Monday, 26 June 2017

Healthcare in BsAs: Pulling a fast one

I was recently listening to the Radio 4’s Start the Week talking about TB and how poor access was one of the real barriers to treatment and care. Lack of access, or perhaps more to the point lack of access to information, sums up my experience of healthcare in Argentina in recent months. The actual care itself, when you get it, is good; my beef is that the system and the way it operates is more about making a quick buck than what’s in the patient interest. And I’m largely talking about the private sector.

A couple of Mondays ago I was supposed to have an operation for a hernia, which I developed after pregnancy. I was all set to go when at 5pm on the Friday before my health insurers called me to say that I had to pay AR$16,000 (~£800) just for the materials. A bit of gauze, staples and forceps. Of course I just happened to have that amount of cash lying around. “Oh but you can pay in two instalments,” said my health insurer. 

Access to good healthcare, particularly information, is a pretty big deal, even more so when you’re abroad. We’re lucky that we have private medical insurance through my husband’s work. However, what I’m realising is that private doesn’t always mean better, just quicker and likely to cover more conditions/procedures if you’re willing to shell out a load of pesos.

Sloppy 

More about my uneventful hernia shortly. Up until when my daughter was born the heathcare has been good, perhaps even a bit OTT as I had to go for endless scans and blood tests while I was pregnant. My daughter’s birth was wonderful, overall the staff at the hospital were professional and competent, and as an added bonus my husband was allowed to stay with us in the hospital.

However, when it has come to medical care for my daughter, my faith in the system has begun to erode. Again, I’m not saying the care itself was bad or that I didn’t trust the doctors themselves, but their manner towards me and my baby daughter has been sloppy, at best blasé. It doesn’t help that I’m a foreigner and I’m conversing in a second language. Yes, you could argue that we chose to come here, but locals also seem to suffer from the same thing.

The price of vaccinations 

The details are too tedious, but one incident that exemplifies this behaviour was getting vaccines for my daughter. For every procedure here (in addition to medicines), you need an orden (a prescription), including for vaccines as they are not done by the paediatrician.

I didn’t know this at the time, that I could simply go to a public clinic and get the vaccinations done for free, as long as I took my daughter's booklet, without showing an orden. Unknown to me, my pedatrician had given me a private orden for vaccines that are only covered by the private system. I went to the public clinic and made the mistake of showing them the orden. Even though my daughter is Argentine and the fact I didn’t need an orden, they refused to vaccinate her with vaccines available in the public system.

Consequently, I went to the pharmacy, which wanted to charge me AR$5000 (~£250) for the vaccines. That was until I showed them my private insurance card, but then they also refused to give her the vaccines because the paediatrician had failed to write down the name of the drugs.
 

By this point I was losing my tether as the prescriptions are largely illegible in the first place and I had wasted hours and taxi fares for nothing. It wouldn’t have mattered if this had been for me but for a two-month-old baby? Really??
 

Another example was getting a newborn hearing test done for my daughter. In the UK, she would have had this within the first month. My paediatrician only wrote me an orden for the test when my daughter was almost three months and after I had asked for it.
 

I had no idea who I was meant to see and assumed it was an ENT specialist. Of course not, I was supposed to see an audiologist. My daughter’s left ear failed this test twice but the audiologist gave me no information as to why it had not passed. Instead, I was simply given an orden for another hearing test that no one seemed to do in babies. It was only after I spoke to a really helpful consultant in the UK and sent him the test results did he explain what they meant and that it wasn’t anything to worry about.
 

I’m very grateful that nothing serious has happened to my daughter; again not because I don’t think the doctors don’t know what they’re doing – but simply because they wouldn’t bother telling me crucial information. It's only her health after all.

Trying it on
   
So back to my hernia. I was due to have keyhole surgery, which the surgeon claimed would have also sort out my diastasis recti, where the stomach muscles separate and you’re left with a not-so-attractive tummy bulge. In the UK, most private health insurers won't cover the diastatis let alone the NHS.
 

Two working days before the day of the operation, my health insurers called me to say that they would only cover the conventional (open surgery) procedure. However, the hospital called me the next day to say that no, keyhole had been approved. The surgeon also said that the cost of the materials would be covered too (bearing in mind this was the first time that materials had been mentioned). 

At 5pm on the Friday, the last working day before my operation, I found out that I would have to pay for the materials, regardless of the procedure. Plus an undefined amount in the difference of cost between conventional and keyhole surgery.  I don't know who was trying it on here - the doctor because he would get paid for the procedure or my health insurers. Probably both.


My hernia’s one thing, but the cost of medical care for my daughter (I don’t care about the several wasted taxi journeys) has come at too high an emotional price for me. 



