We started off today with a lecture from Dr. Flor Ledesma who works for ASE, one of the obras sociales, or unions, for managers. ASE and its parent company, Medife, are in a unique situation. Medife owns two entities, ASE and a private insurance company by the same name as the parent company Medife. The benefit of the same company owning both the union and the insurance company is that the money only gets moved around but never leaves the umbrella company. It is also interesting because ASE has their own insurance coverage separate from Medife. The more we have been learning about the system, the more convoluted and contradictory the system appears to be. Many processes are much more complicated than they need to be because the system was planned so that power would be decentralized. This meeting was very helpful, though, for understanding the more complex systems within the obras sociales. Below I drew a rough diagram of how money flows through the obras sociales. It definitely looks very complicated, but essentially the money from workers salaries goes through the unions who then choose various ways to provide insurance and coverage.

After we finished up this meeting, we headed to ICBA, a private cardiovascular institute. We had two lectures, one about how the hospital was run and one about their nursing practice. The hospital was really interesting because they very closely tracked many different performance indicators in real time. This allows them to gather lots of information about the functioning of the hospital and how to best improve their systems. The differences between nursing practice in the US and Argentina were also really interesting to hear about. We learned that here in Argentina, nurses have a much smaller scope of practice, and there is no formal framework for advanced practice nurses. However, the hospital has a program where nurses can specialize in different areas within the hospital and act more independently from the physicians. Following the lectures, we took a short tour of the hospital. The facility was really interesting because they focused heavily on same day discharges for surgeries. In one of their floors, they didn’t have any traditional hospital rooms. Instead, there was a lounge, almost like an airport, with rows of recliners, snacks in the corner, and iPads available for entertainment while waiting for surgery or discharge. They are able to do this with cardiovascular surgery by going in through the radial artery as opposed to the more traditional iliac artery. This allows the patient to walk out of the hospital without issue. Seeing how advanced the technology was in the ORs was amazing. Each one had a large screen right next to the table, and they were filled with any possible piece of equipment the physicians might need.

Our final stop today was MALBA, one of the most important museums in Latin America. The museum specializes in modern art, and there was also a temporary exhibit about the history of Afro-Brazilian culture. We got to see some of the most famous pieces by Latin American artists, and there were so many beautiful and thought provoking pieces. One of my favorites was a sculplture by Jorge Gumier Maier. I also really enjoyed another temporary exhibit that was displaying work created by a man who was institutionalized for fifty years. He used bedsheets, threads from shoelaces, and broomsticks to create beautiful tapestries depicting life in the institution, his previous career as a navy officer, and the names of people who would be judged by God on the second coming. After leaving the museum and getting a very tasty dinner, we wrapped up another wonderful day!