María Inés Stapaj, general practitioner at the “Dra. Debora Ferrandini” and Professor at the National University of Rosario. Photo: Jorgelina Tomasin.
María Inés Stapaj, médica generalista del Centro de Salud “Dra. Débora Ferrandini” y docente de la Universidad Nacional de Rosario. Foto: Jorgelina Tomasin.

In Argentina, there are already almost 110 million people vaccinated against COVID-19, according to the Public Vaccination Monitor of the National Ministry of Health.

Rosario, Argentina

By Flavia Campeis y Jorgelina Tomasin

Fernando Cambría is the benchmark in the vaccination area of the “Dra. Débora Ferrandini”, located in the populous Ludueña neighborhood, in the Northwest District of the city of Rosario, in the south of the province of Santa Fe.

Dra. Débora Ferrandini Health Center Photo: Flavia Campeis and  Jorgelina Tomasin

Fernando has vaccinated at least 15,000 people against COVID-19, reaching 90 patients per day from May 2021 onwards. To date, the application of the 4th and 5th reinforcement doses continues.

Fernando is 54 years old, has a degree in Nursing from the National University of Rosario, and has been working as a nurse for 33 years. He worked for 29 years in the Intensive Care and Coronary Unit sectors, with the most seriously ill patients, in one of the largest hospitals in Rosario and the region, the «Hospital Clemente Álvarez».

When the pandemic and mandatory isolation arrived in Argentina, on March 20, 2020, he had to remain isolated because he was asthmatic. He began to study the specialization in Critical Care, because, he says, he could not be doing nothing.

In May 2021 he returned to work and this time he did not have to deal with the most seriously ill patients. But instead had the role of giving hope: vaccinating against the virus that was killing millions of people around the world.

“Vaccinating was a new challenge for me, because I was used to seeing hospitalized people and coming to a place where the supposedly healthy were, it is different to see another community, nursing from another point of view,” he said.

Fernando Cambría, graduate in nursing. Referent of the Center’s vaccination
Health “Dr. Débora Ferrandini” Photo: Jorgelina Tomasin

Fernando vaccinated people of all ages, from babies to a 102-year-old woman. He assures that in his years of experience he has never experienced something like this: “in 33 years I have never experienced this, and I hope not to repeat it again. It was very hard because people came and attacked because they wanted the vaccine, as if they were going into a supermarket to loot, and we couldn’t give them the answer they wanted.»

Fernando refers to the moments when many people from the neighborhood went to the Municipal District to receive the COVID-19 vaccine. but they had to wait to receive a shift that was issued from the province and where the place of vaccination and the date were indicated.

“It was very tense, because people arrived in shifts assigned from the province. But there were times when people from the neighborhood had to go several kilometers, to the center of the city, to the Rural, to get vaccinated, and they had no way to get there. Here sometimes we could make room for them so that they could be vaccinated and sometimes not. So they got tense and people reacted badly.» 

Fernando recalled, adding: «People came and wanted the vaccine, whatever it was, the one that would save their lives, because there were many deaths at that time and there was a lot of fear. But sometimes we didn’t have any and they would get angry.»

A titanic task

When vaccination began, at the time of the greatest number of applications, Fernando says that there were 600 shifts per day at his workplace: “we were 5 vaccinators and three people to load the information into the system. It was a lot for so few people, around 550 people came a day”.

Many of the people who were vaccinated felt grateful, but others were afraid, because they did not know what they were putting into them. For Fernando, all this meant an «emotional shock» between the citizens and the medical personnel who worked together to get the long hours of work ahead.

The arrival of the vaccine in Argentina

Sputnik-V vaccine batch. Photo: Jorgelina Tomasin

In Argentina, the first vaccine that arrived was the Russian one, Fernando remembers that moment: “when we started vaccinating it was with Sputnik, the one that everyone hated first, the one that everyone wanted later, and the one that everyone hated again because it did not allow them to leaving the country, that is the reality, then came Sinopharm, Moderna, and Pfizer, which was like the queen, everyone wanted that one. Already today one says that there is such a vaccine, and they accept it; the reception is different ”.

When asked how many people he vaccinated, he laughs, calculating that he managed to vaccinate 90 people a day. But above all, he remembers a place to which he led hope: «I had the luxury of going to the island to vaccinate with a colleague.

In a boat they crossed the Paraná River, they reached the islands located in front of the city of Rosario, and in an island school they vaccinated the population that lives there: students, teachers, fathers, mothers.

«It was a beautiful experience, they received us very well and were very grateful,» he recalled.

Vaccinating was new for him, about that, he took stock:

“The experience itself is good; there are some ups and downs, but for me it was an excellent experience. I would not repeat it again. I would rather not, because it was very hard, and when the raid of people comes you have to be there” and concluded: “the people knew that public health was available, and they came, and they came and looked for public health”.

National health during COVID-19

The health system in Argentina is a system where three fragmented forms of access coexist. On the one hand, you can pay and have a private service through prepaid coverage, or have social work, in case people access jobs with contributions to the social security system.

