Ernesto continues to analyze the difficulties brought about by the loss of La Poderosa. Even a malfunctioning vehicle is more expensive than most people can afford, and owning one identified him and Alberto as members of the “wandering aristocracy.” Now, when they look like poor hitchhikers, locals are much less friendly to them. Still, they manage to find a fellow Argentinian who puts them up and gives them food at his tavern, La Gioconda.
Ernesto starts to truly realize that his happy-go-lucky experience in the first part of the trip was in large part a function of his class status. Identifying himself as part of the “aristocracy” shows him explicitly acknowledging the privileges he at first took for granted. Notably, Ernesto doesn’t mourn the loss of those privileges but embraces it, showing both personal maturity and an increased sense of political injustice.
While Alberto tries to obtain passage via boat to the leper colony at Easter Island, Ernesto meets an old woman with asthma in La Gioconda and attempts to treat her in her home. Although asthma is a treatable illness (Ernesto suffers from it himself), it requires regular healthcare and medicine. Ernesto can’t do anything helpful for the woman because there are no reliable local medical facilities. Ernesto feels inadequate because he’s able to do so little for her..
Even the most altruistic doctors working in underserved populations can’t do much if there aren’t adequate social services available. For the first time, Ernesto experiences the limits of what individual doctors can do to help people. This puts a damper on his career aspirations, because medicine no longer seems like such a clear path to social reform.
Looking around the woman’s tiny, crowded apartment, and squalid living conditions, Ernesto observes that her sickness affects her whole family’s socio-economic status. Because she can’t work and because the family has no personal savings or public safety net to help handle an emergency, they remain trapped in poverty. Moreover, of her inability to contribute, the woman becomes a pariah in her own family.
By evoking the domestic tragedy catalyzed by a simple case of asthma, Ernesto shows clearly that public health isn’t an isolated issue but affects economics and even basic family dynamics. At the same time as medicine begins to seem less and less like a useful career, health is emerging as a more and more central social issue.
He concludes that this woman’s case is not unique, and that a lack of social services prevents the working classes from becoming upwardly mobile and makes their survival much more precarious than that of the middle class. If politicians continue to foster this kind of inequality, he theorizes, they will face radical action by the angry populace.
Public health isn’t independent of political ideology—in fact, it’s dependent on political circumstances. This episode shows Ernesto’s political convictions proceeding directly from his early experiences in medicine. Moreover, by extrapolating from the circumstances of one woman to those of the entire working class, Ernesto shows that his ideology is rooted in personal experiences.
Finally, the men find that they can’t go to Easter Island because there are no ships for the next year. Ernesto and Alberto have to change their plans and move towards a new destination. Rather than crossing the barren terrain in the middle of Chile on foot, the men stow away on a ship sailing to the north of the country.
Ernesto chose the Easter Island leper colony as a destination when his thoughts on the field of medicine and his own career were less complicated. Turning away from Easter Island is also a symbolic turning away from practicing medicine as he had anticipated.