If there is something that pandemic from Covid-19 crudely exposed in Argentina are the conditions in which the health system works. Two weeks ago, the National Academy of Medicine (ANM) renewed its authorities and, during the ceremony, the new President warned in this regard by pointing out some of the challenges to be resolved to improve access to a quality care and timely, that effectively allows to meet one of the objectives that the countries committed to achieve by 2030: the universal health coverage.
In his office on the first floor of the ANM, opposite the Las Heras Parkin the porteño neighborhood of palermothe academic Juan Antonio Mazzei receive to THE NATION to talk about “the distortions” of the system that end up affecting the relationship with patients; Among them, he cites the Limited time that the professionals can dedicate to inquiry and, as defined, it is “fundamental to achieve empathy between both, essential in the medical act, and avoid suspicions regarding the quality of care provided”. Also, as he did in his speech, he will refer to “the shortcomings of the educational system” for the training of doctors, among other points.
“It is very important that Argentina discuss what health system it is going to have because, although it is true that the amount of money that is allocated to Health it is not little [entre el 8,5% y 10% del PBI]the results that are obtained are not optimal if they are measured by indicators, such as infant mortality, maternal mortality, life expectancy, the control of certain diseases that must be reduced, as indicated, for example, by the number of patients with tuberculosis or the percentage of coverage with the vaccines [de calendario]. And, this, at the same time speaks of the system efficiency”, poses.
He maintains that in order to increase this efficiency, basic consensus must be reached, among which he mentions: that doctors have decent wagesthat hospitals have extended hoursa technology upgrade adequate and, also, that it be done prevention.
“It is proven that the preventive medicine it saves money, suffering and prolongs life –he maintains–. For this reason, it is essential that the hospital be the axis of health care, without any of the other systems (private, PAMI and social security) disappearing for this reason. All the subsystems must be allowed to coexist and the Condition guarantees all the inhabitants to be able to access the same quality of attention that a president could access, for example, because, otherwise, he would be discriminating against poverty”.
The demand for consultation control, studies and practices was contained during the pandemic. At this time, it is enough to walk through the halls of the hospitals and the clinics or ask about the delays in shifts, which can exceed a month, to see how they are catching up. “It is a very common complaint from patients. The system now has to adapt to this new demand”, says Mazzei.
Another challenge ahead is in the treatment of diseases: the rehabilitation and the recovery of capacity after certain interventions. “In this -she evaluates-, we are delayed and access is very difficult for patients”.
Mazzei graduated with a gold medal from the Faculty of Medicine of the Buenos Aires’ University (UBA) in 1967 and completed his residency at the Hospital of Clinics, where he specialized in internal medicine and pulmonology. He perfected his studies at the University of Iowa (USA) and, after returning to the UBA hospital, he created the Pulmonology Division in 1983, which he incorporated as the headquarters of the specialist career. Rene Favaloro He called him to add his specialty to the Institute of Cardiology and Cardiovascular Surgery of the Favaloro Foundation. After competing, he returned to the UBA at the end of the 90s to occupy the chair of internal medicine, the same one in which his father, Egidio Mazzeihad happened to Mariano Castex. He was also director of the Hospital de Clínicas between August 1999 and 2000. He was the personal physician of the singer sandro for a decade, among other public figures he attended. He assumed the presidency of the ANM on the 200th anniversary of its foundation. In addition to his seven grandchildren, he spends time collecting scale models of the ships that participated in the Battle of Trafalgar (1805), which pitted English ships against those of the alliance between Spain and France.
During his inaugural speech two weeks ago, he referred to “the shortcomings” of the educational system for training of doctors. “Due to the pandemic –he says–, the teaching of medicine has largely become virtual and there is nothing, especially in the specialties, that can replace the practice in the hospital”, which complements teaching at the university.
If there is something to review in this process, beyond the contents of the degree, it is, as he considers, “the Number of students that they have the medical schools and that, in many cases, it exceeds the educational capacities of the universities: if a chair receives 200 students, it is very difficult for personalized teaching, practice and evaluation of learning to be imparted”.
About the residencesbelieves that “the places have to be sufficient for the doctors who graduate”, while the recertifications “should be mandatory” for the constant updating of knowledge in medicine.
“The training of doctors has to be very specific and with very clear objectives of which doctors the country needs to have, how many, what is the distribution of human resources and how the recertification has to be so that they continue exercising. In this sense, the scientific societies have a fundamental role, together with the ANM – he defines -. There is also the importance of training professionals related to medicine, such as Nursing and the technicians, who are fundamental in the different areas of diagnosis”.
Another “thorny” issue, as he admits, is the number of doctors. “According to World Health Organization –he explains–, there has to be one for every 500 inhabitants and the country has one for every 200 inhabitants, so it could be lightly said that there are too many. In reality, what is not clear is its distribution: not all places in our huge country have the number of professionals they need and, therefore, access to care is not the same in the city as it is in the poorest provinces. It is very important that, in this regard, the State has an active policy to encourage doctors to settle where there are more need and less availability”.
He points out the same about nursing: if the ideal, as he says, is for there to be four nurses per doctor, the available statistics show that there are 1.5 doctors per nurse in the country. “That is to say, there is a lack nursing staff”, indicates Mazzei. Why? He points out, first, that the profession must be qualified within society, be a duly promoted professional activity and have decent salaries. “The nurse has a very important role in medical care, especially in hospitals and in intensive care. In some countries, they can also perform some therapeutic procedures that, here, are still reserved for doctors”, she points out.
To the end, Mazzei take a few minutes to pandemic from covid. “The doctors, like the rest of the health personnel, gave an example that was extraordinary and I don’t know if the dedication they had on the battlefront was still fully recognized, especially the young doctors and despite the fact that the economic compensation is poor and they have to resort to poly-employment. This is unacceptable: there are essential occupations that do not receive the corresponding economic recognition: health, education and security”, he concludes.