The flu

I haven't written about the influenza A(H1N1) epidemic in Argentina. Everyone else has, though, so I'll leave it at that. For me, it had its good and bad sides. The good side was that children and teenagers cleared the streets, buses, and other public venues for us grownups, leaving us room to enjoy our city without being bumped into,  or bombarded with trashy music out of MP3 players. Oh, some people died. Not many, certainly an insignificant number compared to the people who die of other preventable diseases or in traffic accidents caused by drivers' carelessness. Several acquaintances of mine fell with the flu, but it was nothing serious.

The bad side was the hysteria and the paranoia. I'm sure you've seen your share of this. What happens here is that as soon as, let's say, an outbreak of a disease is announced, society divides itself into two main groups: those who panic, go to ridiculous extremes to protect themselves, and generally bother the rest of us, and those who just dismiss it all as an invention of the government, the media, or both to make us forget of the really important matters, and place the rest of us at risk because of their carelessness. You may have noticed there's a third group, what I've called "the rest of us" — make of that what you want.

As the first wave of the flu subsided, many people have started to forget the cautionary measures against contagion. This may or may not be OK. Others continue to be hysterical, in both the usual and the figurative meaning: they remain fearful and paranoid, and they're very funny — tending towards the "pathetic" kind of funny. At work, I've had perfectly healthy people, who usually offered me their cheek to kiss every morning, refuse to come even close to me. During the initial phase of the epidemic, one of my co-workers first became very agitated, then tried to force her daughter's school to shut down, and then basically locked her up at home (this was a few days before the Ministry of Education finally decided to shut down the schools). There's still alcohol gel everywhere, and by the looks of it, some people think it's an all-powerful, virus-proof barrier against the flu.

The cold, and with it the flu, will be gone in less than two months. I can't wait to tell you about the upcoming dengue epidemic...

Vacations: Malargüe revisited: Last day

On our last day in Malargüe we repeated last year's trek to the dam on the nearby Malargüe River, 8 km from the hostel, only we set off in the morning, as early as we could manage to get up, after a delicious breakfast of home-made bread and jam. We took a more direct route, so we arrived earlier, but then we spent a lot of time leisurely lying on the grass and sipping mate.

On our way back to the hostel (in fact, right before the entrance gate), we found an overflowing irrigation ditch and had to walk on the little wall that formed the edge of the bridge crossing the ditch. By lack of attention or sheer bad luck, I stepped on the wrong spot and found my right leg sinking into the cold water of the ditch along with half of my body. The other leg must have slipped somehow, though not before my left knee hit the concrete edge. I cried out for help, and my two friends promptly lifted me up. Though I was soaked from the waist down, the water was clear and my backpack got only slightly wet in the bottom. My wallet was miraculously spared, as was the bag with my camera in it. But my knee hurt so much I couldn't stand or walk.

After the initial pain subsided, I managed to stand on my feet, supported on both sides by my pals, and step by step get into the hostel. Once in my room, I changed my clothes and surveyed the damage. I got a few bleeding scrapes and bruises, nothing serious. But the knee was hurting badly, and I was devastated — I thought I'd broken something and this was the end of my vacations.

In the end, I took a Diclofenac pill from one my friends, and plopped into bed for a nap. I felt much relieved (and less desperate) when I woke up.

In the late afternoon we took a cab to the city in order to visit the seat of the Pierre Auger Observatory, which is the largest cosmic ray observatory in the world (about 1,500 high-energy particle detectors spread over 3,000 km² in the southern Mendoza desert). We heard a lecture explaining their work and their latest findings.

(We tried to get into that lecture when we went to Malargüe in 2007, but the facilities had been overwhelmed by a troop of about 20 nuns.) After the observatory, we walked around town looking for places to restock our cooking supplies. We got noodles, rice, oil, some non-perishable vegetables, and a few other things we needed. My knee bothered me all this time, but I could follow, if only at a slow pace.

We had bus tickets for San Rafael, and from there to Neuquén, booked in advance. The next day we left Malargüe.

