By rmattiola
Thus far, I’ve toured and observed 6 health centers with in the public sector: Two CESFAM (centro de salud familiar: Family Health Center) one CESCOF (centro comunitario de salud familiar: Community Family Health Center) one Posta Rural (rural post), UNACESS (la unidad de atención y control en salud sexual:a sexual health center) and Teleton (a center for children with motor disabilities).
A brief explanation of the private and public system before I begin with my observations and opinions:
The public system is entirely government run. In fact, the level of government involvement in health care is surprising. It is easy to classify their system of health care as “socialized” although it is not universal. However, there is still an obvious connection to social medicine (which studies the social determinants of health). Between 80 and 90% of Chileans have public insurance called FONASA (Fondo Nacional de Salud) which has 4 levels, A, B,C, and D. Those with A and B receive free health care. Those with C and D pay a percentage of their fees to the government for their health care (10% and 30%, respectively). The public sector adequately covers primary care, although the region of Arica and Parincota is seriously lacking in emergency care centers, and specialists. In fact, there is only one SAPU (urgent care center) and one hospital where specialists are difficult to utilize. Apparently, all the specialists are concentrated in Santiago.
Regarding the private system, I only know that insurance is much more expensive, there are more specialists, and wait times are supposedly shorter (there is plenty of justified complaining from locals about wait times in both sectors). As far as I know, the government only regulates the private industry and has no other involvement.
We’ve been informed of the policies that guarantee free basic health care to immigrants, foreigners and pregnant women. I’ve also seen bilingual posters and ethnomedical practitioners in primary care centers (although literacy in indigenous languages is low, and thus posters in indigenous languages is somewhat ineffective). Therefore, from my rudimentary knowledge, I believe the private sector provides adequate and inclusive access to intercultural health care.
I was fascinated by the physical design of the health care centers. They are true to their name in that patients can go to one centralized location and receive care from a doctor, nutritionist, psychologist, dentist, social worker, midwife, nurse, physical therapist—all under the same roof. In this setting, one can receive health care, not just care for a discrete symptom. This automatically creates an environment that is easier to navigate and more logical for a holistic medical culture. I feel that Chileans see the individual as the sum of many parts, which interact with various elements of life that can develop health or sickness.
The usuarios (users) are mainly mothers with children and senior citizens. It is uncommon to see a single middle aged man in the waiting room.
It seems that health care centers double as educational centers. There are plenty of informative posters and handouts decorating the walls of every health care center (much more so than in the US). Each health care center has a large poster near the entrance demonstrating and listing patient rights. Most centers also have posters about vaccines, healthy diets, and other various illnesses like Tb and Yellow fever.
During my first observations, I was excited to see treatment centered around self care, diet and lifestyle changes. I listened to conversations between doctors and patients about daily food intake and necessary exercise. I was impressed by the patience of the patients regarding their treatment. They did not question this lengthy treatment plan or ask for medications that they thought would cure their ailments in a faster, simpler manner. This method of guided self-treatment is still considered alternative medicine in the US. But when possible, especially for chronic illnesses, we should transition to this less expensive and more sustainable treatment style, following the footsteps of the chileans.
Arica has the highest rates of morbidity and mortality for HIV and Tb in all of Chile. The HIV epidemic is blamed on fierce taboo and stigma which prevents schools from educating their students about the disease and it’s prevention. Those who live with HIV often do not tell any of their family members due to the fear of discrimination. Apparently, for every person accounted for as HIV positive in Arica, there are 3 other who are living with it unconsciously. Although Arica has an identified problem, accessing HIV tests is still an issue. Policies have been adapted to reduce the barriers to access, but still, many do not get tested. The high mortality rate is blamed on abandonment of treatment and co-infection with Tb. I personally think that this region would greatly benefit from sexual education implementation and a program that mobilizes health care professionals to physically confirm the treatment plan for HIV or Tb is correctly followed (house visits).
The travel period begins this week. On Sunday (26) we leave for Putre, then briefly return to Arica before flying south to Temuco, then Pucon, then Santiago. In Putre, we’ll live at around 11,500 feet and be traveling to 14,700 feet. These are considered very high altitudes. I will be chewing coca leaves and drinking a tea made from other herbs known to reduce the symptoms of altitude sickness. We’ll be back in Arica April 17. I'll have easy access to the internet in Temuco and Santiago, but it might be a bit more of a struggle in Putre and Pucon. And by struggle I mean a glorious break from technology! I’m excited for new scenery, new kinds of people, new knowledge and the travel life.
Chilenismo of the week: po: Nearly untranslatable. It is liberally tacked on to the end of many sentences. Most closely resembles, “of course”, but used in many other forms as well.
Example: Sí, po.
Next time, you'll hear about some of the adventures in Putre!
Wish me luck!