Loose ends.

I HAVE 8 HOURS LEFT IN CONCEPCIÓN. This is really bittersweet. I wasn't ready to leave two weeks ago...now I am. I'm really excited to be home for Christmas, my 9.5 days at home are almost completely full with plans to get together with friends and family, and I can't wait to see everyone at Middlebury...but I don't want to leave. Especially today, I've been trying to notice everything, trying to do everything I have or haven't done this semester...and of course, I made sure to absorb as much Vitamin D as possible before my journey to the tundra. Ooh, talk about shock.


The other day I decided to reflect a little about my experience here. I've been forced to "reflect" all semester, as the Midd program requires us to write in a journal (which is then corrected for grammar, ha). I've enjoyed that. So I decided to write a more thoughtful blog entry than usual, not just detailing the events of my life in Chile.


One thing I've noticed, and which I may have referenced before, is that I feel so CONSERVATIVE here, from a political standpoint (although I don't consider myself particularly conservative when I'm in the US). Before arriving, I had heard that people from other countries say that the two political parties in the US are right-wing and more-right-wing...and I understand why. The first round of the Chilean presidential elections was last Sunday, and one of the candidates was from the Communist Party. I had a conversation specifically about this with some students in my rural sociology class, and found myself trying to explain US politics (of which I know VERY little) and ideology (individual liberty/freedom is the most important/valued thing...maybe?), and when we got on the topic of communism, I realized that usually the US viewpoint of communism associates it with dictatorships, at least in what I've seen, which is much more negative than the Chilean viewpoint, which just sees communism as another form of government, in which the government has more control over social decision-making. It doesn't sound so scary when there's not a dictator involved (at least not to the Chileans...). Anyway. Another application-- In my internship at the Consultorio (public health clinic), I got to understand the public health system in Chile pretty well. This was really interesting for me, as there isn't the divide between "public" and "private" in healthcare in the US. One thing I noticed is that there is a lot of talk about rights in the public system. Those are important. Especially after a military dictatorship. One conversation that I had with a nurse, though, really got to me. We were talking about the day-after pill. Specifically, I was asking if it was sold (legally) in Chile (abortion is illegal here). He explained that it is sold legally, but that it isn't accessible to everyone, because although anyone can get a prescription from their doctor (public or private), the pill can only be obtained at an external pharmacy, where it needs to be bought. Users of the public health system can't get it at the pharmacies in the consultorios--they need to go elsewhere and purchase it. From this nurse's point of view, this setup basically shows that poor people don't have the right to the day-after pill, but that people with money do. What?!? (that was my reaction.) I guess it makes sense, ish. It depends how you look at the situation. As I see it, any user of the public healthcare system can go in to get prescriptions for birth control and condoms...and can get them at the consultorio's pharmacy. Therefore, why is it necessary to also be able to access the day-after pill? People should be personally responsible, right? They had the option of prevention...if they didn't use it, why should the government be bound by the people's "rights" to provide a backup? Of course, there are complications of this situation as well, like when people are raped, or the birth control method malfunctions, but in general, I just thought his viewpoint was strange, as he declared that people's rights were being violated through this setup. Trying to see it from his standpoint, it makes sense. If the pill is seen as a medical necessity, the patients who can't pay are going to lack a medical necessity, to which they are entitled. We differ on the point of necessity.


Another part of my LONG conversation with classmates last week involved talking about the healthcare setup in the US. This was interesting. A couple of people mentioned how they had heard that US citizens needed to go to Cuba to get medical attention when they had medical issues because of the effects of 9/11 (ex: NYC residents whose lungs had been affected by debris in the air)(note: I could not confirm or disaffirm the validity of this, as I had NEVER heard this beforehand...). Others mentioned Obama, as a figure of healthcare reform. After they completely bashed the system in the US, I asked them what they thought of the Chilean system. They said it was "a joke". A lot of people use the private system when they're young, working, and relatively healthy. Therefore, the healthcare taxes that they pay (7%) go to the private sector. Then, when they're old, not making money, and have more health problems, the private system is too expensive, so they switch to the public system, which they may have never paid into. This creates an issue where the public system is burdened with caring for these people, on top of the other users of the system,whose 7% is probably smaller than the 7% that the private-system patients pay, because the public-private divide is marked by socioeconomic standing, in most cases. This all doesn't have much of an impact on my ideas about health reform in the US, because what's being proposed, to my knowledge, is not a dual system of attention like the setup in Chile, but it just seemed funny to me that all of these sociology students want their government to control more of their resources when they think that they're not used efficiently...