Monday, 17 April 2017

My c-section experience in BAires: abdominal binders and no talking


Three months after my c-section I have the scar, separated stomach muscles, and a post-pregnancy belly. Most importantly, however, I have a gorgeous baby girl.

Like many women, I imagined I would have had a natural birth. Alas this was not the case as my baby didn’t turn. I don’t know why she didn’t turn (not that it even matters now), but what I can say is that the c-section turned out to be a truly beautiful experience. Plus I didn't have to endure contractions or go through endless hours of labour. I certainly don’t feel disappointed or cheated in any way that I wasn’t able to have a natural birth.

I think that ad our baby abroad, in Argentina, made it all the more memorable, although often frustrating and at times comical.   

Scheduled as planned 
It was the height of summer in Buenos Aires and it was scorching. I had got myself into such a state a few days before the operation that I thought my contractions had started and that I would have to have an emergency C-section. It turned out to be just a case of really bad trapped wind. So my elective C-section would be going ahead as planned in a hospital in Quilmes, a suburb of BA. 

On the sofa 
My husband is a teacher and one of the benefits of working in the international sector is getting private health insurance as part of his job. This meant that he was allowed to stay with us in hospital for the duration of our stay. Admittedly on the sofa, but having him there was an absolute godsend. I honestly don’t know how I would have coped on my own with the baby when I could barely get out of bed. 

Sticklers for admin 
On C-Day, we arrived at the hospital at 6.15am, 15 minutes earlier than instructed to sort out the necessary paperwork and secure our room.

While I was laying on the operating bed, my husband Alistair was stuck downstairs in admin because the photocopier had broken down. Obviously processing paperwork was more important than him being able to witness the birth of our child. It was only because my obstetrician had turned up late that Alistair made it just before the baby was yanked out. She was so beautiful, just absolutely perfect! 

Quick and hassle-free 
The operation itself was like clockwork, it was so quick and over before I knew it. The longest part was being stitched up, which took about half an hour compared to 10 minutes for the birth of our baby. 

No talking 
I couldn’t feel my legs for what seemed like ages. However, worse than that was I advised not to talk for the next 10 to 12 hours after the surgery. Apparently this was to prevent gasses building up in my stomach. It was a bit difficult when the nurses kept on asking me questions. 

Abdominal binder 
To top it off, Alistair had to buy me an abdominal binder, which I had to wear immediately after surgery. The nurses, and even my obstetrician, insisted that I had to wear the faja for up to 60 days after the operation. I hated every minute of it - it was uncomfortable, pretty skank and it’s made no difference in reducing my belly. But hey who was I to argue in my less-than-perfect Spanish..? 

24-hour food ban 
I wasn’t allowed to eat for the first 24 hours which was ok as I was too drugged up to care. Alistair did pretty much everything, he was the one to first change her nappy, the first one to hold her etc. We had to ask the nurse what to do as we had learnt pretty much nothing in our antenatal classes, except that I shouldn’t talk. 

Extra services 
As part of our care, we were told that we could get the baby’s ears pierced, her head shaved and baptised all at the hospital. I opted for more painkillers instead. 

Fragmented healthcare system 
I should have realised at this stage just how fragmented the Argentine healthcare system is. What I mean by that is that you have to see a different specialist for everything, and I mean everything. There isn’t just one consultant who you can speak to. For example, on our last day, I was discharged by my obstetrician at midday but we had to wait until 5pm for the paediatrician to come and discharge our baby.  

Home sweet home 
We stayed just two nights at the hospital which I initially thought would be too short a time. Come the third day I was itching to leave as we had barely left the room we were staying in, it felt too much like the novel Room.

Ideally, I’d like to experience a natural birth if we have another baby, but hand on heart the method is irrelevant, for me anyway. I'm just so grateful that our baby girl was delivered safe and sound. I even quite like my scar, but I’m happy for the belly to go.   

Monday, 2 January 2017

Waiting for baby in BAires: facts vs no facts

I’ve managed to see in the New Year in Buenos Aires without giving birth yet. That’s a good thing as my baby is in a breech position (bottom down position rather than head in my pelvis) and I have a planned caesarean for this Thursday. Like many other mothers/mothers-to-be, I was initially a bit disappointed to learn that I’d be having a caesarean instead of a natural birth. Anyway, that’s by the by now and I’ve come to accept that that’s life, things happen that are beyond our control.  

I wanted to write this post not to talk about a C-section vs natural birth (I’m none the wiser); it is really just to highlight the importance of having the facts and evidence on the risks vs benefits and make informed decisions. It shouldn’t matter where you live, but it has really brought home to us how invaluable good professional care is – whether that be in BA or London.

