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It was a little after midnight and we’d just finished a great dinner of Argentinian steak in Buenos Aires.  We were walking to a bar to have some after dinner drinks when all the sudden, my friend missteps on the broken sidewalk.  He goes tumbling to the ground.  We’re all laughing, including my friend who’s just fallen over.  He tries to get up, but quickly realizes there’s something wrong.  His arm is hanging there and he can’t move it.  Luckily, someone in our group had some medical experience and evaluated the situation and told us that we should go to the hospital.

We hail a cab and the cheerful driver told us he’d take us to the closest hospital.  He regails us with tales about how dislocated shoulders are somewhat common in Argentina because polo is a popular sport.  He doesn’t seem to concerned about my friend’s pain as we zoom around Buenos Aires’ curvy and somewhat bumpy streets.

We arrive to a run down, but very functional public hospital to find about 20 people sleeping outside the front door.  Unlike US hospitals, there is no long queue.  As we enter, I immediately speak to the person at the door who takes my friend’s information and tells us to wait in the first patient room.  The room is spacious, dimly lit, and filled with old style medical equiptment.  There were used medical supplies that hadn’t been thrown out, open razor blades on the counter and there didn’t seem to be much organization.

Hospital staff workers kept entering and exiting and we quickly realized that our room doubles as a supply closet.  A cheerful physicians assistant arrives and asks us what happened.  He does a few tests, then prescribes an xray.   My friends and I carry/drag our friend to the xray room, which uses machines that look like they were from the 80s.  My friend is unable to pose correctly because he is in too much pain and the ornery orderly gives up petulantely after two tries.  I try to convince her to try once more, but she refuses.

We’re sent back to our room and the cheerful assistant comes back and is not pleased that the xrays hadn’t worked.  He tells us he’s going to try to pop the shoulder back in.  He tells us to leave the room, then tries for 15 painful minutes.  The waiting room is dingy, has hardly any chairs and is filled with the typical people you’d see in any emergency room around the world.  There are the drunk/drugged out kids, elderly chronic care patients, car accident victims and their friends and family.  Everyone gets a number fairly quickly, but then has to wait for their care.

After awhile, the PA invites me back into the room, and asks me to help.  He rolls up a bedsheet, puts it under my friend’s arm, then tells me to pull as hard as I can while he pulls on my friends arm in the other direction.  We’re pulling REALLY hard, to the point where if I let go, the physicians assistant would go flying into the medical supplies closet.  I never thought I’d get to be a part of the medical treatment, but here I am, in Buenos Aires, attempting to help reinsert a shoulder into a socket.

After 20 minutes, we’re both exhausted.  The PA says he is going to find help and returns with reinforcements: two burly orderlies.   I’m sent out of the room and the three of them manhandle his arm.  Nothing’s working and my friend’s in pain.  The hospital staff is getting more frustrated by the minute.  Without saying anything, the orderly gives my friend a shot in his back to knock him out.

After he was out, the three orderlies spend the next hour twisting, pushing, pulling, cursing and smashing.  A friend and I are sitting outside of the room the entire time and keep hearing loud screams from the room, sometimes from our friend, other times from the frustrated orderlies.  It goes on forever.  Finally, the shoulder is back in its socket

Finally, his arm is back, but he’s completly knocked out.  The orderlies tell us to hang out in the room and 10 minutes later, our friend will wake up and will need an xray.  An hour later, he is still completely out.   Nobody comes to check on us, nobody gives us any info when we ask.  After an hour and a half, we decide to take matters into our own hands and attempt wake him up.  He is in a deep sleep.

We put both of our cell phone alarms next to his ear and splash water on his face.  Nothing.  We try again.  This time some rumblings, but mostly incoherant ramblings from the sedative and pain killer.  We decide to wait another 20 minutes.  We use our same tactics again and this time are able to rouse our friend.  We carry him to the xray room where the sullen tech takes xrays while I hold my unsteady friend up to make sure he doesn’t pass out and dislocated something new.  We search for an hour, but can’t find anyone to look at the xrays. It’s shift change and everyone is busy.

Finally, the xray tech says everything looks ok, but she doesn’t really know and that if our friend feels ok, we can leave.  There’s no organized discharge process.  We just walk out the front door with our still heavily sedated friend, xrays in hand, then find a taxi and head home.  We take the intake form with us for our records.  The hospital does not issue discharge papers or have any sort of record that we’d been there, other than my friends name at the front door.

We’d spent close to six hours in the hospital and our friend’s arm was popped back in.  We didn’t have to pay a dime.  The process was unorgainzed, the facilities dirty and a bit rundown, but in the end, they got the job done.  It was quite the contrast to the expensive, process and paperwork laden US based health care system that is terrified of being sued.  They got the job done in the end, but in a different way than I would have expected.

In the end, I wouldn’t go to that hospital for anything life threatening if I could avoid it, but I think its amazing that they can do basic medical care for free and at a decent level.  Figuring out how to merge the positives from my Buenos Aires experience with the positives from the US system could create a very compelling health care system.