¡Hola!
Sorry I have not blogged in a while, time has a way of slipping through my fingers without me even realizing it. However, a friend recently asked if I was in a hut somewhere wearing a flowey dress helping deliver babies...so I decided it was time to catch you up on my life...
I have been in Chile for about 5.5 weeks and I am in my fourth week of school. I am settling into some sort of routine here in Chile, but not too much of a routine, cause that would be boring. Besides playing in the sand while drinking beer on the beach (see below), I am learning a lot about the Chilean health care system, constantly working on my spanish, preparing for my Independent Study Project (ISP), shadowing medical professionals, spending time with friends and family, and eating lots of mangos.
Chilean Health Care System (in brief): Chile has both a public and a private healthcare sector. About 80% of the population uses FONASA, the public sector and the remaining 20% use ISAPRE. The wealthier Chileans have ISAPRE and it has become a status thing of sorts. In FONASA there are 4 programs (A,B,C,D) depending on one´s income and number of dependents. Everyone in FONASA pays 7% of their income excluding FONASA A who have no income. If hospitalized or when seeing specialists, group A and B have no co-pay, group C pays 10% of costs, and group D pays 20% of costs. A person with ISAPRE pays 7% plus however much their specialized plan is depending on illnesses and dependents. FONASA and ISAPRE have different health centers, specialists, and hospitals. There is currently a deficit of specialists in the public sector because doctors, who make much more in the private sector, opt to work there.
There are a few health amendments that assure proper care for anyone that needs it. The ¨Ley de Urgencia¨ states that no healthcare organization can deny rapid attention to a person in need or deny them care due to lack of proper documentation. There is also a program called AUGE/GES for people who have one of 80 specified pathologies including Diabetes, Hepatitis B and C, Breast Cancer and AIDS. A person with a ¨patología GES¨ is guaranteed the best treatment available in a specified time frame. Due to this amendment every person with a serious illness gets attended to equally.
Some of the most serious health problems affecting Chile right now are HIV/AIDS (increased 40%) which coincides with the 40% augmentation in TB rates, adolescent pregnancies, and childhood obesity.
The Chilean Healthcare system is a 3-tier system. The third tier deals with people who are hospitalized. This could be for a chronic illness or only for a few days like after delivering a baby (parto). Level 2 consists of specialists and referrals from primary care. The majority of the focus and funding is in level one, promotion and prevention. This level consists of CESFAMS ( Centros de Salud Familiar or Family Health Centers, CESCOFs Centros de Salud Comunitaria Familiar or Rural Health Centers, and Emergency Rooms. The Healthcare professionals in primary care include paramedics, nurses, doctors, physical therapists/ respiration specialists, matronas (specialize in women´s and sexual health), child educators and psychologists. In my program we are focused mainly on the first level because that is where the majority of the public health initiatives take place. I have shadowed a matrona, a child psychomotor evaluator and a paramedic. I really enjoyed talking with the psychomotor evaluator who told me about the TIPSI test that all 3 year olds take which evaluates coordination, language skills, and motor skills. The educator also holds a variety of mandatory workshoppes for parents and I got the opportunity to sit in on a workshop for parents of 4.5 year olds discussing prevention of sexual abuse.
Things that have surprised me in my pasantías (CESFAM shadowing):
- Children get frequent checkups, but adults do not get yearly checkups and only come in if they are having a problem. I saw one many with very serious ulcers and an infection on his leg that he had ignored for the last 20 years.
- Lack of confidentiality: Doctors freely talk about patients and show us patient folders, patients are called from the waiting room by their full name, there are maps of the wall indicating where all of the chronic care patients live color-coded by illness: mental health, TB, bedridden etc-the purpose of this is so doctors and nurses know where to make house calls, but it still is a violation of privacy in my opinion.
- There are TONS of posters on the walls advertising healthy lifestyle choices, cervical cancer screenings, child health, sun cancer prevention etc. Even better, people actually stop to read them!
