My First Week of Clinical Observation

I certainly saw and learned a lot this week!
I spent Monday and Tuesday at Hospital Sótero del Río, which is one of the biggest hospitals in Chile. It also serves a lot of the poorest population of Santiago. The first thing I noticed was all the people in the waiting rooms. They were super-packed and it was rather difficult just to make it down the hallway amidst the patients, families, and snack-vendors. As I have learned, the long wait is one of the biggest problems with the public health care system here. It is not uncommon for patients to wait 2-8 hours for a doctor.

The hospital buildings themselves didn’t really seem like those of a hospital; there were no sterile-looking white floors and walls and bright lighting, but rather dingy tile floors and dim rooms and hallways. Another thing that was a bit shocking was the ease in which we entered and traversed most of the building without any questioning. I did not see any types of guards or security within the hospital.

The first day at Sótero del Río, I was taken with a few other students up to the general medicine floor, which contained mostly elderly patients. We went to the cardiac wing and spoke a little with a doctor and some nurses there. We also attempted to speak to two male patients about their experience. This did not go so well, because I really didn’t understand more than 5% of what they said to us, but luckily a nurse was with us to translate everything into simpler Spanish. Both patients said they were very content with the health care they had received at this hospital; in fact, one patient said the only complaint he had was that he wasn’t going to get to watch the Chile v. Honduras game on Wednesday.

Privacy is basically nonexistent here. There are six patients to a room, and the beds are not blocked off by any type of curtains. In addition, the patients’ full names are posted in bold print above their beds, and all of their charts are sitting at the foot of their bed for anyone to read. If this were to happen in the U.S., it would be a serious issue, but here it is no big deal. I really think a big reason for this difference is the culture; Chileans are much less individualistic and don’t seem to view confidentiality as something to be valued. Rather, they value community much more, and find worth in shared experiences. I think this is definitely something we can learn from—I’m not saying we need to start paper-planing patients’ charts around—but I’ve definitely observed and learned more about the merits of interdependence and community since arriving in Chile.

On the second day of observation, I got to go to with a group to the puerperio of the hospital. This is basically a post-natal unit, with eight beds per room. This means there’s a total minimum of sixteen people at one time, if you include the mothers and the babies, who always remain at their side. All of the babies were so adorable…all of that cuteness in one room is a bit overwhelming!

We first talked to a mom named Lisa who was only 19 years old. She was a member of FONASA level A, which is basically the level of public health insurance for the poorest group of Chileans. While the other levels of public health insurance require a monthly payment of 7% of your salary, level A requires nothing at all. Like in the U.S., teen pregnancy is a prevalent issue in Chile, especially among the lower economic class.

The next lady we talked had just had her first child, Franco. We talked to her about her birthing experience, her health insurance, and what she thought about the care she had received. We even got to see a midwife perform an entire checkup on the baby—it was really neat to see that. I really enjoyed the time I spent in the puerperio because I was able to have interesting conversations with the patients about their experiences and see how post-natal care is provided in a public Chilean hospital. Despite the hospital’s lack of resources, it provided an impressive quality of care to these women.

On the third day of observation, we went to Santa Clara, a home for children with HIV. Many of the children are living there because their family did not know how to handle their disease, or because they lived in abusive homes. It is very disheartening to know that these children have to live with a disease that they never deserved or asked for and that may have been prevented had the mother known she was HIV-positive or had she taken the proper clinical precautions to prevent transmission (taking proper medications, having a C-section, not breastfeeding). When all of these steps are taken, the chance of transmission is less than 2%. A big problem in Chile is the negative influence Catholicism has had on the people. Most Chileans, from what I have seen, are Catholic in culture but not in faith. Because of this, many are extremely conservative, prejudiced, and opposed to change. Chileans are also very homophobic, which is very unfortunate when it comes to HIV. If there weren’t such a stigma here attached to HIV and homosexuality, less people would feel ashamed or afraid of getting tested for HIV. It is, however, important to remember that Chile was just freed from the dictatorship of Pinochet in 1990. It seems like that dictatorship contributed to a culture of passivity in Chileans, and I think they do need more time to recover from that. For this reason, I realize it’s not quite fair to compare the receptiveness of the U.S. to homosexuals to that of Chile, since we never had to suffer such a dictatorship. I do hope and pray, however, that people here will become more open and loving towards each other—that could make a really big difference in so many ways.