Chica en Arica: Bienvenidos a Putre

The past four days, I spent without wifi or a computer, in the rural area of the XV region of Chile, Parinacota, in the “city” of Putre. In this entire region, there are only about 1,300 people, mostly living  in the main pueblo of Putre, others in smaller, farther out communities of 30-40 people. Health care in this region is not only complicated by the geography (the huge rolling desert hills of the Altiplano make for very treacherous windy roads) but is also enriched by the influence of the Aymara traditional healing practices (Aymara are another indigenous group in Chile; they inhabit northern Chile, Bolivia, Argentina, and Peru). This half of the region of Chile is 90% Aymara.

Despite feeling a little dizzy from the lack of oxygen (Putre sits at about 3,000 meters above sea level), I really enjoyed the excursion. The first day, we toured the public family health center in the city, and talked to the doctors, nurses, nutritionists, techs etc. there. The next day, we learned about the herbs and medicines of the Aymara, ate lunch with some locals and discussed community empowerment with them (Side note: lunch was alpaca meat, actually pretty good!). We got a chance to go to one of the smaller pueblos, Socoroma, to visit the primary school and play with the children. Also in Socoroma, we learned about the monthly rounds the health team in Putre makes to the smaller surrounding villages, to do check ups and lab work for patients who can’t travel to the center in Putre. Some of these villages are 3 hours away from Putre. In cases of emergencies, these villages have radios, from which they can call an ambulance, but if you live 3 hours from Putre, you’ll need to wait, and the center there is only a primary care center: barely equipped to handle the most basic emergencies. The closest secondary or tertiary (more serious) care hospital is in Arica, which can be an additional 3 hours away, on a good day.

On the last day, we took a trip up to one of the highest lakes in the world, lake Chungara, which sits up there at 4,500 meters or 14763.8 feet above sea level. There were a lot of llamas hanging out, this is probably my favorite shot of the day.

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Chica en Arica: Meeting the Mapuche

Today, we drove out of the city of Temuco to Hospital Makewe, run by the Mapuche. The Mapuche are one of the indigenous populations in Chile; there are 1,442,214 people in Chile as of the 2002 census that claim Mapuche ancestry. The history with their relationship to the government is long and complicated. I was introduced to this history by a Chilean friend, who told me about how they were the last group of native South Americans to resist the Spanish conquest.

We arrived at the hospital and entered a Raku, or house. The Raku was one room, with a fire pit in the middle (It’s pretty cold here and the Rakus are heated only by the fires). Our first lecture was about the cosmovision of the Mapuche and their spirituality, taught by our Mapuche leaders/guides/friends. The Mapuche’s spiritual beliefs are not separate from their everyday lives. The word Mapuche literally translates into “People of the earth/land” but this translation lacks a lot of special connotations and additional meanings of the word Mapu (it means not only earth and land, but also space, physical and spiritual). A lot of words don’t translate well from Mapuzugun (language of the Mapuche) to Spanish, and then, of course, it’s going through another translation into English right now. I won’t get too into my limited understanding of the cosmovision, though, considering the fact that I took a single 2 hour class on the topic.

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La Chica en Arica va a Peru (health care, home visits, and HIV)

Sunday, the group hopped on our tour bus (we’re now calling it oruga, which means caterpillar) and headed up to Tacna, Peru. With a quick passage through border control, the trip took about an hour total. I heard that if you take a public bus, the trip costs a whopping $2, which I will keep in mind for my personal excursion up to Machupicchu.

The next morning, we arrived at a community health center to learn about the Peruvian health care system. Despite various health care reforms in the 1990s, there remains a lot of inequality in the system, and around 30% of Peruvians are uninsured. In the next 5 years, goals of reform include inclusion of all socioeconomic classes in the system, and especially universal coverage. This will prove to be difficult, considering hospitals and major primary care centers are located in the capital cities of each region (province) of Peru. In the most drastic case, it could take a patient 7 days of travel to reach the capital city of their region, if they happen to live at the border of their region and another. Medications tend to be pretty cheap in Peru, but are still only feasible to obtain with insurance. Even so, the Ministry of Development and Social Inclusion in Peru is in charge of a few programs that caught my eye: Cuna más, in which the state hires nannies for parents who both need to work during the day, Beca 18 which allows the top students in public high schools in each region to get a full ride to a university (again provided by the state), and PRONAA which provides breakfast for students in public elementary schools as a means of supplementary nutrition.

The overall focus of health care in Peru is on prevention. A biopsychosocial approach is stressed in settings of primary care, and the medical staff, which works with patients in teams of doctors, nurses, obstetricians, social workers, and medical technicians, is dedicated to being companions to the patients. This allows for a horizontal approach to a patient’s care, in which all parties work together on equal playing field, and all aspects of a patient’s life are respected as components to overall health. After our class, we were able to see this approach first-hand, as we accompanied staff out into the community to do home visits.

Individual staff members walk from the clinic to the homes of patients who cannot make it to the clinic themselves or who have missed appointments. My group visited with a woman to encourage her to go into the clinic for her first pap smear, and give her information about cancer screening. She had set out chairs for us to meet in her front yard, and we discussed her home and marriage situation, the health of her children, her insurance, and her own health concerns. The whole appointment lasted a little over an hour. The attention she was able to receive was incredible to me; a free consultation with a health care professional, who was not busy taking notes or checking vital signs during the entire conversation, just listening and laughing with the patient, and nodding and offering advice. On the other hand, this method goes slightly against the whole horizontal model, considering that the doctors, nurses, and social workers come into a patient’s home and play a bit of the “we know what’s best for you” game.

Yesterday, we went to the private University in Tacna, la Universidad Jorge Basarde G. Concha, to help the obstetrician students run an HIV testing fair. We handed out condoms and pamphlets of information to the students. I got to perform a few of the tests myself, and give the results to some students (that part was the hardest for me, trying to compose myself in a professional manner and explain complicated and serious things in Spanish, but I did it).

The end of the trip brought a trip to a pisco vineyard. Pisco is hard alcohol made from grapes, and it tastes like a very dry wine, with a flavor of dried fruit. We took a tour of the vineyard and learned how to make pisco sours from the campesinos. Needless to say, there were a lot of pictures of us sampling various types of pisco.

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