Also, it's been fun here seeing how people view the US. Some, like a few sociology classmates, get all heated about the US's involvement in Chilean politics, especially in the pre-dictatorship period and in the education that the University of Chicago gave to a bunch of young Chilean economists, who then, armed with the ideas of Milton Freidman, helped to turn Chile into a very neoliberal place. Others, who are more idealistic about the US, have asked me if there is poverty there, if there are crimes, etc. When I explain the college application process, people tell me, "Oh, just like in Legally Blonde!" (and some think we don't need to pay for said college. oh my, are they wrong there). They see the American humor of Homer Simpson and the fairytale endings and massive homes of Extreme Makeover: Home Edition. I'm obviously generalizing here, and it's been better getting to know people on a personal level than note the stereotypical ways that Chileans think about the US. It's easier to talk about stereotypes, though. Also, although a lot of people don't like the way the US works (capitalism, international intervention, etc), they recognize that it offers them opportunities, particularly for higher education. I have met so many students here who are planning or hoping to study for a doctorate in the US...the Chilean government helps with scholarships to some.

One thing that people need to go get those doctorates, though, is that they need to speak, write, read, and understand English. I've been meeting up with a professor all semester to just converse in English so she can practice--she's got one of those scholarships, and wants to be able to use it! In working with her, seeing how the English teaching in schools can be badly orchestrated, and talking to people about how they want to learn English, I've come to the resolution that maybe I'll come back to teach English. Having a native English-speaking teacher is quite rare here, but can make a big difference in learning the language. I don't know how to teach English, but that could be remedied, right?

Anyway, enough reflecting and rambling. Sorry about that. Now I need to go, to finish my final essay for Juan, and sleep!

Love and excitement,
Tiernan

Blueberries in December

On Thursday, my rural sociology class went on a field trip. We spent the day in Negrete, a small town about two hours from Conce. We visited their association of canal members and a blueberry-kiwi-raspberry farm (we ate LOTS of berries, and got to see the area where they pack the blueberries to be exported). The day was topped off by a big lunch of roast meat, boiled potatoes, tomatoes, onions, and bread. Chilean hospitality at its best. Some of the students finished up the day with a party in the back of the bus on the way home, finishing up the wine and beer from our large lunch.

At the farm, I had my first notably embarrassing moment in Chile. I've said and done other thoughtless/stupid things while I've been here, but this was the most remarkable. We were discussing kiwis, and our guide was telling us that all of the really good, large fruit is exported, so the kiwis in Chilean grocery stores are, comparatively small. He asked me where I was from, and if I had noticed how much smaller the kiwis in Chile are. I really haven't noticed this (I've eaten some quite massive kiwis here, witnessed in an earlier post), but I didn't want to completely say he was wrong, so I started explaining, "Well, by now I've eaten a lot of Chileans..." Obviously, "Chileans" referred to kiwis, but seeing as the term "to eat" is sexually connotative in Chile, and I omitted the name of the fruit, I got the entire class laughing. Whoops. In times like this, it's good to be a foreigner...

Love and fresh fruit,

Tiernan

The North!

I just got home (to Conce) after a week of traveling around northern Chile with Amy. It was a good week--we got to see a lot of different types of places and have some adventures. To describe the week, I present photographic evidence of our travels, as well as some travel tips:

Travel tip #1: Don't forget your towel. Some hostels have them, some hostels rent them, sometimes you want to go to the beach...life's just easier with a towel. Amy forgot hers, so we tried to buy one in the grocery store in Santiago, the first stop on our journey. As it was just a normal-sized supermarket, her best option was a double-absorbent floor cleaning cloth, about 1 x 1.5 ft. She bought it. It did the job.

Travel tip #2: If traveling by air within Chile, wear whatever shoes you like...you don't need to take them off to go through security!

Travel tip #3: If leaving from the Santiago airport during this travel, buy a piece of pie de limon (lemon pie) before getting on board. It is quite the treat for a plane flight...

