It was very important. He had been waiting,  for quite a while, to have a knee surgery and that was the letter of the famous surgery-bank checks. When a person is waiting for a long time, they get a bank check and with that bank check  they can have that surgery in the private sector.
Era muy importante. Había esperado,  mucho tiempo a una cirugía de rodilla y era la carta de un cheques para cirugía;  cuando una persona espera mucho tiempo, logra un cheque para hacerse  la cirugía en el sector privado.