Lessons learned from Sotero del Rio & Common ground: public health in Chile

Laura studied abroad in Chile this summer. Photo courtesy of Laura Ruch / GlobeMed at Northwestern.

This summer, 2010-2011 GlobeMed at Northwestern globalhealthU co-coordinator Laura Ruch studied public health abroad in Chile and blogged for The 195. Below are excerpts from Laura’s blog, which covered her experiences this summer.

LESSONS LEARNED FROM SOTERO DEL RIO

Six weeks, dozens of women, and numerous hour long metro rides later, my research has wrapped up, and I realize I’ve learned about a lot more than what I set out to understand. Our project focused on how women can have a positive labor experience and what can be done to alleviate excessive pain during childbirth. Some of our “findings” were pretty obvious – epidurals do the trick, so long as they are administered quickly enough. The most painful part of labor is the “big shabang,” the dar de la luz. Also, when they are holding a brand new, healthy baby in their arms, most women will tell you they were pretty happy with their labor experience. However, I couldn’t help but notice the staggering inequalities between the public and private hospitals here. Chile has the 10th worst rating in the world for countries with the biggest income gaps, so it comes as no surprise that the quality of healthcare shows a broad range. While the upper class women give birth in meticulously clean hospitals with all the latest technology, similar to those in the US, the public hospitals have a whole different standard of care.

While nothing like so called “hospitals” I’ve seen in Guatemala, public hospitals in Chile don’t have that antibacterial, iodine smell that I’ve grown so used to in US hospitals. There are no potted plants, no automatic doors, no soft melodies playing out of mounted speakers to lighten the mood in a place often filled with mourning. Exhausted and alone, new mothers generally wait five hours or more until they can hold and feed their newborns. To me, the salasde postpartum feel crowded and stressful; the nurses go down the factory line of unadjustable beds, doling out dinners of pan and powered jugo.

There is a new option, however. A team of truly amazing public health workers has managed to get the funding to build a new ward in the hospital through a program called MASIP. Here, each patient has her own brightly painted room, complete with a Jacuzzi, private bathroom, adjustable bed, boom box, and scented candles. Perhaps even more importantly, her family can visit her almost all day long, and the nurses are highly trained in giving emotional support. The benefits of this program are tremendous, although right now it only admits “low risk” women. While many women here don’t receive any anesthesia, all of those we talked to gushed about their experience in the program. Their mothers affirmed that there was simply no comparison between their own labor experiences, in a normal public hospital setting, and those of their daughters. And the best part? The program actually saves the hospital money because women don’t have to keep changing rooms, the same health care workers treat them during their entire stay, and they are almost always able to go home sooner due to a quicker recovery time.

To summarize, I came to a few perhaps basic, yet still personally interesting realizations. First of all, pain is relative. A woman who knows the feeling of say, dislocating a shoulder, will likely not describe childbirth as being as painful of an experience as a woman who’s never dealt with serious pain before. Secondly, just like with our other senses, we can distract ourselves from the feeling of pain. Here is where the calming environment and supportive staff at MASIP play an important part for women going through labor. Finally, I was reminded that our life experiences, and the way we perceive them, are shaped in a large way by our mindset going into them. Those women with higher self-esteem and confidence, and those who really wanted to have a child, ultimately had a more positive, comfortable labor experience, no matter how many of their nerve endings were fired in the process.

Reflecting on these observations, I’ve realized that I’ve been thinking about health care the wrong way for a long time. I’ve always believed in the power of medicine, in the power of the physician, to serve as the backbone for a healthy society. I’ve forgotten about the power of the patient. What Chile really needs, and perhaps what lots of societies need, in order to improve the health of its people, is to empower them even before they require medical attention. It’s going to take a long time and a lot of economic development before the Chilean public hospitals will mirror the extravagance of the private ones. In the meantime, great strides can be made in improving the health care system by altering the mentality of the community. For the particular issue of maternal health, this means addressing the social forces behind the medicine. Women need to be treated as persons deserving of high quality, individualized care. They need to develop, at a young age, the self-esteem to realize they should ask for, or rather demand, that their needs be met. Finally, society should set the bar high for women, encouraging them to develop lofty goals and pursue their dreams rather than burden them with raising a family at a young age. That way, when a woman is ready to have a child, she will be excited and prepared, more confident and more capable.-LAURA RUCH


Photo courtesy of Laura Ruch / GlobeMed at Northwestern.

COMMON GROUND

Breaking news: time travels faster in Chile. According to my American watch, I’ve been here for three weeks, but I’ve definitely only been here for one MAX. All I can say is that I hope my returning flight ticket works on Chile time, because only five more weeks here just won’t do.

Yesterday was rather ironic. I began my morning meeting with my research group and going to one of the public hospitals for the first time. We learned about our project, which explores different methods of labor and postpartum care for mothers. Essentially, there is a push right now to convert to a more modern style, where the woman stays in the same room through labor, delivery, and recovery, and she can have family and friends visit as she wishes. In contrast, in public hospitals here, women are in one room for labor, another for delivery, and yet another for ~48 hours afterwards. Rather than having their own room, they share one large space with 10 or so other new mothers. When I walked into one of these rooms yesterday, I was shocked to see six new mothers on either side of me, of all ages, all total strangers. As I talked to them, rather than dwelling on their lack of privacy, they celebrated being surrounded by other women all in the same boat. They laughed with each other and admired one another’s guaguas (Chilean for “babies”). They all had that aura of pride and hopefulness in the possibilities for their child’s future, even though many of the mothers were poor, young, and single.

After class the same day, we went on an excursion to the Cementerio General, the oldest and largest cemetery in Chile. I normally hate cemeteries (who doesn’t?), but the overawing beauty of this place overrode the creepiness factor. Almost all the graves were above ground, made of stone, and impressive looking. There were wide paths, palm trees, and colorful flowers and vines. A four meter wide stone wall separated the graves of Catholics from the non-Catholics, for fear of uncleansed souls contaminating the pious ones (I’m glad they decided to err on the side of caution – everybody knows that the souls of the deceased can cross three, but not four, feet wide stone walls). Almost all of the Chilean presidents were buried in this cemetery, including Salvador Allende, the first democratically elected Socialist. He was overthrown in 1973 (with the help of Nixon and the CIA) by Pinochet, and committed suicide on September 11. Beside his majestic white grave, where his wife and daughter were also buried, a plaque read a few lines from his farewell speech, given hours before his death, in which he said, ”They have force and will be able to dominate us, but social progresses can be arrested by neither crime nor force. History is ours, and people make history.”

However, just like at the hospital, space was limited in the cemetery. Only a few inches were left between tombs, so it again felt like the emphasis lay in the collective whole, in the memory of the entire community, rather than the individuals. Only this time, corpses rather than newborns lay side by side. In a broader perspective, this speaks to me about the cultural differences between Chile and the US. At home, I value my privacy. I like to spend a bit of time every day by myself- reading, running, playing music, etc. While I still do that here, the culture places a bigger emphasis on being with family and working in groups. I’ve always heard that Americans tend to think of themselves as individuals, while in other countries, individuals view themselves in light of their community, and for the first time, I have really felt that difference. -LAURA RUCH

Photo courtesy of Laura Ruch / GlobeMed at Northwestern.

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