Travel tip #4: Don't spend the night in Calama. If you're in Chile and want to go to San Pedro de Atacama, the #2 (?) tourist destination in Chile, you can get on a 24-hour bus ride or a 2-hour flight from Santiago. Amy and I chose flight (with pie), which meant we arrived in Calama, the nearest city to San Pedro, late at night, after all the buses to San Pedro had left. We stayed at a hostel in Calama. Eww. We covered ourselves head-to-toe with clothing before climbing into our previously-slept-in beds (evidenced by hair from other sleepers). We slept quickly, and were up and out of there on the first bus to San Pedro...

Travel tip #5: Go sandboarding. It's fun, and not that hard. Climbing the dunes was the most tiring part, but once you're at the top, you get to sit on top of a sand dune!

Travel tip #6: Go to the Valle de la Luna and the Valle de la Muerte (Valley of the Moon and Valley of Death). Without the crowds, if possible.

Travel tip #7: If experiencing signs of altitude sickness, lay down for awhile with your feet higher than your head. This may be useful if you go to see the geysers El Tatio, a geyser field that's a two-hour-ish bus ride from San Pedro (which leaves at 4:30 AM). If you're lucky, your tour guide might feed you cookies and chocolate for breakfast (like ours), or eggs hard-boiled in the geysers.

Travel tip #8: If you get a chance to try llama meat, go for it. We ate llama meat ke-babs in this teensy village called Machuca on the way back from the geysers. it was a pretty strange place, an old town that has basically been preserved purely for tourists' visits. Between five and six people live there now, one of whom sells llama meat to the tourists. Ironically, the entire village is alongside a llama pasture... Travel tip #9: The Termas de Puritama (thermal baths) are lovely. Travel tip #10: GO SEE THE STARS. If you're in San Pedro, you should definitely sign up for a star tour. Amy and I did--it met up in the town and bussed us to a badly-lit location (with the goal of escaping light pollution). Our "tour guide" was a French astronomer who now lives in San Pedro and gives star tours (www.spaceobs.com). He explained the basic astronomy we should understand before beginning (ie. the Earth is round, the Sun is the center of our solar system), and then showed us the Southern hemisphere's constellations with his laser pointer. He told us how he thought many people were probably on drugs when they defined some of the more absurd constellations, and he made us feel really small by explaining the size of the Earth in comparison to the Sun and other stars-galaxies-etc. He taught us how to take a date stargazing. Haha. There was a set of large telescopes that he and his assistant focused on specific things, so that we could see some star clusters, emerging galaxies, the rising moon... and in the end, we were all herded inside for some hot chocolate. Success. It was interesting, entertaining, and beautiful. The stars were so clear and plentiful-- they actually twinkled!

Travel tip #11: Grado 10. If in San Pedro, this tour company is good. We went to the salt flats (where there are flamingoes! they can exist in the middle of a salt desert because there are pools of water in which grows a certain type of algae, which feeds a certain type of plankton (sea monkeys!), which feeds flamingoes) and the Altiplano Lakes with them. The guide was interesting, the bus was comfy, and the lunch they prepared was delicious!

Travel tip #12: Don't arrive at your destination at 7 AM on a Sunday. In Chile on Sundays, everything is closed. We hadn't thought about that before our arrival in Caldera. Oops. Since we were only going to spend a day there (on the beach, in Bahía Inglesa), we didn't have a hostel to crash in or anything...so we took a taxi to the beach. Some nice hotel receptionists let us store our backpacks in their hotel for the day, and we ate breakfast in a strange dome-shaped restaurant...

Travel tip #13: Wear your sunscreen, even when it's cloudy. The sun was hidden for most of our day at the beach. We went for a walk along the shore, napped on the sand, ate lunch, rented a kayak, and (finally) sunned at the end of the day. However, against Amy's wise warning, I didn't apply my sunblock. And I got burned. My skin is currently peeling to teach me my lesson...

Travel tip #14: Talk to the locals. When we arrived in La Serena, we walked around the city for awhile (which we liked--it's pretty, with lots of palm trees and colonial arquitecture), and then we headed to Coquimbo, because we had heard there was a nice beach there. A woman in the grocery store bathroom, however, pointed us to a better beach, where we headed after browsing the port area.

