northeastern chile 1.0: text version

So here goes my post to tell everyone about the absolutely amazing week I had on our excursion east.  I'm going to try to break it down day by day so it's a bit more manageable and I don't start rambling about unimportant things.  Here we go!

Day 1:

• We all loaded into our tour bus (yet again) and left Arica around 9:30am.  Putre technically is only about 60 km away but it's also 12,000 feet above sea level, which makes for a long, winding drive.  We stopped 4 times on the way to take a breather and adjust to the quickly rising altitude.

Almost to Putre - view from the bus

• After an absolutely breathtaking ride, we arrived to Putre in the early afternoon. We checked into our home for the week, Hotel Kukuli, and ate lunch. Almost immediately many of us were feeling the effects of the altitude - shortness of breath, pounding hearts, headaches.  Eh. 

• Lunch concluded and we walked to the town center to a small meeting room where we'd be having our classes for the week.  We met the excursion coordinator, Aldo, who acted as our "guide" of sorts for the week and he gave a presentation on the Indigenous Health System and Putre's context in particular.  I can't say I paid much attention to any of this - I was nauseous, light-headed, and feeling like I couldn't breathe.  One girl got up because she thought she was going to faint (and proceeded to puke outside the door) and I swore I was going to be next, but somehow I made it through the presentation. We were given some coca leaves to chew on or make tea with after an that helped a lot. 

• Later that afternoon we visited the local CESFAM (Centro de Salud Familiar; aka public health center) for a tour and to speak with the staff. The place was very tiny (sometimes they only have 5 or so patients a day!) but had a nurse, dentist, psychologist, and child developmental workers on staff.  There's also a paramedic that lives in the building who can be called 24/7 if an ambulance is needed.  The interesting part is that most of these people aren't actually residents of Putre but of Arica and they spend every other week in Putre.  Working in a small CESFAM like Putre's wouldn't be thought of as a very prestigious job in the Chilean medical field (the majority just enter the field for the money and prosperity instead of the desire to truly help people of all locations and statuses), so it's hard to fill the positions full-time to somebody who's interested in staying long-term. 

• Free time, dinner, bed.  Altitude sickness = no appetite and energy, so it was a bit of a rough night.   On top of that, very very cold!  The temperature dropped to around 30 degrees Fahrenheit around dinner time (and there's no heaters!) so we all piled on all of our warm clothes yet again. Thankfully there were about 5 (heavy) blankets on each bed so it wasn't too bad (minus the already suffocating feeling of not having enough oxygen).  My heart was still racing from chewing on coca leaves all afternoon, but after a while I drifted off to sleep.

Day 2:

• After a long night of strangely vivid dreams (which interestingly, quite a large number of us claimed to have) and waking up multiple times during the night gasping for air, Day 2 was ready to roll!  We ate a delicious breakfast in the hotel - cereal, bread, avocado, fruit, cheese, yogurt, and juice - and walked (still very slowly) to our classroom a few blocks away.

• Meeting with representatives from the Aymara community!  About 90% of the population in Putre (and the surrounding little communities) are of Aymara descent.  This morning about 10 different representatives of this community - doctors, midwives, farmers, etc - came in to talk to us about their role in the community and their health system.  I was grouped with 4 other Americans and two Aymaran women who came all the way from their pueblo that's about 3 hours away by bus.  These women weren't part of the traditional medicine system but were farmers.  They both came from the same village of about 10 families (and I thought Luverne was small) and their primary form of income was raising goats and farming.  They raise the goats as a food source and make fresh cheese to sell in Arica.  In terms of farming they grew all sorts of vegetables but were known for their oregano, which is also sold in Arica (and many other places as well).  One common thing that was heard among all the groups is that all of the children of these community members had moved away from their villages or Putre after school to live in Arica.  There aren't opportunities for higher education in these places and not many opportunities for work, so unless the children want to stay and work the land like their parents did they generally go to Arica.  These is causing an extreme demographic change in the area -- the population is overwhelmingly adultos mayores (older people).  It really makes you wonder what the future of Putre and the surrounding areas are - with a steadily aging population, who will sustain the community? Will Putre turn into another Chilean ghost town 50 years from now?  It's hard to say. 

