Argentinean Experience

In January, 2011, my wife and I left for a trip to the Chilean and  Argentinean Patagonia.  I was well prior to the trip and was a part of a study of past smokers to get annual chest CT scans for carcinoma screening.  The CT two weeks before we left showed some right middle lobe and left lingular atelectasis , but no lesions. It also showed a known small hiatal hernia.  I have had a chronic cough for years. 

I had no trouble during most of the trip until after we went to Cape Horn.  We had to climb about 60 steps to get from the ocean to the top of the rock.  Upon reaching the top the wind was blowing about 50-60 miles an hour and the rain and hail were coming horizontal.  I stayed up on the rock for about 30 minutes before giving up and returning to the ship.  

Our next stop was Ushuaia, the southernmost city in the world.  I started to cough more and become slightly weak.  I had some Cipro with me so I took 500 mg twice a day for the one day. We flew to Buenos Aires for one day and my cough became worse.  

We then left for two days at Iguasu Falls.  The first day I started to feel like I had a fever and I skipped the several hour hike around the Argentinean side of the falls.  Antibiotics can be had over the counter so I stopped the Cipro and started Azithromycin.  The following day I felt somewhat better in the morning so I went to the Brazilian side and took an hour or so hike to see the falls.  I really was feeling terrible during the hike but there was no turning back.  I even said to my wife that this was the most beautiful piece of nature that I had ever seen and now I could die in peace.  I knew I needed a hospital but decided to wait until I got to Buenos Aires.

We flew back to Buenos Aires later the same day and when we landed I asked the trip leader to take me to a hospital as I had shaking chills along with the cough and weakness.  Argentina has a dual medical system.  There is the public section which anyone can go to and there is no charge.  The money is paid from taxes.  There is also, at least in Buenos Aires, a private sector as well.  I found out that 10% of all wages are taken out to fund this sector.  The sector is made up of multiple hospitals and each one is its own HMO.  

I was taken that evening to Aleman Hospital or the German Hospital.  I had no idea what to expect but I was too sick to care.  We went to the ED and since I was not a member of the HMO we had to pay a fee prior to seeing the physician.  The doctor spoke English and after listening to my lungs put a pulse oxymeter on my finger which showed the expected increased pulse as well as a oxygen saturation of 89%.  He also ordered blood tests which I do not know the results of and a chest x-ray.  On going to the radiology suite we passed the lithotriptsy area which made me feel much better.  When I got to the Radiology suite, I received an even bigger shock.  All the radiographs were digitalized and there was one person who oversaw all the x-rays and could get the old ones as well as manipulate the current one by a touch screen computer.  I had never seen anything so advanced.  The x-ray showed bilateral pneumonia in the same areas as the prior atelectasis. While I was getting the lab and x-rays my wife was paying for each prior to the exam being done.  The ED doctor wanted to hospitalize me but there were no beds. He gave me a prescription for Amoxicilin which we filled in a private pharmacy across the street from the ED. He said to go back to my hotel and come back at 10 am the next day.  I might add that I was in and out of the ED in under two hours.  I was extremely impressed with the efficiency both that night and for the remainder of my illness.  

The next day my wife and I returned at the appointed time and again had to pay to see the physician.  This physician again examined me and agreed I needed to be admitted.  There still were no beds but she kept me in the ED until one became available.  I had more tests (paid for in advance) including a radial artery stick for blood gasses.  I was told my blood oxygen was in the mid fifties and oxygen was started by nasal canula.  Several hours later a private room became available and as I was being wheeled up in a wheelchair, my wife was giving the hospital a retainer for my hospitalization.  They asked for 13,000 pesos, just over three thousand dollars.  The American Express card was getting a work out.