Travel tip #15: Tours to the Valle de Elqui are fun. The Valle de Elqui is a fertile valley between La Serena and the Andes. It's an area of a lot of contrast, because the valley is completely green, aided by the Elqui River, but the surrounding mountains are desert-like. We went on a tour to explore the area, and we saw lots of plants (for papaya, avocadoes, grapes, etc), a pisco factory, and some small towns. We ate at a restaurant where all the food is cooked in solar ovens!

Travel tip #16: Don't expect foreign movie theaters (Chilean ones, at least) to offer a wide selection of good films. Before our night bus out of La Serena, we had a good six hours to kill, so we decided to see a movie. Our options included Terror in the Antarctic, 2012, New Moon, and The Princess and the Frog. Guess what we saw? The newest hand-animated Disney feature. Dubbed in Spanish. It was kind of fun.

Travel tip #17: If spending a day in Santiago without a hostel, you can leave your bags in the Middlebury in Chile office (if a Midd student), or in the baggage custody area in the Alameda bus terminal. What a back-saver...

Travel tip #18: Watch out for false advertising. Amy and I had read about a restaurant that served American-style pancakes, no the skinny crepe-like kind the Chileans usually offer. Since Amy still has two months in Chile, we decided to search for the restaurant. We found it, and we were even more excited to see they had maple syrup on the menu! And real coffee! With anticipation, we took our first bites, and instantly realized something was wrong. They had lied about the maple syrup. It was something else. Don't go lying to Vermonters (and pseudo-Vermonters) about your syrup...

Travel tip #19: Cerro San Cristobal in Santiago is a great place to go to see a panoramic view of the city, but you may wish to buy funicular tickets for going up AND down. Amy and I decided we'd ride up and hike down...How hard is it to walk down a hill? After reaching the top, and seeing our fill of smoggy Santiago, we realized there isn't really a direct way down. There is a road that winds around the hill, but it takes a long time to walk (we were pressed for time to make our busses), so when we saw a path cutting through the woods, we took it. We ended up muddy and on the other side of the hill when we finally reached the bottom. Ha. It was fun to be "lost in the woods" in the middle of a huge city...

Travel tip #20: Go with a friend.

Now I've got to go! Field trip to the countryside tomorrow. Only 12 days left in Chile. What?!

Love and aventures,

Tiernan

Just realized it's DECEMBER!

Ridiculous. I got the Middlebury CF Christmas party invitation yesterday. It was red and green, and mentioned mangers and cookies...I experienced some type of culture shock. Spring does not feel like Christmastime, and I haven't eaten a homemade cookie in four months! Guess I'll just keep enjoying the spring, and feel reallly confused upon my plane's landing in Milwaukee...

Procrastination and preparation.

Our bus tickets have been bought. Our hostels are reserved. My clothing, shoes, and a week's supply of apples are waiting to be packed. Two essays are waiting to be finished. I am finding it incredibly hard to concentrate on schoolwork, due to (1) excitement and (2) a seemily decreased capacity to do schoolwork, thanks to my LONG break from Middlebury. So I'm writing a blog entry instead. Short story:

Two days ago, I went to the grocery store. As I was watching my items be scanned by the cashier, the man in line behind me said hi. Which never happens. I responded similarly, and he proceeded to tell me that my hair is really blonde. Hahahahaha....

Experiences like this (and crossing the street--vehicles are much more likely to stop) make being blonde in Chile really fun.

Back to work.

Love and essays,
Tiernan

Santiago and s'mores.

Two Thursdays ago I ran out of my rural sociology lecture to eat lunch, pack my backpack, and run out of my house in the direction of the bus station. I had one hour between class and my bus ticket to Santiago, and I had not planned/packed adequately beforehand. This left me with 20 minutes to get to the bus terminal, which isn’t far from my house…however, in my hurry to get there, I jumped in the first group taxi I saw that said “terminal”, and as the driver took an unexpected turn, I learned it was going to the OTHER bus terminal in Conce. An anxious wait and taxi ride later, I arrived at my bus, in the correct terminal, which, thank goodness, was running behind schedule.

