Why would someone who had achieved so much, who had revolutionised cardiac surgery in a way that continues to save millions of lives, and who was recognised internationally as one of the most important figures in medicine, kill himself? At the time of his death, the answer appeared to be that the Medical Foundation, which he had founded in 1975 with the aim of radically improving Argentina’s healthcare system, was on the brink of bankruptcy.
However, when Favaloro’s suicide note was officially released in 2009 it stressed that his death was not just a response to his debts, but an act of protest against corruption in Argentina’s medical system. Favaloro described the extent to which bribery and corruption had infiltrated health care and asserted that he would rather die than give into the demands of a crooked system.
This month marks the tenth anniversary of Favaloro’s death. Yet although a decade has passed, emotions connected with the doctor’s suicide still run high. Many regard him as a national hero: a facebook group demanding an official government tribute to the doctor already has over 57,000 members. A television documentary in the series Otro Tema described him as “possibly the most respected doctor in Argentina”. An article posted on taringa.net called him “one of the most honest and generous people from Argentina and from the whole world.”
Favaloro was born in a poor area of La Plata, the son of a carpenter and a seamstress. He reportedly decided to become a doctor when he was just four years old. He studied medicine and distinguished himself through hard work and dedication; his biography on the Fundación Favaloro website recalls that while completing his residency he “practically lived in the hospital”. After graduating he was employed as a country doctor in a small town in the Pampas, where he radically improved the health of the rural community, almost eliminating infant mortality and drastically reducing the cases of malnutrition and infection. Until the end of his life, he would proudly refer to himself as a “country doctor”.
From this relatively humble position, and with almost no knowledge of English, he was given the opportunity to go to the United States and study cardiac surgery at the prestigious Cleveland Clinic. After completing his residency he worked hard with a world-class group of heart surgeons and in 1967 he performed the first successful cardiac bypass.
At the time, the surgical technique was revolutionary. Dr Roberto Favaloro, René’s nephew and the current president of the Favaloro Foundation, explains: “at one time it was the most commonly performed surgery in the world.” It has saved and continues to save millions of lives.
After turning down offers from prestigious institutions in the US, Favaloro returned to Argentina in 1971, and in 1975 he founded the Fundación Favaloro, with the ambition of making it an important centre for treatment, education and research, in the style of the Cleveland Clinic. Complex surgeries were performed in the hospital and the idea was not just to provide healthcare for the rich, but also to set out a special provision for those who couldn’t pay. “We insisted on the admittance of a number of beds for the poor. This meant that hundreds of patients were treated completely free of charge,” Favaloro wrote in his final letter.
However, by 2000, when Argentina’s economic crisis was beginning to take hold, the Foundation was on the brink of collapse. Government subsidies that the institution had originally received were at first reduced, and then cut off completely in December 1998. This, as well as other financial difficulties, meant that when Dr Favaloro shot himself in 2000 the hospital was US$75 million in debt.
Favaloro’s death caused a public outcry, particularly when it was revealed that before committing suicide the doctor had sent a letter to President De La Rúa asking him for help: “I’m begging you to use your influence to get us an urgent donation… I’ve never been so depressed,” he wrote. The president said that he had not read the letter until 2nd August, four days after Favaloro died.
When Favaloro’s letter to De La Rúa was released to the press, questions were asked whether the President was partly responsible for the suicide. But the tone of Favaloro’s letter to De La Rúa, while desperate, does not blame the president: the doctor signed himself off “with the same affection as always”.
By contrast, Favaloro wrote two much harsher letters, one to the newspaper La Nación a few days before his death and another to the general public, just before he shot himself. Both are full of bitterness towards Argentine society and Argentina’s medical system.
His letter to La Nación complains: “recent times have transformed me into a beggar,” and ends “I feel alone in this society, which is truly made of shit.”
In his final suicide note, Favaloro’s anger at the corruption in the health care system is intense. He describes the representatives from Obras Sociales, unionised health insurance programs, as “a bunch of corrupt individuals that live at the cost of the workers”. He condemned the system of kickbacks, which he said dominated Argentine healthcare and he stated that the Foundation’s financial difficulties were due to the hospital’s refusal to participate in this crooked game: “It’s indubitable that being honest in our corrupt society has its cost. Sooner or later they make you pay,” he lamented.
Ultimately he asserted that he would rather die than become part of the corruption: “At this moment and at my age, it is incredibly difficult to break off with the ethical principals that I got from my parents, my teachers and my professors. I can’t change; I would rather disappear.”
