There are basically two options for insurance: FONASA, the public insurance that is funded by taxes which 75% of the population is signed up for, and the ISAPRES, the private insurance an individual can buy based on their own health needs. Because of this system, and this is a huge generalization, the insured population is divided between the young, healthy, and rich that can afford Isapres and the old, sick, and poor that sign up for Fonasa. If you have Fonasa, you can only go to public hospitals and clinics unless you can pay for private centers, which boast low wait times for surgeries and better quality healthcare overall. Public hospitals suffer from a lack of resources and are often understaffed, sometimes leaving people waiting days in the emergency room and months for surgeries.
Today in my clinical observation, I had the opportunity to observe the emergency room at Hospital Sótero del Río. It's a public hospital in an area of Santiago with fewer resources than wealthy Providencia, where I live. It was an exhausting day, but I learned a lot about the realities of the public healthcare system in Chile.
I arrived at 9:30 am in the waiting room, which was already packed with people, and got shown back to the actual room where patients are treated and met the doctor I was going to follow for the day. He was very friendly, outgoing, and upbeat. As the day went on, my respect for this man increased exponentially as I saw how he maintained his positive attitude in light of the circumstances he works in. The emergency room's main room has 15 beds, separated by curtains, with just a computer and an IV stand next to each. There are three rooms that open into the main room, each with different roles: the first is the waiting room where people wait hours to be treated, the second is for people waiting to take blood tests, x-rays, or other exams. The third one is reserved for people who were hospitalized. There aren't enough beds, so four to five different IV's hung in front of a row of patients sitting in waiting room chairs.
To start the day, the doctor talked with a man who's liver was failing due to alcoholism. I could see the yellow eyes from jaundice; he was only 49. After that, the doctor spent a while filling out the patient's "ficha", the physical document that stays with the patient during their hospital stay that has all the medications, tests, medical history, and other relevant information, and organizing the ficha's of other patients. Although they have a computer system which logs the medical history, it's not available to every patient. The electronic system also serves as a mode of communication between different parts of the hospital, so the doctors can request different tests and send patients on their way. The system broke down twice, so the patients were stuck in limbo and the doctor's were unable to move on to other patients while the system got fixed.
After that, I moved on to the "sala de reanimación", basically the room where the most vital attention is given. Although the room was technically outfitted for 3 beds, there were 5 in the room. The most attention was being given to an 83-year-old woman who was moaning in pain and not breathing well. The doctors were discussing what to do, and they came to the conclusion that they should perform an intubation on her. They explained to her what was going to happen, said "Usted va a dormir ahora" (you are going to sleep now), and she nodded her head. I didn't realize that that would be her last communication with the world; she passed away after more than an hour of chest compressions. I was surprised at how much it didn't affect me; I guess surviving my mother's passing really did make me stronger. While they put her under, it was fascinating seeing all the doctors and nurses working as a team. They communicated and trusted each other during the entire process.
After those pleasant experiences, we went to lunch. It was really weird, transitioning from the enclosed emergency room with all the noise and movement, to going outside where a strange calm envelopes the rest of the hospital. While I was eating lunch with the doctor and the supervisor of the emergency room, it was hard for me to separate the ER environment from two normal people having a conversation about what they were going to do for the weekend. I guess that's something you learn on the job, separating your work from the rest of your life.
After lunch, the activity in the ER picked up noticeably. Stretchers from ambulances were used as beds because of the shortage. People were standing in the hallways because their weren't enough chairs. Because of my white lab coat I need to wear for the observations, people came up to me thinking I was a doctor and telling me their symptoms and asking when they were going to be seen. I constantly repeated myself saying "no soy doctora; no trabajo aquí" (I'm not a doctor; I don't work here). I heard the phrase "hay que esperar" (you'll have to wait) more times than I could count.
The second half of the day was WAY more exhausting than the first. I think it was because I started to feel trapped: I was in this place where clearly so many people needed help, but I couldn't do anything. I just sat and watched. I couldn't help the doctors organize the fichas, send requests for exams, listen to patients, I felt helpless because I didn't know anything. The doctor I was shadowing kept the same understanding and level of patience throughout the whole day, and didn't show any signs of exhaustion. I guess that's something else you get from the job, endurance.
This observation was the most challenging (even though I didn't come close to fainting once!!) but by far the most valuable. I saw a new reality and learned some truths about the quality of public healthcare in Chile. Most of all though, it reinforced in my brain that some of the most important and valued work someone can do often goes unrecognized. The doctors who work in the public system don't get paid as much as in the private sector. But they stick with their jobs because they know these people need help and they know they're needed, even though they know they can get more of a monetary reward working in the private system.
Now that I've seen Chile's public ER, I need to see one in the US to compare how bad the discrepancy is. The US has SO much and people never realize it and appreciate it enough. I wish there was a way we could balance out the quality of healthcare for everyone in the world. Such a Miss-Congeniality-world-peace-style desire, but one can dream, right?
It's a right, not a privilege, to have a functioning body that allows you to pursue happiness. And nothing should stand in your way of achieving that.