All of this rushing around was for a good reason: I had plans to meet up with Celine and Lauren, two friends from Midd, at the Hillsong United concert in Santiago. My bus would be arriving one hour and twenty minutes before the concert, so I really couldn’t delay the trip. I arrived safely, successfully navigated the metro (subway), and found my friends! It was good to see them. As we walked into the concert, obviously foreigners, and obviously traveling (I was carrying my big backpack), a reporter started asking us questions. Lauren’s theory is that they were hoping we were crazy Hillsong fanatics, following the group on their tour. We disappointed them--students studying in Chile aren’t quite as exciting.

Exciting or not, the concert was interesting. Hillsong is a Christian worship band, based out of Hillsong Church in Australia. I was familiar with their music, but have never followed their songs or known their repertoire too well, thanks to my lack of experience in youth groups. Although the concert was introduced as a time of worship, it felt much more like a concert. I’m glad I went, if for nothing else than to experience a sea of cell-phone and digital camera LCD screens lighting the crowd in old-school cigarette-lighter fashion, and to take a few short videos for my host sister, Irina, who is 11 and loves Hillsong and really wanted to go see them live.

Celine's friends, Celine, me, and Lauren:

Anyway, enough about that. Lauren and I stayed in a hostel in Santiago, and spent the next day seeing the city with her Chilean man, Martín. We did the typical Plaza de Armas, museum, Cerro Santa Lucía (hill/garden in the city), and met up with Celine and her friend Luciano for awhile. The museum we went to was the “Museo de Bellas Artes”…Museum of Beautiful Art? Jaimie, a friend from Midd, had recommended it to me, and I really liked it. The art was really politically/ religiously charged, and I liked feeling like a cultured person, trying to interpret art. Ha.

The Bellas Artes metro stop. Love it.

And…what is that? Of course, a pyramid of human teeth.

Some kind of religious/ ruling type figures, along with bacteria, viruses, cultural tragedies and transvestites. Hmm.

And art made out of beads. Liked this one.

View of Santiago from Cerro Santa Lucía.

Saturday morning started our “excursion” with the Middlebury Program. The majority of the Midd students studying in Chile came to Santiago do some culture and nature. This meant that we hopped on a bus to go to the “Park of Peace”, a memorial site in Santiago which used to be called Villa Grimaldi. During the military dictatorship, which started in 1973, Villa Grimaldi was a secret government-run torture center, created for the treatment of political prisoners. The title “political prisoner” basically meant “anyone who supported/supports the previous president (Allende) and his socialistic ideals.” I’m oversimplifying this, but the general idea is that Villa Grimaldi represents a lot about the dictatorship. It was an intense visit—our guide had been detained there for thirteen months as a law student in the ‘70s—and we learned a lot about how the center had worked, specific methods of torture, etc. Although it was pretty sickening, I am glad we went. It’s important that people remember the horrifying things sometimes, and recognize the progress that’s been made in their wake.

We followed this by a visit to the General Cemetery of Santiago, which I really enjoyed. I know the words “enjoyment” and “cemetery” don’t usually arrive in the same context, but there we are. In general, I find cemeteries to be really peaceful places, and this one’s structure was an interesting social commentary of sorts…the importance of class, or inequality between classes, was very apparent. Where we entered, the tombs were large, elaborate, a lot of them basically family-sized mausoleums. There were trees and other plant life between these, but a lot of cement, with street signs naming the “roads” between tombs. As we progressed through the cemetery, the tombs became less and less impressive. We passed the “apartments", pictured below, and finally the graves that are in the ground, also pictured.

Big, “important” tomb

“Apartment”-style burial.

Burial in the ground...

Burial site of people who were buried without identification during the dictatorship, who since have been identified.

To change the pace after all of our culturing, we got back on the bus and took a little drive to el Cajón del Maipo, a valley/canyon in the Andes. Our destination was Cascada de las Ánimas, a resort and campground where we were to spend the night. We stayed in cute little cabins and shared delicious, good meals together. On Sunday morning we took a hike to some waterfalls (“cascadas” in Spanish) before eating lunch and heading out.

Drinking tea in our cabin.

Got to love some nature (see the snowcapped mountain tips in the distance?!).

Amy and me!

It was a really nice weekend. I was glad to get to know Santiago a bit better, as well as getting to meet Martín and Celine’s friends. It was also good to get to talk with the other Midd students. Some of them had flights home earlier this week, others will be staying through January, but in whatever case, we talked a lot about our experiences in Chile…it was a nice way to start wrapping the semester up.