Healthcare this way

My right leg has been behaving strangely as of late, which I blame on my new jogging habit, though I knew there was something wrong with it before. My knee feels a bit hurt all the time, and a kind of weakness propagates upward from there. I let it pass for a while since it looked like a simple adjustment from sedentarism to a regime of consistent exercise, although weirdly it didn't bother me at all while jogging. But now it's bothering me even as I stand or walk. I can give up jogging, but I go everywhere on foot.

Given that, I need to go to a doctor, and I thought it'd be interesting to speak of medicine in Argentina. I've read a lot of reports of foreign visitors and expats marvelling about the quality and price of health care here, and especially the existence of universal socialized medicine. The latter is not something you usually hear much about, since people with $$$ don't really need to go there. The most expensive quality medical treatment you can find in Argentina is still a bargain compared to the costs of medicine in the United States or Europe.

If you have a good salary, you can pay for a private health insurance plan. They're not cheap, and they've become extremely restricted — you can get away with emergency service and basic treatment, but not surgery or other complicated procedures, for which you have to pay additional money. Alternatively, if you're working en blanco (formally registered), you may have a health plan associated with your union. It won't get you everything you need for free, but you can get away with simple medical matters for a few pesos.

However, if you don't have money or a job, or you don't have a unionized healthcare plan, or your plan is insufficient, you'll have to brace yourself and go look for attention in the public health system. There's a provincial system, with hospitals in large towns and cities, smaller health centers in small towns, and little primary care centers everywhere, covering the entire area of Santa Fe. Overlaid with it there are local (municipal) health centers, which are usually coordinated with the provincial system. Rosario, being much larger than any other city, is a special case, and even more so because of the constant competition and bickering between the provincial and the municipal governments. The municipality manages several major hospitals on its own, including one for emergencies and one for children, and a multitude of primary centers.

The provincial health system is divided for administration into several Health Zones, each divided in turn into Programmatic Areas, each one having one base hospital and several primary care centers. The main difference regarding patient attention is that the provincial centers accept people from anywhere in Santa Fe (and even outside), while Rosario's municipal centers tend to send non-rosarinos elsewhere. I worked in one of the three largest provincial hospitals in Argentina and I can tell you that the quality of medical attention can range from very good to atrocious, depending on luck and on the good will of the doctors and employees; I don't know about the municipal hospitals. There's an unspoken assumption (acknowledged by the provincial officials) that Rosario's public health is better managed, though I couldn't tell for sure; conversely, the handling of internal jurisdictions, finance and large amounts of patients in the provincial system's hospitals is completely chaotic, in part because the hospitals were left to their own devices during the Reutemann administration.

Picture this: a large organization, self-ruled, with huge expenses, led by an unelected political official appointed by a faraway authority and with lesser authorities partly elected by votes of its employees (usually bought or pressured by a politically-connected union, if not entirely forged), which receives money from its higher authority but must not answer for it, and needs to gather extra money to work but cannot formally ask the patients for that money since in theory the public health system is free and the government is proud of that. This mess could be maybe corrected by re-centralization and enforced by tight controls, but that would make the central Health Ministry accountable for each little fault. With formally autonomous, self-managed hospitals, that responsibility is diluted.

Anyway, tens of thousands of people seek public health care in Rosario every day, and they get it, maybe after long waits or in less-than-optimal conditions, but usually from decently good professionals. If you want to become a doctor, you need to do your residence in a public hospital, and everybody knows that those young, eager residents are the ones that really do the grunt work in hospitals. Moreover, it's still a source of status for a doctor to serve in a public hospital, if only for short periods, even while he or she has a private practice; and hospitals are also schools, so residents always receive advice from qualified specialists. It's possible to give birth to a child, to have a serious fracture mended, or to get years of treatment for cancer in a public hospital for nothing, or at the very least for a fraction of the cost of private medicine, in any major public hospital in Santa Fe.

This is sadly not true of all of Argentina. Many patients in the interior of the country don't have a half-decent coverage, and need to travel long distances to their provincial capitals or even to other provinces. Some end up here in Rosario, others go to Buenos Aires. (I remember once a patient from Paraguay got a mammography in my hospital. She travelled once a year to Argentina to visit her extended family, and it was cheaper for her to pay a few pesos and get a decent study while she was staying here.) Some complex and expensive treatments, such as the ones surrounding pediatric bone marrow transplants, are only available in Buenos Aires. All in all, this makes it more attractive to live in a big city... and it's one of the reasons why poor small-town and countryside residents migrate here. The only way to fix that is simply to take good health care closer to them.

