IEE in Cordoba, ArgentinaAriel Johnson

School of Medicine

Cordoba, Argentina

• 2nd Largest City in Argentina• Buenos Aires 1st

• 1.5 million people

• Separated into Barrios• Nueva Cordoba

• Juemes

• Cerro

• Universidad Nacional de Cordoba• Free public university

Sanatorio Allende

• Private Hospital • Dr. Guillermo Allende

• Departamento de Traumatologiay Ortopedia• Dr. Bartolome Allende - Joints

• Dr. Christian Allende - Joints

• Dra. Victoria Allende – Peds

• 2 Separate Resident Teams

Health in Cordoba

• Public vs Private Hospitals• Similar quality of care• Wait times much longer at public hospitals• Access – fewer public hospitals• Free healthcare – only applies to public• Government regulation?

• Physical Activity• Walk everywhere within reason• No A/C – people spend evenings at parks

• Motorcycles very common – lots of associated trauma

Public Health in Argentina

Causes of Death Related Modifiable Risk Factors

• Tobacco• 22.1% smoke vs 14% in US

• 46% exposed to 2nd hand smoke• >30% at work indoors

• Diet

• Lack of Drug Use

In the US, drug use disorders are the 10th leading cause of death; a 163% increase since 2007.

Postsurgical Opioid Use in Argentina

• The Norm• Most patients receive Ketorolac initially

• Later, pain managed with Tylenol and/or ibuprofen

• If patient is having a lot of pain → Tramadol in the hospital, rarely more

Sanatorio Allende Pain Protocol

Insights from Orthopedic Surgeons in Cordoba• Patients rarely complain of pain in the postsurgical period.

• IV pain medications are never prescribed by surgeons. • In extreme cases, only anesthesiologists prescribe

• Patients rarely go home with opioid prescription

• Absence of Opioid and Heroin addiction in Argentina• Deaths due to drug overdose are very rare

• Most addicts in Argentina are users of cocaine

• How can we do better in the U.S.?• Patient and provider expectations and attitudes about post-surgical pain

• Prescribing habits by surgeons

• Access to psychiatric care

Most Profound Clinical Experience

• Suzuki external fixation of phalangeal fracture• Surgeons first time performing

• Equipment

Milwaukee drill used in surgeryCompleted Suzuki ex fix

Potrero de Garay: A Cultural Experience

View of Los Molinos Mountains

Bus stop I missed in Potrero de Garayand the ensuing hike to Potrero from the next stop

References

• Institute for Health Metrics and Evaluation

www.Healthdata.org

• https://en.wikipedia.org/wiki/C%C3%B3rdoba,_Argentina

Language & Culture

• Spanish dilect very challenging• Como estas? → Como andas?• “Sos”• LL, y pronounced “sh”

• Music • Reggaeton• Cumbia – “ATR”

• Social Activities• Mate• Asada

Mate, Yerba, Bombillo

Asada thrown by the residents