Don’t expect to hear from me for awhile…I’m heading off on Wednesday on a flight to the north! Where there are deserts! Amy and I will be traveling together, heading to San Pedro de Atacama and various other cities in northern Chile. We’re planning on bringing lots of bottled water and sunscreen. Be back late on December 9! Time is flying. After this bout of traveling, I’ll have a field trip for one of my classes, a number of final assignments, and only twelve more days in Chile! Wow.

Hope you all are well!

Love and bus tickets,
Tiernan

P.S. Almost forgot…I’ve got to tell you s’more! Ha. Sorry. Tonight we made s’mores at my house. On Thanksgiving (which is not celebrated in Chile), I had hoped to whip up a pumpkin pie (“whip up” meaning “go buy butternut squash, cook it, puree it, make it into something resembling what Libby so nicely prepares, make a pie crust, and turn it all into something delicious”), but when Amy visited awhile ago, we realized the oven doesn’t work. So, pumpkin-pie-dreams crumbling, I elected to buy American marshmallows, chocolate, and graham-cracker-esque cookies, to make something “American” for my host fam on Thanksgiving. The actual s’more making was delayed until tonight, but it was good, gooey, and delicious. And prepared on the stovetop. Yum.

Happy Thanksgiving!

GYMDANCE!

As I've mentioned before, the typical Chilean diet contians a large quantity of bread. In my efforts to immerse myself in the Chilean culture, I have, therefore, consumed large quantities of bread.

So I decided to find myself a gym.

I started yesterday, finally. It's this funny little place about a fifteen-minute walk from my house, where there are mixed aerobics/dance/punching/situps/jumping classes every weeknight. From what I can tell, most people go a few times a week, if not nightly, which I like, because it a) motivates me to go more frequently and b) will hopefully let me get to know some of the people there!

All of this is not that exciting or important... but there's something that is.

This is the guy who teaches the class (and owns the gym?). His picture is blue because I took it from their website. But that's not important either. What's important is that his name is Angelo. And he really reminds me of Angelo (Fu) from Midd. They dance kind of similarly, although Chilean Angelo has yet to whip out the robot... hahahaha. I will never forget my aerobics instructor's name...

Love and endorphins,

Tiernan

Done with observation!

Get ready for the longest post ever.

I know I’ve mentioned the Consultorio a few times, or mentioned people from the Consultorio, or specific things I’ve done there, but I’ve never really explained it in full. Since I just finished my internship there on Friday, I thought I should explain exactly what the Consultorio is and what I did there for fifteen weeks…

The word “consultorio” technically just means “office”, but the term is used to refer to primary care centers in the Chilean public health system. Although I’ve referred to the Consultorio as a “clinic” in some posts, that was just to save us all the explanation--- Although the Consultorio has basically the same function as a clinic in the States, in Chile, the word “clinic” applies strictly to the private sector of medicine. For an explanation on the way the healthcare system works in Chile, see the P.S. at the end of this message.

Anyway. Back to the Consultorio… Its more formal name is CESFAM Villa Nonguen, which stands for Centro de Salud Familiar (Family Health Center). Family’s really big in Chile. The CESFAM has a whole bunch of medical professional-types who work there for the greater good (and health) of the community. People come in to see the doctor, to have their kids “checked-up”, to have cuts, gashes, and other various wounds and ailments treated, to enroll in an exercise program, to have a basic blood test, etc. In my role as “intern”, I got to spend time observing in a lot of different areas of the Consultorio. Observing is a key word here. Since I am really not qualified to do anything, I did a LOT of observation. Which can be interesting. Or not. The variety of places which were available to me for observation was what saved the day and kept things fresh.

The picture above kind of shows what the Consultorio is like. It’s really a bunch of little buildings connected by roofs to a big building:
Also, Chileans are into protecting their rights. I guess with a military dictatorship within the last 40 years of their history, that makes sense. It just was strange to me that there is talk of “rights” everywhere…
“November, Month of Mental Health [every month has a theme]. ‘I have the right to receive a first and last name that distinguishes me from the other boys and girls.’ Say NO to child abuse! Program of Mental Health. Family Health Center Villa Nonguen.”

