SOCIAL, POLITICAL, ECONOMIC

INFLUENCE ON SURGERY

Córdoba, Argentina
Sanatorio Allende
Orthopedic Traumatology Service
Nick Faunce
 Argentine Population Density

Argentina Population.. World Population Review Retrieved March 28th, 2017, from http://worldpopulationreview.com/countries/argentina-population/
 Background - Argentina
• Population: 44.16 million
• Heritage: 25 million Italian
• Ethnicity:
• 97% white (Spanish and Italian)
• 3% Mestizo, Amerindian, and other non-whites

• Government
• Presidential Republic
• History of Military Juntas

• Economic
• GDP: 879 Billion; per capita $20,200 USD
• Industry Distribution:
• Agriculture 11.4% (sunflower seeds, lemons, soybeans, corn, tobacco, peanuts, tea, wheat, livestock)
• Industry 30.2% (food processing, autos, consumer durables, textiles, petrochemical, printing, metals/steel)
• Services 50.4%
• Inflation: 42.8% (2016)

• Health
• 3.86 physicians /1000 pop.
• $1,137 per capita healthcare spending
“Cordoba Capitol”
• Population: 1.42 M
• 2nd Largest Economy to Buenos Aires
• Universidad Nacional de Córdoba
• Public – free
• Founded by Jesuits in 1613
• 111k students
• Universidad Católica de Córdoba
• Private
• 10k students
• Sierras de Córdoba
 Sites

• Sanatorio Allende – Nueva Córdoba (Primary) & Cerro (Satellite)

• Private
• Founded in 1938 by Traumatologist Dr. Guillermo Allende
• Grandsons head residency programs

• Hospital Misericordia
• Public
• In-house Residents
• Private physicians (often) rotate
• Hospital Municipal de Urgencias
• Public
• Private residents (often) rotate
• In-house physicians
 Why Social, Political, Economic
Influence on Surgery?

• Because Argentinian History is impacting its future

• Social
• Education/Training
• Access: Insured vs non
• Patient – Physician relationship
• Political
• Trust
• Prevention
• Infrastructure
• Regulations
• Economic
• Historic Remnants
• Import tariffs
• Education costs
• Anesthesia
• Destination Plastics
 Social
• EDUCATION • Insured:
• FREE Nationalized Medical School – • On demand
• No debt • Similar to 1st world
• Large class sizes standards
• Variable training by location • Uninsured
• 50% Residency Match rate • Public Health System
• English taught in Primary school – limited use outside • Long delays
Buenos Aires • Pseudo 3rd world standards –
• Specialists Volunteer
• TRAINING • Materials/Resources available – Not ideal fit or form
• Resident Private – Strong on theory/weak on skillset
• Resident Public – Weak on theory/skilled in practice • PT-PHX RELATIONSHIP
• Less demanding of particular procedures
• “Fellowship”-
• Expected abroad for premium positions • DISTRUST for certain procedures – Amputations
• Licensing often prevents active patient care • Some Phx fear in room hand washing
• Research/observe at premier institutions for 6 months – • Low long-term opiate use
2 years

• ACCESS
 Political
• (dis)TRUST • Road maintenance
• History of military juntas
• Guerra Sucia (1976-1984)
• Regulations
• 30,000 dissidents disappeared
• Hospital safety standards less regulated
• Implicit corruption/bribes for
• OR rollers
permitting/building • Raising rails on beds post-op & fall risks
• Sharps protections
• PREVENTION • Anesthesiologist outside OR
• Policing of erratic driving low • High insurance costs
• Occupational safety enforcement limited • High Impact MVC’s
• Construction Standards Low • Autos modified d/t import tariffs on
side/frontal airbags
• INFRASTRUCTURE • 3 people on motorcycles
• Poor identification of efficiency boosters in • Helmets not required
public hospital ie. computers, emr, rooming
nurses

Carlos Alonso, collection of “Manos Anónimas” presented in Museo de Palacio Ferreyra Córdoba, Argentina
 Economic
• HISTORIC REMNANTS • Education costs
• Default in 2001 recession • FREE
• Limited international investment outside of Buenos • Reduced resident/physician salaries
Aires • Resident $750/mt adjusted every 6 months for
• Limited imports of goods on credit inflation
• Isolationist economic policies • Limits ability for foreign travel, conferences, and
interaction
• IMPORT TARIFFS
• Inferior Argentine brand covered by insurance
• Out-of-pocket payments for foreign medical • Anesthesia
hardware • Spinal/Regional blocks first
• INSURANCE • Decreased post-op complication
• Private insurers dictate care • Destination Medicine
• Open appendectomy • Strong market for cheap plastic surgery
• Hardware for hip/knee arthroplasty, rods, plating,
screws
 Summary
• Socially
• Language isolation is greatest hindrance to information access
• Stronger English skills would give them greater access to ideas
• Space for International Physicians to host seminars:
• Technical training
• Advanced procedural techniques
• Introduction of modern technologies and accompanying techniques with emphasis on cost-saving

• Politically
• Must adopt safer work place and transportation safety policies
• Public hospitals could benefit minor investment in efficiency tools
• Computers
• EMRs
• Patient check-in tools

• Economic
• Restore investor trust for updates in hospitals and public services
• Open markets for international medical supplies with better long-term results
• fewer revisions, failures, and complications
 Profound
Cultural | Clinical
Where:
Torres del Paine, Chile Sanatorio Allende Cerro,
Who: Left-to-Right Sara (British Civil Engineer), Me, Roberto
(Chilean Mining Engineer), Zohar (Israeli Veterinarian), Javier
(Chilean Psychiatric Police Captain), Hérnan (Chilean Public
Valuations)
What: Spontaneously coming together as the “Equipo de seis”
for 5 days and >50 miles on the O-Circuit of Torres del Paine.
During that time we learned about each other - our homes,
families, dreams, desires, what brought us to Torres, and where
we want to go next.
Why: Extraordinary cultural exchange with a shared sense of
accomplishment.
Where:
Córdoba, Argentina
Who: Intubated polytrauma patient who worked in construction
and fell from the 14th story at his jobsite.
What: First procedure was a complicated multi-fracture femur
with intramedullary rod placement. As the case terminated his
arm cast slid off and he had bilaterally deformities that flopped in
my hands – nobody seemed to care. 2 weeks later, still intubated
we did a combined case where our team fixed his left radius and
plastics fixed his right zygomaticus. Then we rescrubbed and
fixed his right olecranon.
Why: He reminded me of a patient I rounded on for a month last
Summer. I play scenarios in my head of what their lives were like
before and will be after.
PATAGONIA Parque Nacional del Glaciers, ARG

Perito Moreno Glacier, ARG

Torres del Paine, Chile

 References
1. Argentina Population. 11.20.2016. Retrieved March 30th, 2017, from http://worldpopulationreview.com/countries/argentina
-population/
2. Country Profile – Argentina. Accessed 3/28/17. WHO. http://www.who.int/countries/arg/en/
3. Beveraggi EM. Surgery in Argentina. Arch Surg. 1999;134(4):438-444. doi:10.1001/archsurg.134.4.438
4. Camogli, Pablo; Luciano de Privitellio (2005). Batallas por la Libertad. Buenos Aires: Aguilar. ISBN 987-04-0105-8.
5. Giethner T. (2003). Lessons from the Crisis in Argentina (Doctoral Thesis). Retreived from IMF 3/29/17. https://www.imf.org
/external/np/pdr/lessons/100803.pdf
6. CIA Factbook. Accessed 3/30/17. CIA. https://www.cia.gov/library/publications/the-world-factbook/geos/ar.html