When Health Politics Fail, by Lillian Perez

PerezL 4.JPGOn the first day of my internship with CEPAC, my supervisor, Dr. Saúl Yustón Demarchi, took me to a barrio called Tolosa, which is located about half an hour from the center of La Plata, to show me how the organization addresses health needs in marginalized communities and to explain a concept I have been curiously exploring since that day, health politics. Dr. Yustón began by stating that ‘in order to have optimal health, you need good politics; that is, good economic politics for good health politics.’ Now it would seem like common sense to see that governmental investments are necessary to provide “beneficiencia” – the same opportunity to health for all – but lack of funds and political corruption here in Argentina has consistently shown that achieving “beneficiencia” is far from real. In the consultorio (small neighborhood health clinic) of Abasto, where I work, I have witnessed how past political exploitation has led community members to become skeptical of outside interventions, even NGOs. Last year, CEPAC conducted a health needs assessment study in Abasto to present to the government program ARCOS, which then provided the funds to establish the consultorio and pay a few doctors to serve there. Unfortunately, in the past six months, political conflicts have stalled aid going to public health programs such as ARCOS. As a result, doctors’ salaries were cut in half and medicines and medical equipment have been slow at arriving. Speaking with Dr. Yustón, Dr. Liliana Alberino (the general practitioner at the consultortio), and some of the community members of Abasto, I have become more familiar with the idea of health politics and what happens when it fails.

PerezL 3.JPGWhen the consultorio was established last year, the people of Abasto were excited to finally have a place to go for their primary care needs; before, many were going to the hospital, where they would have to wait for hours before they could be attended to. The consultorio was promised to be equipped with essential medical instruments and a monthly supply of medicines. The medical equipment has yet to arrive and medicines are low in stock, if they haven’t run out already. Dr. Alberino described the situation in the following way: ‘The medical equipment I use at the consultorio I bought with my own money; if anything breaks, I can’t afford to buy a replacement nor can I expect anyone [the government] to supply me with one anytime soon.’ Last week, due to state funding constraints, her salary was cut in half, forcing her to cut down her hours at the consultorio in order to work at the hospital to earn a salary she can live off of.

PerezL 2.JPGDr. Yustón explained to me that when investments are made to provide communities with essential resources, such as health clinics, many times they are made with the motives of receiving national recognition for such actions – this is known as “principio de descrecionalidad.” In the case of Abasto, a consultorio was established and funded with government money. People were grateful and saw the action as a good sign from the political end. Unfortunately, assistance to the facility has not been consistent since the new government changes (six months ago). Today, the same pink building [consultorio] sits on the grounds of Abasto, but inside, things are slowly disappearing – from medicines to doctors. In the end, the ones who suffer the most are the community members. One Uruguayan woman described the situation with a story: when her four year old child suffered a dangerously high fever, she had to take him in her arms and walk three hours to the nearest hospital because she didn’t have a peso to take the bus and it was the closest place to her that had doctors and the medicines to help.

When economic politics are unstable, health politics suffer, and the consequences are felt by all, doctors and community members alike. It has been a true learning experience for me to witness first-hand the realities of health politics in Argentina. I have been exposed to much of what I had only read in books on community development, particularly, on how the third sector (civil associations) addresses community needs when all else fails, including politics.