I want to share the rest of my thoughts in bulletpoint form. They got longer than I anticipated. Sorry…
- Everyone who works at the Consultorio is not a doctor. Of course, there are nurses, and secretaries, and social workers, but there are also a lot of health professionals who are not technically doctors: the matrona (women’s health specialist), kinesiologist, dietician, psychologist, etc. They are professionally trained for their professions, but they don’t require med school.

- For my first day, I helped out in the reception/filing area, where all the patients’ folders are stored. In the process of helping retrieve folders, the secretaries started laughing at me…because I could reach the top shelf without the stool! These ladies ended up being really nice, and good to spend time with. Susana, the “boss” of the filing system, always had a little chocolate hiding somewhere, and she continually asked me if I’d found a “pololo” yet (boyfriend). I finally told her that, in general, they were just too short!

- Are you pregnant? Six years old? Have a sore tooth? Then you should go to the Consultorio! There are two dentists at the Consultorio, who mainly treated kids, older people, and pregnant women. What I thought was funny about their box was that the two of them would often talk on cell phones…during appointments…or would chat with each other while drilling their patients’ teeth. At least they used novacaine, and gave out coloring sheets to the kids.

- I got to watch a small surgery one day in the “curations” box…a woman came in with the hugest (i.e. thickest, not longest) toenail I have ever seen. Apparently, it was really a fungified toenail on top of a healthy one…so a doctor pried the whole thing off. Anesthetic was also used here, but it was gruesome. I have seen lots of invasive surgeries up close and personal, but this was worse. Usually, the “curations” box is filled with people getting blood pressures taken, getting injections, having their cuts/scrapes/wounds/ulcers cleaned, etc…not quite so horrifying as removing toenails.

This is one side of the “curations” box:

And this is the other. There are three cots to be occupied by patients.

- People can pick up milk at the Consultorio. Children, pregnant women, and elderly people are entitled to a certain amount of powdered milk every month. Each type of milk is formulated differently for the specific age group, and the older crowd can also get a bag of cream stuff that can be dissolved in water to make a nutrient-supplement soup. Yum.

- The nutritionist must be the most-lied-to medical professional out there. Out of all the appointments I saw, about 5% of the patients admitted to liking sweets. In a country where, at least in my house, there is jam and manjar (caramel) on the table at 2 of the 3 meals, I find this incredibly hard to believe.

The nutritionist had a food pyramid filled with plastic food on the wall. The little kids really liked that…

- I spent a fair amount of time with the matrona, seeing pregnant women, women looking for some birth control, women coming in for their PAP exams, etc. I also saw one male come in…I think he was forced by his mom, who accompanied him to the appointment. Apparently, men can go to the matrona to get a prescription for condoms. Not many come (shame factor? awkwardness?), although in the Consultorio’s pharmacy, things are basically free…

- The pharmacy. As mentioned, medicines, condoms, etc. are basically free. In most consultorios, they are completely free, but in the one I observed in, patients are charged about 25-50 cents per medication so that meds that they’re running short on can be ordered.

- When something is free, you want to use it, right? Like “riding the panther” at Midd, some people here feel that since they have the right to receive medical attention, they should come into the consultorio for everything. Or, if they’re lonely, they can make up an ailment to spend a few minutes with a doctor. I spent an afternoon with one of the doctors, and she had to see five patients every hour (now that’s efficiency!). She explained to me that it isn’t too uncommon that people show up with symptoms that they’ve made up, or that they come in when a child has had a cold for one day, or for other things that, to me (and to her), don’t seem worth a doctor’s time. I don’t want to communicate the wrong idea—the vast majority of the patients are people who should be seeing the doctor. I just thought this was an interesting side note.

- I got to go “a terreno” (to the land?) quite a bit. Basically, I got to go to houses, to schools, etc, to do checkups on kids (at the school), to take blood pressures and talk about health eating (at the local farmers’ market), to be amazed at how small newborns are (with the matrona on home visits, post-delivery), etc. I really liked getting to leave the Consultorio for awhile and see the village. An interesting this with this is that a number of times, we couldn’t find the houses from the addresses listed by patients, and their phone lines didn’t work. Some people, instead of saying that they would not like to have home visits, list an incorrect address and phone number, so that when the matrona tries to come check on their newborn, she goes on a wild goose chase to find their house, all the while calling a phone number that doesn’t exist to get in touch with them. To me, this seems much more inconvenient than just being honest. I think the idea that you don’t want to offend anyone about anything can be kind of strong here.