The room was good size with a regular hospital bed, a chair and a sofa.  Attached to the room was the bathroom.  It had a commode, a bidet, a sink and a moveable shower head.  I was hooked up to oxygen and IV antibiotics were started. My vitals were taken via an axillary thermometer and a blood pressure cuff that looked like the ones I remembered in the 1960s. The IVs immediately infiltrated as the IV intracaths were only one inch in length which barely reached from the skin to the vein.  The veins were hard to find since I was very dehydrated and several sticks were required.  As the hospital is affiliated with the University of Buenos Aires medical school, a young medical resident came to see me.  She spoke English and after doing a minor history and a listen to my lungs she proclaimed that she wanted to start me on insulin and heparin as per a protocol.  Since I am a non insulin diabetic and had been very active I declined both.  She was not happy.  I do not remember much of that day except that I got a call and asked if I wanted meat, fish or chicken for dinner.  Since Argentina is known for its meat I picked it.  When it came it was a filet that I was barely able to cut and that had no taste.  I was never during my stay given anything to drink as they saw I had my own water bottle.  Later that night I began the shaking chills.  A nurse appeared and after taking my axillary temperature hung a second IV.  About an hour later I started to sweat profusely and then fell asleep.

About 6:30 the next morning I was awoken by a nursing aide who got me out of bed and into the bathroom.  She spoke no English but my limited Spanish allowed me to understand that I was to sit on the commode, take off my gown and take a shower.  Since I was too weak to do this, she washed and dried me.  The towel was slightly larger than a washcloth and of course the toilet paper was then soaked.  Prior to giving me my shower she put sheets down between the bathroom and the hospital room so the hospital room would not become soaked.  After the shower and brushing my teeth, I felt better and went to the chair.  Blood was drawn including another radial artery stick.  Soon after my breakfast arrived.  It was the same for my entire stay, two pieces of dry toast, one marmalade and a pot of tea.

About ten a.m. a group of physicians came into the room led by a very jolly physician who explained that he was to be my doctor during my stay.  He listened to my lungs and had some of the residents do the same.  He said my progress was good and they left.  Later I found out he was in charge of all the foreign patients, spoke multiple languages, had a private practice and also took care of all the personnel and the families of 15 embassies in Buenos Aires. He told me that I could regulate my own diabetic meds.  I never received any insulin. The remainder of the day was one of attempting to restart IVs and then late in the afternoon a PT person came in to evaluate me.  I had already been out in the hall walking with my IVs so I got a good grade and never had to fight with my resident again about heparin.  Also the nutritionist came to see me and asked what I wanted for dinner.  I decided to become a vegetarian.  From that time on I got vegetarian or pasta dishes that had no taste. 

I was really tired that night and was feeling pretty good so I got rid of my oxygen and decided to sleep later.  When they came in early to get me to the shower I just stayed in bed and slept.  Finally I got up and could do my own shower followed by my usual breakfast.  I was then taken to the gymnasium where a PT had me walking stairs, walking toe heal on a treadmill and using a bike.  Later the Respiratory Therapist came in and did her thing making me cough up the mucus.  Finally the head physician came in and after an exam told me I could leave depending on an x-ray and the prior done lab tests, including another radial artery stick. The resident came in later and said that I could leave.  I already had my meds from before I went into the hospital.  I was told that my oxygen was still too low to allow me to fly home and to make an appointment for another x-ray and more lab work in five days and to see the head physician the following day. On leaving the hospital my wife again had to go to the payment place but this time we were told we were going to be getting almost half of what we paid returned to us.  This meant my three day, two night hospitalization cost about two thousand dollars.  Try doing that in the United States.

After going back to the hotel each day I could do more walking and got stronger.  We had been in contact with the travel insurance company that we purchased insurance with prior to the trip.  They said that if I need oxygen to fly it was their policy to send a medical person to accompany me.  This meant an additional three days in the hotel.  We decided to cut the insurance company out of the return trip home and made our reservation for the same day as we saw the physician. 

When it was time we went back to the hospital and did the usual payment prior to the x-ray and the lab work.  The next day the physician said I could fly home which we did that evening. 

The moral of this story is to take out insurance prior to going on a foreign trip.  Medicare does not cover anyone out of the country.  Some Medigap policies do have some coverage for medical care only.  They do not pay for trip interruption or needed hotel stays.  The other moral is that other countries have some fine medical care with good physicians and excellent medical facilities.  I was fortunate to have found both.