- The hospital signs are in both Spanish and Mapudugun (the language that the indigenous Mapuche community speaks). However, Mapudugun is an oral not a written language so the written equivalent was created non-indigenous people and many older Mapuches cant read it.
- All medication from the pharmacy is free! This includes contraceptives, condoms, and the morning after pill.
Weekly Horario (schedual):
PM: Métodos de Investigaciones where we prepare for our Independent projects
Tuesday, Wednesday, Thursday AM: Spanish 9-12
Tuesday Thursday PM: Salad Pública Seminar
Friday: Pasantía to a CESFAM in the AM
PM: Week review
For our biweekly seminars we are taught by local experts on a variety of public health related themes. We learned about the chilean healthcare model, environmental health of Chile, familial and marital violence and prevention, and AIDS prevention among other themes.
Other Things That Have Happened:
- There was a level 7 earthquake in Iquique (the closest city below Arica) two weeks ago followed by residual tremors everyday for the next two weeks. Some of the residual tremors got up to 6.4. During the earthquake I was playing volleyball on the beach and had to evacuate due to preventative tsunami warnings. I didn´t really feel the earthquake since I was playing and laughed in disbelief when my friend Randal said the ground was shaking. Some people are very frightened by the earthuakes and they have been the most common topic of discussion for the past two weeks. Ironically, when the earthquake went off Rihanna´s ¨Sound the Alarm¨ was playing on the beach....
- Went to two karaoke barbecues at Randall´s house. Chilean adults definitely go harder than American adults...Randall´s parents and parent´s friends invited us for some intense karaoke and adult beverages as we ate meat Randal´s dad had been cooking for over 2 hours!! Nancy, Randal´s mom, pouted until I sang Amy Whinehouse´s ¨Rehab¨ with her at both barbecues
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| ¨ A ella le encanta la GASOLINNA¨-Daddy Yankee |
- I went to Iquique with 8 friends last weekend. Iquique is another beautiful beach town with a little bit more of a modern, metropolitan feel. Iquique draws more tourists that Arica so there were more gringas and we didn't stick out like sore thumbs...as much. The night before Iquique we went to a karaoke barbecue at Randal´s house then took the 1:30 AM bus to Iquique. My host mom, a proud Iquiquean, said the morning bus was the only way to go ¨Para que no gastas la día¨ so as to not waste the day. We got into Iquique at 6:30 AM and were thankfully able to check into one of out hostel rooms where we snuggled/ siesta´ed until breakfast places opened up. For the rest of the weekend we hung out on the beach, shopped in El Zofre, a tax free mall, celebrated Randal´s birthday on our balcony, went to a club called ¨spacio¨, surfed and other water sports, and explored the city.
The gang in Iquique. As the sign says, ¨Long live the family¨ !!
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| Beautiful Iquique sunset |
- I formed a barrio gang called ¨Las Chicas de Azapa¨ with the other girls in my area. Anyone can join, but you will be hazed.
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| Azapa girls go salsa dancing |
- Signed up for the MCAT!! Woohooo making moves toward the future.
- I stumbled into the 1 year celebration mass for Pope Francis in a church designed by the same architect who designed the eiffel tower. It was a beautiful experience that I will never forget!
- Celebrated my friend Allie´s birthday with her family and 3 other girlfriends. After dinner Allie´s host dad and mom (Rodrigo and Maria Paz) sang her a beautiful duet called ¨Magicas Princessas¨ The song is about a father´s love for his daughter and his wish to protect her heart from any heartbreak and keep her small as long as possible. By the end of the song all four of us were bawling and really missed out dads. Rodrigo naturally responded by making sure we understood every single lyric of the song than singing it again #tears. It was an incredible sweet sentiment made even more special by the immense love Rodrigo and Maria Paz have for their 4 year old daughter, Paz Belín, who contently sat on her father´s lap during the performance.
Here are the lyrics to the song in Spanish, a below average english translation thanks to google translate. It is definitely corny, but enjoy!