The other option is to access the public health system, which is constitutionally for the 47 million Argentine men and women. but which in practice is accessed mostly by those who do not have any type of coverage.

It should be noted that the preventive and mandatory social isolation due to COVID-19 in Argentina was issued on March 20, 2020. According to a report from the National Ministry of Health, during the pandemic, care was provided to the entire population thanks to the expansion of the public sector.

It was precisely in this sector that 66% of all COVID-19 diagnoses in the country were made.

Waiting room of the Health Center. Photo: Jorgelina Tomasin.

In turn, 60% of the people who received hospitalization for this virus, even with social security or prepaid, went to the public system.

One of the measures at the national level that had the greatest impact was that the number of beds that were available at the beginning of the pandemic was doubled, incorporating 4,060 new intensive care beds, of which 77% were for the public sector.

Health in the territory

Rosario is the third largest city in the country, with around one million inhabitants. It is located 300 kilometers from the Federal Capital, Buenos Aires.

Currently, there are 53 Health Centers that depend on the local municipality that are located in different sectors of Rosario, providing free public health in the neighborhoods, allowing neighbors to not have to walk more than 4 kilometers to get health care.

One of the 53 Centers is called “Dr. Débora Ferrandini”, is located eight kilometers from the city center and has been operating for 14 years in a building where there are also different municipal offices that serve the population, that space is known as the District.

Plaque in tribute to the doctor who gives its name to the Health Center. Photo: Jorgelina Tomasin.

This is a neighborhood where many social organizations have historically worked, especially in the 1990s, in a context of the implementation of strong neoliberal policies in Argentina that increased inequalities.

It was in this same Ludueña neighborhood where in December 2001, in the midst of looting and the greatest economic crisis in the country, Claudio «Pocho» Lepratti, the main social figure in that area, worked with the Church for the poorest in a children’s soup kitchen.

The health center “Dr. Débora Ferrandini” is located on a large property, with green spaces in front and large trees. In the middle of this neighborhood are low houses of working families, which in recent years has been affected by the upsurge in violence caused by drug trafficking and the sale of narcotics; an area that is guarded by the National Gendarmerie and the Provincial Police.

Health Center “Dr. Deborah Ferrandini”. Photo: Jorgelina Tomasin.

For several years, Ludueña has been one of the strongest centers where confrontations between neighbors take place, as a result of territorial disputes, with a large toll of violent deaths, especially of young people, many of them patients of the Health Center.

The work of the first level of care

María Ines Stapaj is 38 years old, is a general practitioner and professor at the National University of Rosario. María Eugenia Di Pato is 29 years old and is a Social Worker. Both are workers at the municipal Health Center. “Dra. Débora Ferrandini”, which is part of the first level of care.

.María Eugenia Di Pato, a social worker, and María Inés Stapaj, a general practitioner, both workers at the “Dra. Deborah Ferrandini”. Photo: Jorgelina Tomasin.

The first level is the one that organizes the passage through the other levels of greater complexity. Each population has Ann ascription by territory to a health effector, and in turn there has a reference general practitioner who is in charge of a population of around a thousand users. If you need to access a specialist doctor, it is the generalist who makes the referral.

In more serious cases, it is referred to a second or third level, which are hospitals with medium or high complexities, where there are Intensive Care Units (ICUs).

In the Health Centers, we always work as a team. Among the professionals are doctors and general practitioners and pediatricians, social workers, psychologists, dentists, administrative and pharmacy staff.

Fernando Cambría in his work area. Photo: Jorgelina Tomasin

General practitioner María Inés Stapaj has been working in the public sphere for more than 12 years. She explained how health is organized in the city:

“Health centers were born in the 90s, a policy that is more than 30 years old, with the decentralization of quality health and based on primary care. There was a strategy to decentralize some medical specialties, so in this Health Center, which functioned as the head of the Northwest District, there were also sub-specialties such as cardiology, endocrinology, ultrasound, among others”.

The work that had been carried out from this Health Center, as in the other 52 in the city, was modified as of March 20, 2020, when social, preventive and mandatory isolation began in Argentina.

It was only in mid-2022, two and a half years later, that its health personnel were starting to return to pre-pandemic ways of working. But the years that passed changed both the daily work and the way of thinking about health from now on.

The saturation of work during the waves in Argentina

María Inés Stapaj experienced first-hand the three waves of virus infections. In the country, the first wave arrived around September 2020 until the end of November.

The second wave affected the population mainly between the months of April, May, and mid-June 2021, at which time, according to María Inés, patients arrived with respiratory insufficiencies and there was a greater saturation of the referral system. , since the patients on arrival required immediate life support (oxygen therapy or referrals directly to the Intensive Care Unit).

Archive of the medical records of the patients of the Health Center. Photo: Jorgelina Tomasin.

For its part, the third wave specifically saturated the first level of care, since the omicron variant, in January 2022, although it brought less mortality, did generate much more contagion, and the diagnostic method was saturated.

«There came a time when we had the test result almost at the same time, at the same time that the person already had to be discharged, without the possibility of following up,» says María Inés.

According to María Inés, the third wave was the one that most affected first-level care workers, since they were not prepared in terms of organization of the work team.