But despite Favaloro’s emphatic declarations against corruption, there are some who doubt his motives. One example is Dr Claudia Beatriz Costa, another prestigious cardiologist who attended conferences with Favaloro and who is now the director of a foundation researching “mal de chagas”, a disease that affects the heart.
“If he really owed money and he was a person with as much passion and who was as virtuous as he liked to say, then he should have stayed here and carried on fighting,” says Dr Costa. “If you make a mistake and get mixed up in something that is bigger than you can handle, then you should admit it…sort it out.”
She goes on to argue: “he was a very proud man, a very proud man, and asking for help was too much for him”
There are others who also suggest that the financial difficulties of the hospital were due not to corruption, but to poor administration. Carlos Penelas, the ex-press officer of the Foundation stated: “He had a lot of help. He had a lot of help from a lot of governments. That’s the reality. The issue is how it was administered.”
Corruption in Argentina
Yet despite these arguments, there is no doubt that widespread corruption in the Argentine medical system is a reality.
In Favaloro’s final letter he described in detail a system of kickbacks, which involved doctors referring their patients to specific surgeons, and then receiving a 50% cut of the fees. Favaloro asserted that the mechanism dominated Argentine health care.Dr Roberto Favaloro agrees that corruption is still rife, and lists a number of ways that it affects medicine today. He describes doctors withholding paperwork from their patients, which would allow them to claim the cost of their treatment from their insurance brokers, until the patient has paid a bribe. He also describes surgeons teaming up with medical suppliers to overcharge patients for equipment, and then pocketing the difference.
Dr Costa presents an equally negative picture of corruption and decline in Argentine medicine. She says that both doctors and medical resources are badly distributed through the country, with the result that almost everyone from across Argentina has to come to Buenos Aires for hospital treatment. However, the provinces still receive considerable amounts of money to pay for health care, but instead of investing it properly in the medical system, provincial governments simply pocket the cash.
Ten years on. What happened?
After Favaloro’s death, the Foundation faced major difficulties. His nephew describes: “It was very hard because we had to find a balance. And you find the balance by making cuts. The nastiest part of that is that you have to cut human resources. We went down from 200 beds and 1200 employees to 100 beds and 800 employees.”
In addition, the Foundation had to stop treating patients for free except in very exceptional circumstances. Instead, it expanded departments that perform more profitable surgeries including kidney transplants, liver transplants and even plastic surgery. Now the Foundation has to be careful, but is doing well. “The question is not to lose our balance, otherwise what happened before will happen again,” explains Dr Roberto.
Favarolo: The Man
Now that the Foundation is operating successfully, the question is how Favaloro will be regarded by history. In the light of his medical achievements and his suicide, he is often seen as a national hero. More than this, he is praised for combining great work and sacrifice with personal modesty. His nephew describes his personality, saying: “Despite his greatness he had humility…He was a great man who was able to be charming and be a normal person. In the end he was always carried on being a country doctor in his way of life.“
However, accounts of him as an individual vary. Dr Costa asserts that he was “very pretentious…A proud person”. Rubén Ravera, an acquaintance of Favaloro, offers an opinion in the middle: “He was a proud man, but he wasn’t superior. He was just proud of what he had done.”
Like his personality, his legacy is somewhat elusive. Despite being praised as one of the most morally upright men in Argentine society, there are some who question his record. A documentary in the series Otro Tema points out that Favaloro worked with the military government when he first founded the Foundation. The program reports that Favaloro was “heavily criticised” for collaborating with the regime, but “he justified this link by saying it was a way to prevent his Foundation, which was going through financial difficulties, from being seized by the state.” The explanation does not seem entirely consistent with the content of his suicide note.
What seems certain however is that both Favaloro’s life and his death were very much affected by his own worldview, which was idealistic and rooted in the values of the past. Favaloro dedicated his doctoral thesis to his grandmother, and by all accounts identified very much with her and her generation.
“That was the generation that was all about honour, and the value of your word, and ‘I’ll kill myself’…Society expected it. If you couldn’t honour your debts, if you were a man, this is what you had to do,” says Dr Costa.
Favaloro combined these old fashioned values with powerful idealism. At a conference in Tel Aviv in 1995 he told his audience: “I have always believed that in the future reality will be constructed on the foundations of ideals and utopias.” Ten years on, we can see that these convictions formed a great part of how he lived, and how he died.