Spanish:
Tengo dos excusas en mi mente,
para recordar mi vida ya mi casa regresar,
son un par de magicas princesas,
con pijamas y con trenzas que juegan a ser mama.
Ya se han dado cuenta que soy debil,
y con solo una sonrisa pueden todo conseguir,
de mi corazon se han vuelto dueñas
y me alegran la existencia con solo en ellas penzar.
Entre gimnasia y la tarea,
van creciendo muy de prisa.
Hay hay hay.
Las quisiera detener,
Pero un dia se iran de casa
y en sus cosas llevaran un pedazo de mi vida
que jamas regresara,
mientras tanto quiero darles tantas cosas,
quiero darles tanto amor tanta atencion,
y enseñarles cada dia su importancia y su valor,
quiero cuidarles el corazon.
Son como un jardin en primavera,
que se viste cada dia de belleza y esplendor,
son como palomas mensajeras
que el Señor mando del cielo
para hablarme de su amor.
Entre gimnasia y la tarea,
van creciendo muy de prisa.
Hay hay hay.
Las quisiera detener,
Pero un dia se iran de casa
y en sus cosas llevaran un pedazo de mi vida
que jamas regresara,
mientras tanto quiero darles tantas cosas,
quiero darles tanto amor tanta atencion,
y enseñarles cada dia su importancia y su valor,
quiero cuidarles el corazon.
Hay hay hay.
Las quisiera detener.
English:
I have two excuses in my mind,
to remember my life and return to my home,
They are a pair of magical princesses,
pajamas and pigtails pretending to be mom .
Already have realized that I am weak,
and with just a smile can all achieve,
They are the masters of my heart
and I rejoice in their existance .
Between sports teams and homework,
they grow very fast.
Hay hay hay .
I want to keep them small ,
But one day they will leave the house
and in their possessions take a piece of my life
they will never return,
Meanwhile I want to give so much,
I love them, give them attention ,
each day and teach their importance and value ,
I want to look after your heart.
They are like a garden in spring,
each day of beauty and splendor dresses,
are like pigeons
the Lord sent from heaven
to speak of his love.
Among gymnastics and homework,
they grow very fast.
Hay hay hay .
I want to keep them small ,
But one day they will leave the house
and in their possessions take a piece of my life
they will never return,,
Meanwhile I want to give so much,
I love them so much attention ,
each day and teach their importance and value ,
I want to look after your heart.
Hay hay hay .
I want to keep them small .
- My 28 year old host brother visited from Valparaiso and we went to an indigenous festival in celebration of water in the nearby San Miguel de Azapa. I really did not know what I was getting myself into...It was a full on adult water war. Throughout the town center people were selling water balloons which were used to peg mercilessly at others. I will always remember the feeling of getting pegged in the head by a grinning Aymara grandmother. I was also perplexed as to why there were so many small children in this war zone...? It was an exhilarating time. A full bucket of water was dumped off a balcony onto my friend Falon´s head. Aymaran dance groups paraded traditional dances and songs down the streets. My host brother told me that we experienced the last day of the 7 day festival... such endurance!
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| Water Wars selfie #terror |
Getting to interact daily with a community so different from that in which I was raised has made me think a lot about my life in the states and the things I need to be happy. I talk to Americans who quit their job to hike for 2 years, indigenous healers who are attempting to straighten a world in disequilibrium, first generation chilean high-schoolers completing their technical degrees, and I realize that the high-stress, competitive lifestyle I have been raised in is not the only life out there.
People here are fueled by their children, their hobbies, their travels, and have jobs that purely pay the bills. The importance of family, respect for your elders, and tradition shine brighter than I have ever seen them. I still have the same goals for myself: I still want to be a doctor, I still want to work with children, I still want to bring healthcare to underserved populations. If anything, I feel more centered in my goals with the understanding that there are different lifestyles out there to explore if I so choose, and that at the end of the day family, culture, sun, nature, and helping others make me happier than a high-paying job and a big house ever will.
Besos y Abrazos,
Carrie ¨continuing to be a small fish in a big sea¨ Zimmerman
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