Gustavo Farruggia provides remote communities in Argentina with high-quality medical care through a new system that brings together outside medical expertise, the institutional capacity of universities and public agency, and the active participation of local people in their own healthcare.
La idea nueva
With his organization La Higuera (The Figtree), Gustavo constructs a new paradigm for rural pediatric healthcare in remote areas far from doctors and clinics. Bridging local communities, medical schools and the public health sector, Gustavo has designed an innovative treatment model that is premised on the active role of the local villages themselves. At the core of this work in each isolated community lies the House of Rural Pediatrics, a center for instruction, research, diagnosis, and treatment that brings together local leaders, public health officials, and current medical students. Together, they can provide quality medical attention and follow-up to children, youth, and parents who had never before received such care, or in many cases, any care at all.
Gustavo has harnessed the prowess and manpower of universities and medical students to complete rotations in the Houses scattered around remote areas in Chaco, an isolated province in northern Argentina. Beyond just completing internships and residencies, though, the students are taking part in an entirely new profession of Rural Medicine whose curriculum was developed by La Higuera. Gustavo has designed theoretical and practical courses to teach the particularities of rural healthcare in the hopes of preparing new legions of doctors and medical professionals to serve these isolated communities. Universities have adopted his programs and continue to supply La Higuera with willing, excited and capable medical students, who learn by treating real clients in a context far removed from the normal urban health setting. Furthermore, the students and visiting medical researchers have started to collect medical histories and data to complete epidemiological surveys of the areas, a resource that heretofore has not existed in rural Argentina. Villagers trained by La Higuera will be able to take basic medical histories so that medical professionals can be more productive during their visits. Other village groups will plant communal gardens for a more balanced diet and will teach nutrition and health.
La Higuera is now maximizing its relationships with the provincial public health agencies and government to open new Houses of Rural Pediatrics and to establish new linkages with public hospitals and universities. The system that Gustavo has orchestrated is now prepared for growth to other regions of Argentina, in partnerships with universities and state governments, to provide high-quality pediatric treatment to isolated and forgotten communities. Ultimately Gustavo sees that his clinics will become hubs for greater rural development and a new profession of rural medicine.
The north-central province of Chaco contains some of the most isolated and abandoned areas of Argentina. Nationally the rate of poverty in rural areas, about 32 percent of the population, is more than double the rate in urban areas. Millions of people are not accounted for in the national census, which helps determine apportionment of state-sponsored aid. The situation is especially dire in Chaco, where half of the population subsists beneath the poverty line and the climate and terrain has made it difficult to fabricate basic infrastructure. As a result, the state has largely forgotten Chaco and its inhabitants, eight out of ten of whom come from indigenous origins. High infant mortality rates and incidence of preventable communicable diseases plague the province because of the lack of basic medical services.
The poor to nonexistent education does not include instruction on disease prevention and treatment, allowing public health problems to run rampant. To receive medical care, residents of Chaco must travel hundreds of miles to the capital, Resistencia, or other cities outside of the province, if they even can afford it. Neither doctors, nurses nor public health workers transverse the terrain to provide care, and no one in their stead keeps medical records, personal histories, or epidemiological data. Emblematic of the vast healthcare crisis, there is the alarming incidence of chagas disease, an easily preventable disease transmitted by parasites that can cause significant and chronic infections if not treated. Not only do the people of Chaco lack the rudimentary skills needed to treat chagas, due to the absence of medical records, data does not even exist to quantify the enormous presence of the disease.
Poverty alone does not account for the numerous public health problems in Chaco. There is no medical system there, as doctors—mostly educated in faraway cities since there are no medical schools in the rural zones—do not see any value in operating in such remote areas. Many even disregard the tenet of service to those communities most in need, a fundamental principle in the practice of medicine. The medical professionals there tend to lack a basic grasp on treating these particular medical issues. Above all, the dearth of pediatric specializations allows the infant and child mortality rate to flourish. The university training that medical students and residents receive is mostly directed toward treatment of urban health issues, to the detriment of rural healthcare and its special challenges. This generates myopic thinking, a “one-size-fits-all” treatment model that simply does not work in the rural context.
Furthermore, not even the government and the public health sector see any point in investing in the fundamental medical infrastructure that Chaco needs. The communities are not engaged in politics; they offer few votes or civic pressure that would otherwise be persuasive to the provincial political establishment. Advocates for better healthcare cannot even point to medical statistics since these just do not exist. Without any will, the government will not implement any medical program; without clients who can pay, the private sector does not build clinics. The healthcare system in Chaco is broken, and traditional methods have not been able to repair it.
Gustavo is the architect of an entire rural pediatric health system for Chaco and other areas around Argentina. After several years of carefully and incrementally crafting La Higuera, in 2011 he acquired a permanent organization to undergird his House of Rural Pediatrics, allowing him to initiate the major growth phase of his plan.
La Higuera begins its efforts in a rural community from the resources that are already there. Often, the first partner is the public health official, called the “sanitation agent,” a government employee who lives there and doles out very rudimentary care. School teachers and leading community members are also invited to join. Gustavo opens a House of Rural Pediatrics in the community and brings all involved parties together under one entity. The conventional roles of these seven to eight major community actors change so that they work in tandem as a coordinated healthcare system. They learn to take medical histories and vital statistics, diagnose basic pediatric medical issues and prescribe solutions and treatment. They also receive disease prevention and wellness instruction that they can in turn transmit to parents and children. As the community members demonstrate their mastery of these skills, La Higuera begins to slowly teach them more advanced medical procedures, to the extent that they can perform them without any formal training. Ultimately, the House becomes the nerve center for healthcare in the community with the contributions and interactions from the local population.
