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:
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.
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