By Ibsen Martinez
People at Disney think it is an experiment worth trying and so does the local co-producer. Everyone around me looks jubilant and thrilled at the idea of a medical melodrama set in a big Latin American city. Latin American entertainment television has never produced anything nearly comparable to Dr. Kildare or E.R.
As usual, and despite their general optimism, almost everyone involved in the project throws at the writer the obvious objections raised by the idea of transplanting a distinctly all-American TV genre into Latin American entertainment media.
Every other day I am reminded that the show is not supposed to be aired by cable but on open TV. Consequently, some restraint in action and dialogue seems in order.
For instance, would a Colombian Meredith Grey—the leading female character of the American series—go to bed with a total stranger in the first episode? If so, how will the more conservative—or should I say more oppressed by machismo?—Colombian or Ecuadoran or Peruvian average woman viewer react to Meredith’s sexual mores?
By the way, I keep wondering who is that “average Latin America woman viewer” the producers keep talking about. Next question: How realistic should the surgical scenes be? Latin American film-making does not excel in special effects. Why then risk turning the pathos of a surgical scene into something of a Latin spoof of the original show? The list of this kind of concerns grows every single day.
But I also have questions of my own that, I am glad to say, no one has dismissed as irrelevant or inopportune. After all these years as a columnist at Econlib, almost all of my misgivings naturally stem from the economics involved in trying to make a Seattle Grace Hospital set in Bogotá seem credible. The producers seem to believe that I can answer them all by myself, as if I was the Amartya Sen or the Jeffrey Sachs of medical drama screenplay.
Interestingly enough, after only a few days’ work, my team of young Colombian scriptwriters became growingly interested in policy studies, Latin American studies, and international development and, most especially, in the way some Latin American countries have developed their own system of social protection.
Their analysis of many medical cases depicted in the original “Grey’s Anatomy” scripts, as well as some other cases more frequent in Colombia, often resorts to this “public policy” lens.
Thus, the task of writing a Latin American remake of a very popular American serial that can both entertain and be true to our region’s real health problems—a highly contentious and politicized issue—has proved very illustrative to me as a columnist who often who deals with economic and social matters.
One of the questions raised by my team is what kind of hospital would be the ideal set for the action of our still-in-the-making Latin American medical drama.
If we chose to set the series in a private hospital we risked alienating the show from the lowest socioeconomic segments of the audience.
On the other hand, setting the interns’ love stories in a typical, run-down, God-forsaken public Latin American hospital afflicted with chronic shortage of medicines, with faulty or obsolete facilities, and almost absolute lack of surgical equipment, there would be neither room nor time for romance. The show would probably be more of a docudrama full of destitute patients going through excruciating experiences, while desolate, underpaid doctors helplessly look on.
Such dilemmatic options summarize the tragedy of health care in a region where almost anyone who does not hold a credit card is refused treatment in a private hospital, no matter how serious her or his condition might be.
This merciless situation often develops into what Colombians call “Death rides” during which the patient’s relatives desperately call on various private and public hospitals in a fruitless pursuit of medical care. More often than not, the patient dies before getting attention. It must be noted that this is not a specific Colombian problem. These outrageous stories, often reflected in incensed media reports, keep happening almost in any Latin American big city while you read this article.
In his modern classic, The Rich and the Super-rich (1968), Ferdinand Lundberg suggests that the test for anyone of us to know how poor we are is to consider for a while if we are financially able to cope with a sudden serious medical condition. By this measuring stick, almost everyone in Latin America is poor when it comes to health care.
Certainly, social demands have been incorporated by governmental authorities since the beginning of the 20th century, as part of the process of urbanization and the launch of the industrialization process. Some of the most powerful, complex, and long-standing social security systems are to be found in the region, especially in those countries considered pioneers: Argentina, Brazil, Chile, and Uruguay.
There, social security institutions date back to the turn of the century, and have formed one of the most important channels in the relationship between the populist leadership and the urban working class.
Still, even in these countries, you can find a stratified health care system in which people in the formal labor market are entitled to social security benefits while the rest of the population receives faulty services provided by the ministry of health. This results in significant and cruel differences in access to and quality of services.
The core of what my young Colombian colleagues have found is this: According to many studies, in Latin America, the health sector is a powerful economic force, employing about 5% of the economically active population (EAP). Expenditure on health represents on average 5.7% of gross national product (GNP) in the countries of the region. However, public expenditure on health care accounts for only 49% of total health expenditure in the region; private expenditure for 50% and foreign development assistance for the remaining 1%. In terms of public expenditure on health care, the region does not compare favorably with the world average. Public expenditures on health care in the region is US $121 per person per year, or 2.2% of GNP, less than half of the world average of about US $323 per person per year (World Bank, 1993).1
That is where my team of writers and I myself stand: Though we have not come up with a title—”Grey’s Anatomy” has absolutely no meaning for the proverbial Latin American average woman viewer—we have solved many problems regarding the main characters of the series by reversing the way the “Americanization” of “Ugly Betty” was attained. We even have agreed what names will substitute Meredith, Derek and Allison.
But we still cannot figure out what kind of fictional hospital is the fittest for the young Latin American interns to work and start falling in love.
I find this inability more telling of the backwardness of our continent than many a book on Latin American underdevelopment.
Reshaping Health Care in Latin America: A Comparative Analysis of Health Care Reform in Argentina, Brazil, and Mexico International Development Research Centre. Ottawa: International Development Research Centre, 2000. Edited by Sonia Fleury, Susana Belmartino, and Enis Baris.
For more articles by Ibsen Martinez, see the Archive.