Montevideo, Uruguay - Pope Leo XIV on Friday defended universal healthcare after undergoing surgery for lung cancer as he began a 12-day tour of South America in "fairly good shape."

Leo's sixth international tour takes him to the continent that helped shape his priesthood, just three weeks after being operated for a tumor on his right lung.

The 71-year-old pontiff will visit Uruguay, Argentina, and Peru on one of the most intense papal trips in decades, meeting political leaders, prisoners, the poor, as well as old friends.

Thousands of people, some waving yellow-and-white Vatican flags, lined the seafront of Uruguay's capital Montevideo to greet him as he waved from a custom-made popemobile.

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But the crowds were relatively sparse in Latin America's most secular country compared with Leo's recent visits to France and Spain.

Speaking in a half-empty Plaza Independencia, after being welcomed by left-wing President Yamandu Orsi, the pope lamented Uruguay's high suicide rates – among the highest in the world – and appealed for healthcare to be "accessible to everyone."

He said the care he received after his lung cancer diagnosis made him think of the "many men and women who lack the means to obtain a timely diagnosis" or receive treatment.

On the plane carrying him across the Atlantic, the pope told reporters he was "in fairly good shape" following his surgery, and his advice for others facing their own cancer diagnosis was "not to be afraid."

The pontiff said he was bringing a message of "hope" to the world's most Catholic continent.

Liberal Uruguay is at odds with the Catholic Church – as well as Latin America's new crop of rightwing leaders – on issues such as same-sex marriage, abortion, and euthanasia, which was legalized there last year.

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Leo issued a call for the "protection of the unborn" but also spoke to issues specific to Uruguay, such as its high suicide rates, which he called "painful."

A committed environmentalist, he had praise for the small country's "remarkable" achievement in greening its economy, which runs mainly on renewables.

The visit was the first by a pope in the nearly four decades. He will celebrate two open-air masses and visit a neighborhood experiencing gang violence and drug use.

The highlight of Leo's tour will be Peru, where he spent nearly two decades as a missionary and which he has referred to "one of my many homes."

The Church's first US-born pope, who has repeatedly clashed with President Donald Trump over the Middle East war, spoke on his plane about voting in this week's midterm elections.

His mail-in ballot made history as he was the first pope ever to have been known to vote in a political election.

"I'm proud to be an American and to exercise the right" to vote, he said.

Leo will travel on Sunday to Argentina, the homeland of his predecessor Pope Francis, who disappointed many Argentines by not returning to visit during his papacy. His trip is seen as a double homecoming of sorts, US-based Vatican expert Christopher White told AFP.

"History's first Latin American pope, Francis, never returned to his homeland. Leo, a Peruvian citizen, now carries forward that mantle and legacy," said White, who authored a book on Pope Leo.

Peru has been gripped by pope fever in the run-up to his arrival. In Lima, vendors are selling T-shirts and rosaries with his image on them, while Leo bread is on sale in bakeries. A towering, 46-foot statue of Leo has also been erected in the port city of Callao, which he is set to visit.

The trip will take him to the former Inca capital of Cusco and the Amazon rainforest, but the pope will also revisit his former life as Robert Francis Prevost, with a supper among priests from his old diocese of Chiclayo and a private visit to a chapel he helped rebuild.

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