- In chatting with the people at the Consultorio, I got to learn about them, about Chile, about practical things (which micro to take to get to the bus terminal, etc), and I got to explain things about myself and the United States to them. I clarified a lot of misunderstandings about our health and education systems, particularly. One day, I found myself explaining that, yes, you must pay (quite a bit of money) to go to college in the US…

- Although everyone (myself included) wore a white coat or some other type of clinic-wear, a lot of professionals wore jeans with their professional wear.

Me looking confused, because it’s my last day and because I’m taking my own picture in the bathroom mirror:


All in all, I had a great experience. I learned a lot about how the Chilean healthcare system works, where it is really great and really not so great, the mentality of people about healthcare, and the mentality of Chileans in general. I met a variety of people, spent more hours observing than I ever care to do again (12 hrs/week), and got to dance in the Consultorio’s lobby during the week of their national celebration. Really, what more could I ask for?

Love and learning,
Tiernan

P.S. Here goes. The explanation of the Chilean medical system. If I’m wrong about anything, I’m sorry. This is from an email I wrote to Mom explaining this awhile ago…

To start, each person has a decision to make: do you want to be in the private healthcare system, or the public one?

Private system = ISAPRE (Instituto de Salud Provisional = Institute of Provisional Health?)
Public system = FONASA (Fondo Nacional de Salud = National Healthcare Fund)

Regardless of which system you choose, a percentage (7%, I think) will be deducted from your paychecks to pay for your healtcare.

If you choose to be ISAPRE, although part of your healthcare costs are subsidized by the government (the percentage you pay through paycheck deductions), you still need to pay the clinic/hospital/physician that is treating you for their services. This tends to be rather expensive, but the care is excellent and speedy. If you want a second opinion and have the money to pay a second physician, that choice is yours. If you go to the doctor and you are prescribed a certain type of medicine, you must go to the pharmacy and pay for that prescription out of pocket.

*note: with ISAPRE, you may also elect to pay for private health insurance. This insurance can help cover the costs of your treatment (including meds), but, obviously, you must pay your insurance bills every month, and you will still pay some money out of pocket for your doctor's visits, medications, etc.

If you choose to be FONASA, you are placed in one of four levels: A, B, C, or D.
A = You have no income. You pay 0 for your healthcare. When you go to the Consultorio, all care is free.
B = You make minimum wage. You pay 0 for your healthcare, like in level A.
C = You make money, you pay for a minimal percentage of your healthcare costs (I don't know what this percentage is...I want to say 10%?).
D = You make a really decent living, therefore you pay for a slightly higher percentage of your healthcare costs (30%? 60%? I really have no idea on this one).

*note: AUGE is a program that all members of FONASA are eligible for when they have specific conditions/diseases/problems that need medical attention (for example: cervical or breast cancer, pregnancy, etc). AUGE stands for "Acceso Universal para prestaciones integrales y Garantías Explícitas asociadas a la atención a prioridades," which translates roughly to "Universal Access for comprehensive benefits/assistance and Explicit Guarantees associated with attention to priorities". A bit wordy. Basically, it is a system that puts time constraints on the public hospitals and physicians, saying that they must treat patients within a certain time frame for specific conditions. Therefore, while someone in need of a necessary, but not urgent, surgery may wait a year or more for treatment, patients with conditions requiring more rapid care will receive care more quickly. This still doesn't mean it is extremely fast. Example: Yesterday, a woman came in to see the matrona about her PAP exam results. Her PAP was taken in June, and since the results usually take about a month and a half to be processed, the Consultorio recieved them in August. Since the analysis showed some atypical cells, the matrona needed to request an appointment with the specialist for her patient. The hospital/specialist has one month in which to schedule this appointment. The hospital/specialist tells the matrona when this appointment is scheduled (i.e. Monday at 9 AM), and the matrona calls the patient to come in for a consultation. The patient arrives, and the matrona tells her that the results were atypical, and although this does not guarantee cancer, it converts that patient into an AUGE patient (woman signs off on this). The matrona tells the patient that she needs to go to this hospital to see this specialist at this date and time, and the appointment is finished. If the patient has cancer, her treatment will be controlled by the timetables of AUGE.

Whew. If you are still reading this, I am impressed.