Breech baby presentations
Yes, it was our choice to come here, I get that. So yes, there will naturally be differences in the system and practices. We are very fortunate to receive private medical through my husband’s work and it has been great in terms of providing continuous care. I’ve gone for several blood and urine tests and monthly scans, although I do sometimes wonder how carefully they pay attention to the details. I guess in a country where abortion is illegal, except when the women's life is in danger or in the case of rape, how much is one willing to do and for what end?

Much to our disappointment, what my husband and I have found is that our concerns have been dismissed as foolish or simply ignored, with no willingness to enter a discussion. You’re simply meant to stay stump and do as you’re told without questioning the professionals. Perhaps I’m reading too much Ben Goldacre, but access to clear, objective information seems a real issue here.


Turn baby turn

 
This all started when I found out that the baby was breech, at about week 32 or so. Most babies turn by week 36, but mine hadn’t. That was ok as there was still time, I thought. So much so that my husband and I paid little attention to our first antenatal class, which was about having a caesarean, ironically. Except the part where it said you can’t talk for 10 hours after the operation, due to an accumulation of gases apparently (looking for a reference but can't find one).


Almost 39 weeks later, the baby is still breech position. We saw my obstetrician at week 37 he informed us that we would go to hospital the following week, on 29 December at 9am and he would perform a C-section at 3pm that day.


If I had been in the UK my doctor would most likely have offered a procedure called external cephalic version, where a medical professional tries to turn the baby to a head-down position. I asked my obstetrician about this but he pretty much ignored me, probably because he doesn’t know how to do it. It’s ok, we have the resources that we have and I have to work with that. Or I could have tried a range of exercises to try and turn the baby naturally, but at some point I just had to accept what was meant to be. 

 
I know women may have to have C-sections at a moment’s notice. However, our obstetrician didn’t really explain why he wanted to do the operation at 38+2 weeks, other than vaguely saying it could become problematic if I went into labour. He didn’t tell what to bring, what to expect and basically said I’d be out two days later, when the norm seems to be three to four days.


Too rushed

 
The next day I couldn’t help thinking that it all seemed too rush. I couldn’t get my head around the idea that our baby could be born at the end of 2016 when her due date was around 13 Jan 2017. At every subsequent scan my due date changed from 6 Jan to the latest of 18 Jan.


Seeing as we had not really been given a medical explanation as to why the operation would take place at 38+2 weeks and not later, I decided to consult my handy friend the internet. Some studies have recommended that planned C-sections should take place around 39 weeks to give more time for the baby’s lungs to develop as any earlier could cause respiratory problems. However, this view is now being disputed, with other research stating that the risks between 38 and 39 weeks is minor. In a state of panic I rang my obstetrician to ask if it would be possible to put back the operation by a week.


Unfortunately, he took that to mean that I wanted to cancel the current date. That was not necessarily the case, we just wanted to discuss the risks vs benefits of having a caesarean at 38 weeks vs 39 weeks. Instead, he cancelled my appointment and told me he would book it in for the following week. End of story. He had not told us the new date nor the time, nor the fact that he only operated on Thursdays. When I called him back he was irate, saying that he would do it at 39+2 days and it was at our risk. The risks that he was not willing to discuss with us…


32 weeks the same as 38 weeks?!

 
Essentially our obstetrician had told us that we had put our child at risk as I could go into labour early. In Argentina, and in many places around the world, many clinicians and midwives are not trained in delivering breech births so they are becoming deskilled in this form of delivery. I certainly don’t want to go into labour while the baby is breech, but nor do I want our baby to suffer a higher risk of breathing difficulties.


Upset and unsure what to do next, we went to see our GP. She helpfully said everything was fine. It made no difference whether you have a caesarean at 38 weeks or 39 weeks, or for that fact at 37, 35 or even 32 weeks! I’ll hand it to her in terms of optimism but clearly having a caesarean at 32 weeks is very different to having one at 38 weeks. I’m no medical professional but even I know that. I don’t want to hear that it’s going to be ok. I’m pretty sure it will be; I want someone to be honest and tell us the risks vs benefits. This just something that is not forthcoming here, so is it any wonder that we go on to the NHS website..?


We saw the obstetrician again last week and while he still refused to engage with us in any meaningful way, at least we had maintained a professional relationship with him. Luckily I won’t have to talk to him for at least 10 hours after the operation.

Monday, 28 November 2016

Baby on board in BAires: To ask for a seat or not to ask?


I’m lucky that I don’t have to use public transport that often in Buenos Aires. Not that it’s bad; on the contrary I can get a bus from where I live in the burbs to Capital in about half an hour… and all for AR$11.80, equivalent to 60-odd pence. No, my issue is more of a biological one as I’m now pregnant, which makes standing up on a journey that goes via the motorway slightly more problematic.

