My leg goes to the doctor

This is an update on my leg, and a response to some questions posted by a reader about the medical system in Argentina.


First things first: the cause of the problem seems to be not my leg, but my spine. A couple of X-rays of my lower back shows that one tip of my last lumbar vertebra (L5) is too close to the top of the sacrum (S1), "pinching" the L5–S1 space (I don't know what this is called in English; it's a pinzamiento in Spanish). The numbness in my right leg and my other symptoms seem to correspond to a sciatica, possibly caused by compression of the nerve that comes down from the spine and goes into the leg. In order to confirm that, the doctor told me to get an electromyography. That'll be next Tuesday.

Besides this, and quite possibly because of it, I've developed a slight functional scoliosis, which means my spine is curved a bit laterally, with a convexity to the right. That may be the cause of a small but persistent pain I'd been feeling in the right side of my middle back. In addition, the vertebrae of my lower back are aligned horizontally, while above them, the upper lumbar and dorsal vertebrae are going up in a straight line. That is, when you see my spine from one side, instead of the proper elongated, smoothly curved S-shape, what you see in the bottom half is a horizontally-flipped "Z". Neither of these abnormalities are permanent. The scoliosis will be corrected once the leg is fine again; the other problem is most likely the fruit of a sedentary life and can be fixed by strengthening my lower back and abdominal muscles.

Regarding local medicine, here are the questions:

1. "How was your visit to your local medical center?" — I actually went three times: first to see the doctor (it's a first come, first served system), next day to have the X-rays, and next day to see the doctor again. The doctor should've arrived at 5 PM but both times he came at around 5:20... The first time I was the second patient; the other time I was #5 and had to wait for more than an hour. My mistake for not being there before. The X-ray was very quick. The X-ray machine was made in Britain and must have been 25 years old, but it worked fine. The radiographer kept the films, and the radiologist had the report ready the next day when I fetched them before seeing the traumatologist. Apart from the waiting, everything went OK. The waiting room and the doctor's room were a bit cramped, but clean and comfortable. The doctor was nice and the clinical exam was thorough enough.
2. The question you didn't ask: how much? Well, I had to pay a fee (AR$8) each time I saw the doctor, and I had to pay AR$26 for the X-rays. In a public hospital or another common healthcare center I'd probably get both things cheaper. This is at the neighbourhood's medical center, so it's like an association or club and you have to pay to stay in — only AR$13/month, per family. Not all neighbourhoods have such association, and most don't have such facilities, but mine is an old-time poor-but-hard-working-class barrio of 80,000 residents, give or take.
3. "When you go to a public facility, are the doctors you see all internists? What happens if you need to see a specialist?" — It depends. At the most basic, a public primary healthcare center has an internist and maybe an emergency doctor all the time. The specialists don't work full time in a single place; they come at certain times and certain days of the week, see the patients and leave (for example, the doctor I'm seeing comes Monday, Wednesday and Friday at 5 PM, and leaves at 7 PM). In a public hospital you typically have an office where you can schedule an appointment with the specialist, as in private facilities.
   
4. "How readily available are diagnostic tools such as MRIs and ultrasounds in public healthcare?" — Ultrasound is widely available, even in primary care centers, since public health serves predominantly poor patients, and those include many pregnant women. CT and MRI are available as well, in hospitals, at least in the developed areas (such as Rosario). I'm not sure about the municipal hospitals here, but of the 3 large provincial ones in the metro area, two have CT, one of those has MRI, and the third has a gamma camera. The cost varies according to the economic possibilities of the patient — the full price is significantly less than the one you must pay in a private hospital, and if you can't pay it, you can state your problem and the hospital's auditing office will decide what to do.
5. "If you need extensive treatment in a public facility, does the government (city, provincal etc.) pay for everything? How would you imagine that the cost may influence how good the treatment is in such a situation." — In certain cases (patients that clearly cannot pay) the government will pay for everything, though it might take long, humiliating days or weeks for the patient to go past the bureaucratic barriers. Based on my inside experience, however, the quality of the treatment doesn't suffer. The bureaucracy separates the physicians from the monetary issues. The medical staff may come and do their job without even knowing whether the patient has paid for the treatment. At least in Santa Fe, you can get dialysis, cancer drugs and chemo, HIV drugs, insuline and diabetes medication for free and forever, though there are occasional delays in the provision of drugs.
   
6. "If you have an medical emergency, can you go to the ER of any hospital and get treatment?" — Yes. This is common even for patients with private health insurance or with union-based healthcare systems. In theory, when you go to a public hospital the administrative staff takes care of checking whether you have insurance, so as to send them the bill later. In practice, many small emergencies are taken care of and the patient goes without anybody paying for anything.
   

I hope this answers your questions!