«He found us at a time when health personnel were on vacation after not being able to take leave for a long time or there were positive cases of COVID-19 among colleagues, and we were clearly getting it at work,» he says.

With the pandemic, he says that there were no reinforcements of personnel in the health centers or more personnel to attend, “the policy was to dedicate ourselves exclusively to COVID-19, as if everything else could wait. So we found ourselves with the most symbolically serious problems; for example, we couldn’t see some children for two years, and we found ourselves with development problems,”, he says.

The mental health of workers

Before the arrival of each wave, with the increase in infected patients and deaths, the saturation of the teams also impacted their mental health. María Inés Stapaj says that many members of the health staff took leave for mental health because the situation was critical.

«Many human teams were broken by this or many people do not want to work at the first level because of what it meant, not only worldwide with what happened, but they had to deal with early deaths, of young patients, with referrals that one I wasn’t used to doing it,» says María Inés.

The doctor says that the Health Centers had to become small hospitals, where all the human resources were available to carry out the work, neglecting everything else and even affecting their own health.

During the second wave, María Inés recalls that “at the same time that there were more deaths, the vaccination campaign began, which was decentralized in the territories and that also implied a triple burden, although positive, but also in our hands, so it was a huge overwork.»

Also read: Mental health in Peru, a great challenge after Covid 19.

Overload of first level workers

The workers of the Health Center attended, swabbed, followed up on the cases by telephone; they had all the complexity of patients that they had already been treating before, plus the COVID-19 vaccination, without adding more people to work in these effectors. .

The doctor says that even when they got sick, they were not replaced, but those who remained had to supply the work, generating an overload in all senses, physical as well as mental.

Work elements of health personnel. Photo: Jorgelina Tomasin

In addition, Stapaj comments that the resource was always placed in the hospital, leaving the health centers that provide primary care somewhat forgotten, which for her is a dismissal of the importance of the work of this sector for social containment. Of the health.

“This happened throughout the country, it is not something that happens only in Rosario, we have to ask ourselves where is the complexity, if in an intensive care or the accompaniment that was done in the first level is equal or more complex, where it can be contained even socially a territory with a knowledge that no other worker has. The policy worldwide, for the most part, was: if they die, therapy must be reinforced, but the primary care strategy was not reinforced, ”emphasizes the doctor.

Is there a return to normality?

For María Inés Stapaj, Argentina is currently working in a “kind of normality”, because although Covid continues to exist, since March of this year only people who have risk factors or health personnel have been swabbed.

In addition, there are rapid tests at the Health Center, which facilitates diagnosis, although swabs are hardly used anymore.

Likewise, many care policies have been dissolving, thanks to a large vaccination campaign that has been carried out in the country, adding to the arrival of variants with milder symptoms.

This is how, since March 2022, the Health Center no longer refers seriously ill patients with Covid-19 to other levels of care.

This has allowed first-level workers to organize themselves to meet the needs of the community and rethink prevention and health promotion strategies.

«The fact that there are milder cases also has an impact on people wanting to vaccinate less, so the third and fourth doses cost more to place, we have to wait, because it is understood that the pandemic is not over and that there could still be another complex situation,» he said. Stapaj.

Vaccination at present in Argentina

In Argentina, until October 2022, 109,867,843 doses of vaccines against COVID-19 have been applied. From the Ministry of Health of the Nation, a map has been prepared that allows to see in real time the number of vaccines that were applied by province in the country.

Currently, people with a complete vaccination schedule reach 37,866,569 and 41,023,111 those with a started schedule, which shows that 83% of the total population has received at least one vaccine.

Vaccination sector of the Health Center. Photo: Jorgelina Tomasin.

In July 2021, Argentina came to occupy the first place in the world for the average number of daily doses applied per 100 people, according to data published on the Our World in Data site of the University of Oxford.

The report from the specialized site reported that Argentina, with 0.87 doses per 100 people, surpassed countries such as Italy (0.86 vaccines per 100 inhabitants), France (0.84), China (0.82) and Germany ( 0.76). In the region, behind Argentina was Brazil, with a weekly average vaccination rate of 0.62 doses per 100 people.

It should be remembered that in April 2021, Argentina became the first country in Latin America to produce the Sputnik V vaccine, with a number that exceeds 6 million doses.

A few months ago, several provinces began vaccination against COVID-19 in children from 6 months to three years old. The vaccine adopted to vaccinate this group of children is the Spikevax from the Moderna laboratory, specially designed for young children.

Also read: From Honduras, the Covid-19 a revealing pandemic.

Monkeypox without major presence in Argentina

Compared to the people affected by COVID-19 in Argentina since the beginning of the pandemic, which were 9,703,938 confirmed cases, with 129,855 deaths to date, by mid-September 2022. Monkeypox, known as “Viruela del mono”, did not have a great incidence in the population of this country.

As of September 13, 265 cases had been confirmed; all people of legal age, between 18 and 61 years old. All the cases, except one, were men. So far no serious situations or deaths from this cause have been recorded in the country, according to the epidemiological bulletin issued by the National Ministry of Health.


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