It was a Saturday night. I had been in Uruguay for a few hours, my first visit, and I was coming back from a pleasant evening with friends. I was just one block away from my hotel, in the old part of Montevideo.
I had a moment’s hesitation – my sense of direction has never been the best. Was it left here or right? Suddenly I felt myself thrown hard against a wall. Someone was pulling at the small rucksack I had on my back. He was joined by another youth, who, for a second, I fancied might be coming to help me.
No such luck. There were blows. My head made contact with something. I was on the ground. They were emptying my pockets and still pulling hard at my bag, a remarkably strong one that remained stubbornly in place. It contained my camera, tape-recorder – and hence a good part of the contents of a forthcoming New Internationalist issue on Argentina.
I was shouting for help, and had my arms crossed to protect my vital organs and also to keep the bag on my back. After what seemed like an age – although it was probably only a matter of minutes – my assailants ran off as people started coming out of their houses to see what was going on.
Soon I was surrounded by half a dozen kindly, helpful people. I was feeling very strange and having trouble breathing. I told them I needed to get to a hospital. A young couple with a child helped me to walk to the Maciel Hospital, just a few blocks away.
The Maciel is a public hospital, Uruguay’s first free one, and it has a reputation for being a ‘poor people’s’ facility. It was founded by a priest, Padre Franscisco Maciel, back in the 1780s. In a conversation with the writer Eduardo Galeano, who came to visit me in hospital a few days later, I learned that this ‘charitable priest’ had another side to him – he was also a slave trader.
The hospital that bears his name can be seen as a precursor to Uruguay’s early – and in Latin America, pioneering – history of social welfare provision which began in the 1920s. Uruguay has many such progressive feathers in its cap: the first country in the continent to give women the vote, to legalize abortion and, in more recent times, to propose a more progressive, legalizing approach to drugs. The country’s current leader, President José ‘Pepe’ Mujica, is a former Tupamaru guerrilla who is known as ‘the world’s poorest president’, as he gives away 90 per cent of his income to social causes.
But my experience of the country’s health system so far suggests that the deep inequality in health provision that plagues so many parts of the world – and increasingly countries like Britain – applies in Uruguay too.
As I entered the Maciel Hospital’s waiting room, I saw people sitting on wooden benches, looking as though they had been there for years. I was only taken through to see a doctor relatively quickly because, unable to sit down, as instructed, I could only lie on the concrete floor. I was also fighting for breath.
A young doctor, looking exhausted at the end of her shift, examined me and sent me off to have an x-ray. The x-ray machine was a museum piece. The x-rays would come back in 20 minutes. By now my old friend, the British-Uruguayan photographer Julio Etchart, had arrived, and was giving me support. The hospital seemed to have a constant flow of people coming in, many with quite violent-seeming injuries. It also seemed to be serving as a social centre of sorts. A very drunk man with a bloodied face was shouting loudly and continuously, but not aggressively. ‘We know him well,’ a nurse said. ‘He often stays the night here. He’s got nowhere else to go.’ Recently two patients murdered another man in this hospital.
In the early hours more results of the night’s activities began coming in: injuries from fights as bars and clubs in the area closed. Still my x-ray results had not turned up. The staff were friendly and concerned, but the hospital seemed to belong to another age. The equipment appeared to be ancient and systems haphazard.
The doctor I had first seen went off shift and her replacement finally admitted that my x-ray results seemed to have gone missing. The pain from my injuries was getting worse. I had been given an intravenous calmante (or painkiller) that seemed to do nothing at all. The lights in the hospital were bright, it was noisy, I struggled to find a position in which I might sleep. Finally, I decided I would probably be better off back in the hotel where I would at least be able to get some rest.
The doctor seemed reluctant to let me go, but eventually came back and said that the x-rays showed nothing seriously wrong with me. I was suffering ‘the pain of blows’. I just needed to rest. He gave me a prescription for ibuprofen but could not give me any actual tablets because the hospital pharmacy was closed. By now it was 5 am. The fact that I had not lost consciousness meant that the huge egg on my temple was nothing to worry about either.
I did as I was told. I found a position that was not excruciating and in which I could actually sleep. The ibuprofen was supplied by the hotel staff, who were mortified by what had happened to me on their patch. Uruguay enjoys a reputation for being comparatively safe, much safer than neighbouring Argentina, for example, or Brazil. But that has been challenged in recent times with rising concern about inseguridad or crime.
The next day the pain was worse. The following day, worse still. Julio arranged for me to go and see Ana, a doctor friend. He picked up the x-rays from the Maciel Hospital – they had been found at last, identified by a medallion I had been wearing around my neck.
The doctor friend took one look at the x-rays and saw a fractured rib. She examined me and found a punctured lung that had collapsed. She pointed to pockets of air on my torso in places ‘where there should not be air’. She ordered us to go to a private hospital immediately – one of the big ones.
We opted for the Hospital Britanico (British Hospital) established in the mid-19th century, to serve the British community but also members of the Uruguayan élite. Once admitted, I was quickly sent for x-rays, a CT scan, and almost immediately operated on to insert a tube into my chest to drain the air and let the collapsed lung begin to reinflate. Further examination revealed five fractured ribs and two fractures in the lumbar vertebra of my back.
I have been here six days now and the treatment I am getting is excellent. The pain is being managed as well as I believe it can be. The hospital has the latest equipment and is spotlessly clean. The staff are pleasant, helpful and obviously well-trained. Procedures are properly explained beforehand. Different staff deal with different aspects of my medical situation, but everything is carefully co-ordinated. I can even get vegetarian meals. I don’t dare ask but I suspect it is all horrendously expensive. Fortunately, I’m covered by travel insurance.
And ‘fortunately’ is the key word. If I were a poorer resident of the old city, living near the Maciel Hospital, like some of the people who helped me back on my feet, where would I be after such an attack? Would I ever have received a decent diagnosis of my injuries, let alone treatment for them?
I’d probably be lying on some bed, immobilized, in great pain, struggling for breath, wondering why my body was making such a big fuss about the ‘pain of blows’.
This experience brings home to me – in an acutely personal way – the profound effects of health inequality. Of all inequalities, right now it seems to me, the most unfair and unacceptable for any society in the world that wants to consider itself civilized.
I’m also aware that the health inequality that applies in Uruguay, also applies in my country, Britain, whether in the ‘postcode lottery’ of current state provision or in the attempts to dismantle the NHS and sell off bits of it to the private sector.
Is this the world we want?