SCOPE Exchange Argentina, San Miguel de Tucumán, general surgery Anne Hermans, 1 September - 1 October 2015 In April 2015 I first heard about SCOPE Exchange. Immediately I was enthusiastic, because after completing my bachelors degree in August, I wanted to go abroad and learn about the health care in a different culture. The reason I chose Argentina was because I wanted to improve my Spanish and because I am very interested in the culture and healthcare of South America. From the first of September to the first of October 2015 I did a clerkship in San Miguel de Tucumán, hospital Angel C. Padilla. On my first day a student from IFMSA Argentina, Carlos, took me to the hospital and helped me arrange all the things I needed to do in order to start the clerkship. He showed me the department of surgery and introduced me to the doctors. I appreciated his help, because I have to admit that I was quite nervous that day. When Carlos left, Agusto showed me around. He is a resident in his third year of the education to become a plastic surgeon, just like his father. Agusto was a really nice guy and he patiently explained all the things about the department of General Surgery. There were 2 wards of 24 beds. The patients were all together on the ward, so there was little privacy. There was one ward for men and one for women. The first thing that stroke me was that it is normal in Argentina for the family of the patients to be always there for them. Therefore it was a bit chaotic and busy all the time. Also I think it was not very hygienic for the patients to be all at the same ward. I think in this way it is easy to contaminate each other with all sorts of infections. Agusto also introduced me to the rest of the surgeons in the department. All of them were men exept for one woman. This was the next difference between surgery in Argentina and surgery in the Netherlands. In Argentina I think there is more of a 'macho culture' than in The Netherlands. Fortunately, everone was really nice to me and they were very patient in explaining things when I did not understand them. Nobody talked English fluently, so I really had to practice my Spanish. In the first
week this was hard for me, but after a while I got better in understanding them and now I think I can say that my Spanish has improved a lot! I considered this to be one of my main goals so I am pleased with the progress I made. Another difference I noticed between surgery in Argentina and surgery in The Netherlands is that there is a lot more hierachy between patients and doctors in Argentina. The Argentinian doctor clearly is on a 'higher level' than the patient and the opinion of the patient in his or her treatment is not really important. My experience in The Netherlands is that the diagnosis and treatment of patients is discussed more and their opinion matters. Maybe the cause of this difference is that the level of education is generally higher in The Netherlands than it is in Argentina. Furthermore, the healthcare in Argentina has a different structure than in The Netherlands. On one hand there are private clinics, which offer a high level of healthcare, but which are expensive. On the other hand there are public clinics (like hospital Angel C. Padilla), which offer free healthcare, but with the consequence that the healthcare is not as good. Doctors explained this difference to me a lot of times, because they are not happy with the quality of healthcare they are able to offer in the public clinics. The surgeons told me they worked in both clinics, sometimes even on the same day. I think they all have the knowledge and skills to perform on a high level of healthcare. For example, they know how to perform laparoscopic surgery. The problem in the public clinic was that there was not enough equipment for all patients to get laparoscopic surgery. This sometimes was frustrating for the doctors and on the same time made them creative in some solutions they had for surgical problems. One time I saw an open cholecystectomia with a calculus that was stuck at the papilla duodeni. In The Netherlands in this case there would be performed an ERCP to remove the calculus. This was not possible in the Argentinian situation, so the surgeon thought of another way to remove it. He opened the ductus choledocus so he was able to remove the calculus. For me, this was really interesting to see. During my 4 weeks of clerkship, the surgeons made me feel comfortable in their group. They welcomed me everyday and they were happy to show me all things they did in the hospital. They became like friends to me. My
days at the clinic started at 7 AM and most of the time I finished after lunch, so at approximately 2 PM. On my first day my supervisor told me I did not have to be there every morning at 7 AM, so sometimes I took a little extra time to sleep and went to the hospital a little bit later. The day started with a round in both wards to discuss the patients. After that I often went with one of the residents to help him look after the patients on the Intensive Care and the Medium Care. There I saw quite a few extreme cases of patients who were shot, stabbed or who had severe infections. Most days I also went to surgery. Unfortunately I was not able to assist during surgery, but this is something I understand, because of the language barrier. I saw a lot of cholecystectomias, but also other interesting things like the placement of a porth- a- cad. Although I did not learn practical skills, seeing these operations improved my knowledge about anatomia a lot. Host familiy During my clerkship, I stayed with a hostfamily in Tucumán, which was very nice. They were warm and welcoming and made me feel at home. I could recommend staying in a host family to everybody who is thinking of doing a SCOPE exchange in Argentina via IFMSA. I tried lots of delicious typical food from Argentina and also it was a good way to practice my Spanish. Social program In September all the medical students from IFMSA in Argentina had a busy month full of exams. This made it hard for them to organise a social program, but I think despite their full schedules, they did an excellent job organising some nice activities! I did not have contact with the whole group, but especially with David and Agustina I talked a lot. In my first weekend I went paragliding (which was amazing) and on Sunday I did a hike with David and his group of friends. We visited 2 waterfalls and hiked through the mountains, which was really nice. After my clerkship of 4 weeks I traveled a little bit through the Northern part of Argentina. A lot of doctors in the hospital gave me tips which places to visit. At first I went to Jujuy with Agustina (a girl from IFMSA in
Tucumán, who lived in Jujuy), then I went to Salta, Iguazú, Buenos Aires, Mendoza and Córdoba, together with a girl from Italy and a boy from Corrientes. The trip has been amazing and I went home with a lot of good memories, both from traveling and from the hospital! I can recommend this clerkship in Tucumán to every medical student who wants an unforgetable experience in a hospital in Latin America while improving medical skills and Spanish language skills. I also think it is important for the student to already talk a little bit of Spanish, because as I pointed out earlier, the doctors in the hospital do not speak English well. Finally I want to thank IFMSA both from The Netherlands and from Argentina for helping me organise this clerkship. I liked the way IFMSA communicated to me and I felt like they were always there for me if I needed anything. This is one of the reasons why this experience in Argentina has been amazing and has made me grow as a person and as a medical professional- to- be. I think that because of this internship I have become more flexible and more able to relativize, ready to respond to unexpected situations. At this moment I do not know yet what kind of doctor I want to become, but I would like to do a specialization which includes surgery as well.