for company, or to reflect to more emphatic and physically close relationship of native Argentineans – whose stock greeting even with acquaintances is a ‘kiss’ of the right cheeks – is difficult to say, but I think perhaps it’s a mix of all these motivations.

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The roar of the crowd is unlike anything the three of us have experienced before. Nearly 50,000 fans are packed into La Bombonera, home of the Boca Juniours Football Club, one of the top football clubs in the world. There are few, if any, opposing fans – to cheer for the opposing side is not particularly advisable if you value your health, and in some cases away fans are simply banned from attending to prevent the violence that would inevitably result. The crowd sang and chanted throughout the entire match – including warm-up, player introductions, and halftime – pausing only a few seconds between each chant.

Myself and Johnny made the snap decision to purchase jerseys on the bus ride to the stadium, and we were glad that we did; despite our near-complete lack of information about the team, league etc. (and despite a gentle warning not to wear colours at all), the blue-and-yellow of the home team earned us an easy acceptance with our neighbours in the stands who were more than happy to tell us exactly who to boo and who to cheer. At some point Chantal, a member of the CBU Women’s Soccer Team, confessed that she “wasn’t a big fan of crowds.” Fortunately this didn’t stop her from having a great time.

We were four rows back from the action and happy to see the home team score a win after they turned it on in the second half. We flooded out of the stadium in a constant stream of bodies, walking a few blocks back to the bus. Despite warnings not to speak English lest we make ourselves easily identifiable to pickpockets, we didn’t have any trouble at all. Our boisterous crew, buoyed by the win, sang songs we knew the sound of – if not the meaning of the words – on the bus ride back to our hostel.

A glimpse into the madness: https://youtu.be/2u4o782DxvI

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We travelled for the first time outside the city limits to the town of Monte Chingolo. A little less than half of our number took Ubers, while the rest of walked toward the port and the bus that would take us to La Sarten por el Mango program, or Food for Thought in English. As always in Buenos Aires, the bus trip left us extremely thankful that the cars in Argentina are generally smaller than their North American counterparts, drivers being resourceful with their use of the road (as in leaving very few inches to waste).

A common wish amongst the students was that we would have come here earlier and more often. The Food for Thought Program combines important lessons about health, nutrition, and sustainability, delivering these lessons to underprivileged youth in the community alongside role modelling and the opportunity for socialization within a safe environment.  In preparing for the students we divided into two groups, one to make homemade pizza from scratch (an occasional treat in the program) and the other to leave their mark on the program’s colourful buggy which – like many parts of the program’s space – was filled with the bright images favoured by children everywhere; flowers, balloons, hearts, and people holding hands.

The children were boisterous and not deterred at all by our lack of Spanish. Some eagerly mounted our shoulders to bring themselves nearer to the basketball rim, the somewhat shyer girls stood off to the side until they were brought into games of jump-rope and hopscotch – the games they played, despite having different names, were remarkably similar to the childhood games we grew up with in Canada. While we knew that it was an underprivileged group, we were nevertheless surprised to find out later that each and every child there was exposed to violence in their home life, and awed at the resilience children show over and above what we as adults might be able to cope with.

We were so wrapped up in our play that only a few of us noticed an incident where one boy struck another several times – the policy, loosely, is that the instigator will have to sit out the next day of the program before being allowed to return. Unfortunately staff did not inform the guardian of the boy who was struck in this case, but what was refreshing to us was that the co-founder and project coordinator, Ben Whitaker, immediately admitted their mistake. In explaining the situation to us in ‘the circle,’ – their iteration of a post-conference or debrief, designed so that everyone can see and be seen by everyone else – Whitaker explained the circumstances of the incident, their failings in not notifying the mother, but did not try to present any qualifications or excuses for the mistake. It was honesty and humility, freely given, because that was the right thing to do. And it was more refreshing than it should have been.

During  our presentation on the Argentinean Healthcare System, one of the doctors said something similarly humble, but without any kind of resignation or defeat: “We know our defects, but as imperfect people, we continue hand-in-hand.”

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We have just finished a walking tour of the city, and while we are fearful of telling our friends and relatives at home and covered in snow that it’s too hot – it’s too hot. In our first week, temperatures frequently rose to above 40 degrees Celsius. We arrive in Puerto Madero, next to the Puente de la Mujer (Bridge of the Women), which is supposed to represent a couple dancing the tango. Perhaps we weren’t yet fully in the grips of heat exhaustion because we didn’t really see it. At any rate, we were able to find some shade to begin a short presentation on Mate, a kind of bitter tea which is ubiquitous in Argentina.

Mate is shared in a group of friends or relatives and, in addition to the properties of the mate itself, has an important social component. The loose mate is prepared in a special cup with a filtered straw (bombilla). The server fills the mate cup with warm water and passes the cup to the recipient, who finishes the cup before returning it to the server for the process to be repeated. Many Argentineans have brand loyalty to a certain kind of mate, or add things like dried orange peels to alter the flavour profile – imagine if Tim Horton’s sold a hundred different styles of coffee beans or tea leaves, and you prepared the beverage yourself, and then you might have some idea.

Walking by our presentation with their own thermos and mate cup, one Argentinean woman, after understanding what was taking place – offered her own preparation to our group. If only we had a double-double to offer her in return.

The casual beauty of Buenos Aires

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Our last day at Roffo Hospital we arrive with many different donations and supplies intended, primarily, for the School of Nursing. Included amongst these supplies are expired dressing kits and other items suitable for the practice setting. While our instructors stay with the donations, our group follow three oncology residents on their rounds, and afterwards receive one final and definitive tour of the hospital’s facilities.

After the tour, we find that our volunteers have put together a farewell lunch for us in one of the patient’s rooms, with enough homemade empanadas to feed a football team. They’ve been the most friendly and, importantly, bilingual people we’ve met all trip; while there’s a certian amount of communication that can be done through smiles and simple phrases, we were thankful we had these capable translators when it came time to visit patients. We were also touched by the photo collage and pins they gave us to commemorate our time there. We take our time eating – we’re waiting for a doctor to examine the materials we’ve brought and accept them before we leave. After this happens, we find out that much of what we had intended to go to the nursing students will be distributed across different units according to need – the staff here lack resources, and are not accustomed to be wasteful.

One of our final group pictures at Roffo is in front of a mural full of butterflies, and indeed we’ve seen butterflies all throughout our trip. I am reminded of one particular butterfly from home, and its unique story, when thinking about all I’ve learned on our trip. The Monarch butterfly migrates to Canada from the mountains of Mexico, where it spends the winter. But the Monarch that leaves Mexico will never make it to Canada – it could take four to five generations before they reach their final destination.

In a culture where instant or near-instant gratification has become so desirable it is important to remember this journey. There are many things in our practice and in our lives which we defer or shrug off as being insurmountable objects, and then deign to take our place as cogs in a bureaucracy which we frequently disagree with. Yet advocating for the right thing, according to our experience and our beliefs, ought to be an end in itself – and if we are to take the mentality into our work, change may not be as far off as we think.

We live according to natural (and legislated) laws more complex and inscrutable than Monarch butterflies, and it may be that we too never reach the final goal that we’re seeking – even with all the more time afforded to us. However, speaking for myself and I think some others who travelled to Argentina this February, we can no longer accept this as an excuse for not pressing forward, hand-in-hand, together.