The community network around the House serves as the foundation upon which La Higuera constructs the rest of the rural pediatric system. Early on Gustavo understood that to address rural healthcare, medical students must learn it and live it, so he designed practical curricula for students and interns. After forging associations with medical schools outside of Chaco, he invited interns to come to the isolated communities and complete theoretical and practical training in rural pediatrics on site. La Higuera now has a permanent, rotating influx of medical interns who collaborate and offer their medical expertise at the Houses, passing through several to experience different contexts.
Gustavo’s medical curricula are tailored to both current students and postgraduates completing their residencies at hospitals outside of Chaco but completing externships with La Higuera. The courses include topics such as emergency care in isolated communities, water-related illnesses, social and community public health, and indigenous naturopathic medicine. There is also a special emphasis on chagas disease. So far such students have completed over 3,000 pediatric cases among a population of some 20,000 in remote areas, many of whom had never seen a medical professional. By documenting their cases, the students start to compile a database of medical information on rural health issues. The students can also participate in writing articles for the Rural Pediatrics Magazine, a journal initiated and published by La Higuera to raise awareness and understanding of medical issues and its vision. The magazine is distributed to universities, medical associations, and other partners. Gustavo hopes that by giving interns and residents powerful, life-changing experiences in Chaco, he can start to develop a profession of rural medicine around Argentina.
Medical school institutions have become natural allies for Gustavo. The National University of Rosario Medical School is the nexus and main source of interns. It has opened a satellite campus at a public hospital in Chaco and has contact with several rural clinics around the province. The university is also developing a knowledge center on rural pediatric medicine and has issued the first academic certificates on the subject. Even doctors and medical researchers associated with medical school take part in volunteer missions to Chaco to expand and refine their practice or complete detailed investigations of the health situation there. Such findings in conjunction with students’ case notes contribute to a new collection of data on rural healthcare. After having achieved such success with the University of Rosario, La Higuera has targeted similar ties with ten other university medical schools throughout Argentina.
The third core element of La Higuera’s work is with the public healthcare agencies. In his early stages, Gustavo sought to foster a productive relationship with the provincial health ministry without losing his own autonomy. By including the public health officials in each remote village into the Houses, Gustavo guarantees the buy-in of the government and creates more natural and deeper partnerships between them and the local communities. Now, La Higuera benefits from government subsidies to expand its efforts. Treatment and prevention of chagas disease has been an especially pronounced aspect of the organization’s cooperation with the public sector, as it fulfills a glaring yet unaddressed gap in the agencies’ healthcare. Now the government has designated some of its public hospitals as teaching facilities for instruction on rural medicine, adopting Gustavo’s curriculum. It has further authorized some public universities to teach his program and has agreed in principal to pay La Higuera to implement its rural pediatrics initiatives. This alliance has been critical to increasing the reach of Gustavo’s organization.
As Gustavo looks to grow La Higuera and builds other Houses of Rural Pediatrics, he is turning his eye toward other abandoned northern states in Argentina beyond Chaco. He envisions the Houses becoming multipurpose facilities for rural development that will offer a myriad of tools for economic growth and improved quality of life. Building from the networks he has coalesced in these centers, he imagines that the communities will become equipped with new techniques to diversify their agricultural production, increase access to clean water and renewable energy, and market locally-made products. Gustavo has also created a community radio station in his home to broadcast information about the clinics and expand their reach to other nearby communities.
To achieve this vision, Gustavo recognizes that a more varied and sustainable funding strategy is crucial. To date, La Higuera has been bankrolled through donations from over 100 different donations from family and corporate foundations. Gustavo will soon receive income from the state government for the services he provides. For future expansion, he is organizing massive media-based fundraising campaigns, allying himself with prominent local figures who supported La Higuera during its startup, such as one of the world’s most famous soccer stars, Lionel Messi, and other Argentine artists to generate national and international. Such leading ambassadors for Gustavo’s work will heighten the visibility of La Higuera and will almost certainly generate on an exponential scale more enthusiasm from national universities, medical students, and other partners to join him.
Gustavo was deeply involved in social service as a member of Catholic Action, became a teacher and taught adults. His passion for medicine began after he learned about Dr. Laureano Maradona, a well-known doctor recognized for pioneering his work in rural areas. The opportunity to meet his role model before he died was a defining moment for Gustavo, who is still committed to Dr. Maradona’s philosophy of providing care for those who live beyond the reach of the Argentine medical system and need it most. Gustavo received his medical degree from the University of Rosario and completed a residency in pediatrics at the Victor J. Vilela Children’s Hospital. Long intending to join Doctors Without Borders and move to another part of the world, he traveled around the country and throughout Latin America learning about the varied realities faced by rural communities. Gustavo realized then that he was best prepared and, above all, most committed to working in Argentina.
An invitation from the Rotary Club took Gustavo to some of the poorest villages in Chaco, where he worked in a small hospital teaching pediatrics to seven students. In 2003, after making several trips to isolated areas and assessing the complexity of the challenges they faced, he created La Higuera. Meanwhile, he continued to serve as a faculty member and chief of residency in pediatrics at the children’s hospital in Rosario where he completed his residency. Gustavo still serves as a recognized expert in rural medicine, having published several articles in medical journals or conference proceedings on chagas disease among children and youth. La Higuera, though, embodies Gustavo’s vocation and mission to promote integrated and comprehensive rural healthcare that is intrinsically tied to the local community.