In the meantime, I'm going to take care of myself... My leg's going to see a doctor in the neighbourhood's community center, four blocks away — the 'hood is poor but the community center has at least a few specialists and, importantly, an X-ray machine!

Mosquito Coast

It's coming, finally, as we'd feared. Tropical weather, and now a tropical disease! An epidemic outbreak of dengue fever has infected 16,000+ people in Paraguay (that's more than 1,000 km closer to the Equator than here) and killed hundreds. The first cases started appearing in the northeastern provinces of Argentina and soon Paraguayans coming to Argentina and Argentinians returning from a visit to Paraguay brought it to the central areas. There are more than 126 confirmed cases in the country, half of those in Buenos Aires City and around. In Rosario we have (I think, today) seven suspected cases and one confirmed.

Dengue is a disease similar to a strong flu, which causes headaches, muscular and joint aches, nausea, and fever. It's transmitted by Aedes aegypti, a species of mosquito. A. aegypti is not commonly found on this latitude, but I believe at least three of the cases in Buenos Aires are autoctonous, i.e. were contracted by human-mosquito-human transmission there, and not brought from Paraguay. The confirmed case in Rosario was infected during vacations in Buzios, Brazil (there are thousands of cases in southern Brazil as well).

Dengue has no specific treatment: people simply have to rest and keep drinking fluids, while the fever and the pain are treated with paracetamol-related drugs (paracetamol is known as acetaminophen in the U.S.), since the disease can have a haemorrhagic variant and you can't use the usual non-steroidal anti-inflammatory drugs (paracetamol is also much cheaper — but it can kill your liver). Patients must be isolated in order to prevent transmission, i.e. so that mosquitoes don't bite them and carry the disease elsewhere.

I haven't seen Aedes aegypti here, though I haven't been looking; they say it's noticeably different from the common local mosquitoes. There are a lot of those anyway. You have to consider that the Paraná River has a huge floodplain, full of shallow canals, marshes and other places with lots of vegetation and stagnant water, a perfect breeding ground. We've always had a lot of mosquitoes in the summer, but lately they're appearing in October and lasting until April or even May, and they're big and nasty.

Topping it off, the level of the Paraná is increasing, overflowing its banks. Rosario is not going to get flooded, but its beaches are already mostly gone. The river is forcing people in its islands to abandon them, and carrying aquatic plants that are left to rot in the shores. In Santa Fe City, 200 km north, 230 people have been evacuated, and some are worrying the population (unjustifiedly, according to the government) that there might be a flood like in 2003 (that one was not caused by the Paraná, but by the Salado River, which comes from the northwest of the country).

The mosquitoes are not going away. Pharmacies and supermarkets have noted that mosquito repellents have flown from the isles and the manufacturers are seemingly unable to cope with the demand. You can apply some cream or use an airborne repellent in your room at home, you can close off all openings with physical barriers, but you can't do anything while you're outside. Jogging along the coast the other day, my buddy and I observed that the moment we stopped to stretch, we were attacked by swarms of little bloodthirsty monsters. There are mosquitoes inside my office, and in the bus, and in the street while you're having a cup of coffee in a café.


The municipality has been spreading insecticide around, but it's not enough. Somebody in the radio today proposed we should breed dragonflies to eat the mosquitoes. Dragonflies, which are traditionally considered a sign that a rainstorm is about to come (at least that's what my parents passed down from my grandads), are repulsive when you see them up close, but they don't bite. I saw one flying inside the bus this morning as I went to work. I don't know if they actually feed on mosquitoes, but I know the weather tradition is grounded in reality, as it's been raining on and off for four of five days in a row.

So we have constant rain, mosquitoes and a tropical disease. What's next? Women wearing as little clothing as possible, pineapple drinks in the beach, a world-class carnival? You wish.