On the whole, I've been touched by how considerate fellow passengers have been here. Once on the way back from Capital to Quilmes, a girl came up to me to where I was standing in the middle of the bus and offered me her seat. The bus driver had noticed my belly and had kindly told the girl to give up her seat. Another time, a lady shouted out for someone to cede their seat for me because I was too shy to ask.

Transport for London Baby on board badge
However, there have been a couple of occasions where I have not fared so well, particularly in the mornings during rush hour. I was about six months gone at the time and was pretty noticeable but we all know what it's like on the way to work. Admittedly I didn't try very hard to protrude my belly and instead plonked myself down on the floor, probably to the annoyance of other commuters.

My husband said I should have asked someone if I could have taken their seat. Maybe so, but I can’t assume that people will automatically give up their seats for me, even if I did have a 'baby on board' badge... which I don't.


Pink Light system

Interestingly, South Korea has trialled the Pink Light wireless system for pregnant travellers. The bluetooth technology alerts train users to give up their seats for pregnant women. In the City of Busan, women carried sensors that activated pink lights fitted near priority seats on the Busan-Gimhae Light Rail service over five days.

While the Pink Light system may be a step too far, Buenos Aires had made its own progress in helping pregnant woman on public transport - or so it seemed. Buenos Aires province had approved a law in 2012 to allow pregnant women to travel on buses for free twice a week. 


The aim was to protect women’s health during their pregnancy and to make it easier for them to travel to their health appointments and check-ups. A worthy initiative, but I’m not sure if it took effect as I’m still paying for my bus fare. Not that I at all mind for 60p a pop. I just don't like drawing attention to myself, but maybe I should. I'm sitting down for two after all.

Monday, 31 October 2016

Preparing for childbirth? Try an antenatal class in Spanish



Mine and my husband’s efforts not to reveal the name of our unborn child before delivery may well be in vain. On Friday, we attended our first antenatal class, in Spanish I hasten to add, and the mid-wife not only asked us our names but also the name of our baby. Hang on, after five scans and six and a half months in, the gender still hasn’t been confirmed… affirmatively anyway.

I don’t know how most first-time parents feel when they attend their first antenatal/NCT class but Alistair, my husband, and I weren’t thrilled with the prospect. Firstly, they're on a Friday at 7.30-9pm, just at a time when we'll be trying to ignore the hunger pangs. Secondly, the language. Listening to tips on labour and delivery in Spanish will be great for our audio skills, but maybe not so great in helping us look after our baby when we don’t understand what the mid-wife's saying.

We really hoped that it wouldn’t be a group therapy session, where we all sit round and talk about how we're feeling. It’s bad enough in English. I’m so glad the mid-wife said that Alistair had to come too.     

Parental bonding..?

So off we went to our little clinic, which is pretty much like sitting in someone’s converted lounge but with rows of plastic chairs that no one can get through. Other couples seemed to recognise each other and had already formed a bond. This did unnerve me a bit as that's why many people in the UK go to NCT classes, to meet other parents-to-be. Don't get me wrong, everyone seemed lovely but our limited Spanish may not go as far as talking about contractions.

Luckily, Ceci, the lovely girl who works in administration at the school that my husband teaches at, also turned up with her husband in toe. She beamed at us and shouted out a big hello in English. Her English is far better than my Spanish, but, hey, I’m trying here.

Next, the midwife hands us a checklist of what we’ll need in our hospital bag – ositos, batitas etc – I have no idea what they are but thankfully Ceci does. Mental note to text Ceci later to ask where we can get all this stuff from.

So the topic of discussion for today is caesarean and post-caesarean. Erm I didn’t realise this is what I had opted for. Well apparently, the topics follow a 10-week cycle and we happened to join during topic no.9. Phew, we didn't have to form a circle and hold hands etc; we just watched a powerpoint presentation and drifted off occasionally.

Vow of silence

One interesting thing I did learn was that if one has a caesarean, the mother should not speak for 10 hours until after surgery. I can’t remember why now, but we also learnt some other new words, such as the Spanish word for gauzes. That will certainly come in handy...

I was looking forward to the breathing and relaxation exercises, which the handout said would be during the break, as my back has been hurting lately and I've been finding it hard to nod off. Five minutes to nine and still no sign of a break or any relaxation techniques. 

Instead we had a Q&A session on what to do if your waters break. My guess is that you’d go to the hospital…? So, that was the end of our first session. Next week is paediatrics, I think. Shame, we’re away next weekend. Still, there's nothing like perseverance so maybe I will be shouting obscenities in Spanish come labour. Although I don't think that will be part of our course.