June 24, 2015
BUENOS AIRES, ARGENTINA — While responding to an emergency medical call in a low-income neighborhood of Buenos Aires one night last summer, Dr. Paula Fernández capitulated to the demands of street thugs in order to save her life.
The ambulance she was riding could not reach two people with gunshot wounds because the streets of Villa Zavaleta, an area on the city’s south side, are narrow.
“We got off the ambulance with the driver and walked two blocks down a corridor,” Fernández recalls. “It rained and rained. The place was crowded with people and police. At the end of the corridor, there was a dying patient, with a gunshot wound to his face, and next to him, another one, with a firearm wound to the abdomen.”
Gazing as if watching that moment in July 2014 unfold anew, Fernández says she immediately tended to the person with the abdomen wound, but allies of the person with the face wound ordered her to stop.
“No, not that one!” she recalls people yelling. “You bitch, help this one!”
Before she could even react to their demands, they carried the person with the face wound to the ambulance.
“I saw they were coming to look for me,” she says. “They wanted to carry me too. So I went fast to the ambulance and we took the victim with us. I thought, ‘I do what they say, because if not, they will kill me.’ I felt scared! Very scared!”
Straightening her white coat, Fernández says she never understood why she had to tend to one victim over the other.
The drug trade has so sharply increased violence in some neighborhoods of Buenos Aires that doctors and ambulance personnel refuse to enter some areas without police backup. As a result, tens of thousands of people are not guaranteed access to emergency health services. Doctors and ambulance personnel train to de-escalate tense situations and manage their risks, but they add that there’s no substitute for public respect.
The Emergency Medical Care System of Buenos Aires, known by its Spanish acronym, SAME, is run by the city government’s Ministry of Health. It aims to cover the population’s emergency medical needs.
SAME stations its 130 emergency vehicles at 34 public hospitals and other strategic locations. An emergency communications center dispatches the nearest ambulance to each of the roughly 2,400 medical emergencies called in each day.
Buenos Aires, a city of 200 square kilometers (124 square miles), is home to 2.9 million inhabitants. The city is surrounded by a metropolitan area known as Greater Buenos Aires, home to more than 15 million people, according to the 2010 National Census.
More than 5 percent of the population – about 163,000 people – lives in slums, according to the census.
Argentines apply the term slum (villa miseria in Spanish) to neighborhoods with dirt roads and precarious housing on publicly owned land.
Almost 20 percent of the city’s population, lacking any form of medical insurance, depends solely on public health care, according to the census.
So far, no doctor or paramedic personnel has been killed servicing the city’s slums, says Dr. Jorge Gilardi, president of the Municipal Doctors Association, the trade union that represents public hospital doctors in the capital.
Still, his colleagues fear for their safety, he says.
“There is fear! There is fear!” he says. “We will keep going, but we won’t commit suicide.”
The increase in violence became noticeable about five years ago, Gilardi says, but it is constantly increasing despite the presence of the police, the Naval Prefecture and the National Gendarmerie, which provides border security, in the slums.
“The assaults were growing in quantity and intensity,” he says. “They became more serious, going from a push, to a blow, to a threat with a firearm.”
At some hospitals, a police unit accompanies each ambulance dispatched to a slum. In other cases, police guards are assigned at the request of ambulance crews.
The situation has been getting worse, says Dr. Alberto Crescenti, general director of SAME. These days, ambulance teams do not know what they will find when they respond to an emergency call.
“This is a profession of risk,” he says. “We know when we are going, but we don’t know if we will return.”
Ambulance drivers also voice fear.
In the year he has driven for SAME, Juan Carlos Murillo has been insulted several times, and his ambulance has been stoned.
“Sometimes we cannot even enter, because even police tell you, ‘We cannot give you a guarantee,’” he says. “The police themselves tell you the thing is intense, and we cannot go in.”
Juan Godoy, 32, a resident of slum 21-24, also on the city’s south side, says he throws stones at ambulances whenever he sees them in his neighborhood because he believes emergency crews discriminate against people of the slums.
“They’re a bunch of cats,” he says, using a local term for people who consider themselves superior. “You call them and they don’t come. They leave you for last.”
Gilardi denies that health care staff discriminates against slum inhabitants.
“We never discriminate,” he says.
Out of institutional principle, SAME responds to every emergency call, Crescenti says. But ambulance personnel are expected to take all necessary precautions, including not entering a situation they deem dangerous, to protect themselves.
“No one is a superhero,” he says. “We are all human, and we must recognize that sometimes we feel afraid. One feels afraid of losing their life, and it is not a minor thing.”
Murillo says he disregards about 20 percent of emergency calls out of fear for his safety.
While letting ambulance teams decide whether to enter a slum may protect them from harm, the practice deprives slum dwellers of a full right to health care, says Maximiliano Marín, a sociologist who specializes in homeless populations.
Sonia López, 37, a resident of slum 21-24, says she has twice been denied emergency care for her children.
In April 2014, her 5-year-old son ran a high fever and had seizures.
“The ambulance never arrived, and my son was about to die, because his face was getting all black,” she says. “I took a taxi right from there and we went to the hospital.”
And in February 2015, her 9-year-old daughter suffered a shock when she touched a bare power cable. Again, she says, no ambulance came, and she took her daughter to a hospital via taxi. Her daughter needed five days in intensive care.
López says her neighbors assume no ambulance will come, so they try to get to the hospital by other means.
Slum violence is worst in areas controlled by drug traffickers, Marín says.
Drug traffickers take over the territory in which they operate, he says. Their control of their area makes it difficult for social workers, doctors and government organizations to carry out their missions.
In high-crime slums, Marín says, doctors no longer expect to be treated with respect for their intentions and wellbeing.
“This has to do with who runs the slum and how he or she does it,” he says. “The state has no control there.”
Organized, large-scale drug trafficking has risen over the past five years, Marín says.
GPJ contacted the Ministry of Security on four occasions to confirm this information and ask about the law enforcement strategies implemented in slums. Elizabeth Bak of the agency’s Communication Department says she is “not authorized” to disclose that information.
The Metropolitan Police force has been carrying out operations aimed at eradicating drug trafficking in the south of the city for more than nine months, according to the agency’s website.
The inhabitants of slums and precarious settlements confirm the rise in drug trafficking in their neighborhoods. They perceived it as rising 50 to 60 percent from 2010 to 2014, according to “Increased Drug-trafficking in Slums, Severe Addiction Problems in Families and Populations at Risk,” a report published by the Argentine Pontifical Catholic University in May 2015.
Leoncia Laino, who has lived in the Villa Zavaleta slum for 42 years, says she has witnessed drug dealers growing in number and gaining more power in the neighborhood over the past year – despite the presence of law enforcement agencies.
“There are the gendarmes, and it’s as if there was nobody,” says Laino, 46.
Marcelo Munilla Lacasa, the prosecutor for the district that includes the Villa Zavaleta and 21-24 slums, also says drug trafficking has grown stronger and more violent.
The drug trade causes collateral damage, putting emergency personnel at risk and keeping innocent slum residents from getting the emergency care they need, he says.
The ideal solution would be to eradicate slums and drug trafficking, Marín says.
“But they are things that are too ambitious,” he says.
To empower its employees, SAME two years ago began requiring training in responding to high-risk situations.
Instructors, including a psychologist specializing in violence, train emergency responders to de-escalate violent situations, Murillo says.
Gilardi urges slum inhabitants to respect and protect the medical personnel who strive to serve them.
“If we as a society take care of the health team, the health team will take care of us,” he says. “We want to use a white coat and not a bulletproof vest.”
Fernanda Font translated this article from Spanish.