• Lunch with the community representatives.  I ate salmon for the first official time, and unfortunately for probably the last time too.  Definitely not one of my favorites.

• In the afternoon class was taught by a yatiri (Aymaran doctor or "shaman" that uses mostly herbs to treat illnesses) and a partera or midwife.  The yatiri performed a few ceremonies to release the soul of somebody who recently passed away and also to wish good luck on somebody going on a journey.  The partera showed us different methods used to turn the baby before birth and also how to unwrap the cord.  Listening to their methods was definitely a learning experience -- a learning experience in cultural competency and open-mindedness.  You have to observe, accept, and support even if it doesn't make sense to you.  Overall, it truly was a once in a lifetime experience.

• Debriefing/feedback, dinner, sleep (with a little exploring in between). 

Day 3:

• Breakfast + load the bus to leave for Belén.  Belén is a rural town (with a population of 28 people) about 2 hours away.  The drive there was absolutely incredible - not like anything I'd ever seen before.

• Once in Belén we visited the posta or health center.  What an eye-opening experience that was!  The posta was tiny - about what you'd expect for a population of only 28 people (plus all the people in the surrounding villages).  It is run by one man, a paramedic who spends every other week in Belén and Arica (when another paramedic switches off with him).  When in Belén he does the work of an entire health team - he serves as the doctor, nurse, psychologist, matrona, everything.  Only very basic services are provided here, but they are available 24/7 because the paramedic lives on site.  For emergencies an ambulance is called in from Putre that will come to Belén and then take the individual to Arica.  Additionally, once a month a full medical staff comes to the area for what is call las rondas or "the rounds" essentially.  Las rondas visit all rural areas once a month and is the time when more specialized care can be provided or even basic care can be provided to those who have difficulty accessing the postas and clinics.  It was really impressive to hear all this one man does for the community.  One complaint he did have, however, was the lack of technology that's available to him.  There's no internet in the area and no cell phone services (companies don't want to pay to install towers in these rural areas when they could profit more off of installing them in more populated areas), and only one fixed phone (which only works with the usage of a calling card, which of course are not sold anywhere nearby and are very expensive).  In other words, besides the posta's radio used to call ambulances, communication is practically impossible.  Such a drastic change from the consumeristic life we're all used to living. 

• After our visit to the posta we visited the school in Belén - which currently as 6 students.  It's an intercultural school where the children learn Spanish, English, and Aymara.  They prepared and performed and traditional dance for us and the school "cook" made us a three typical Aymaran foods - goat cheese flavored with oregano, toasted corn, and llama jerky.  As a group we also brought various candies and kids toys to give to them (silly bands, candy flavored chapstick, toy cars, frisbees, bubbles, etc) because in general they really don't have access to that sort of thing.  It was a really, really touching experience and, once again, really made me open my eyes and evaluate my own life. 

• On our final stop of the day we went to Chapiquiña, another very small rural town in the region.  Here we visited centro de adultos mayores, essentially a house for older people who would otherwise live alone, and were served sopaipillas, a fried dough, with goat cheese and a spicy salsa, and guatia, a traditional Aymaran feast typically used for celebrations.  Guatia was quite the experience.  It is lamb, potatoes, and humitas (corn tamales) that are all completely cooked underground.  I took about 10 pictures of them digging it out of the ground because I was so excited about the whole process.  Once it was all recovered from the burning coals we were served absolutely giant portions -- each person got 4 potatoes, 2 humitas, and a giant hunk of lamb.  It was so delicious and soooo filling; I could barely eat half of my plate's worth.  After eating we strolled around the streets a bit.  Chapiquiña is located in the most beautiful of locations, everything was absolutely breathtaking.  But, at the same time, all very eerily quiet.  Besides the centro de adultos mayores, the city is practically abandoned, but all of the houses are buildings are still standing.  My first experience in a Chilean ghost town of sorts, you could say. The most interesting was seeing the old basketball court and playground at the edge of the city, uninhabited and rusty because not a single child lives in the town.

• Another long bus ride back to Putre.  That night we walked around the town a bit and perused though some of the stores for alpaca items (I bought a sweater and a headband) and watched the most beautiful sunset descent over the mountains.  All in all, the most incredible of days. 

Day 4

• Words can't fully describe the beauty I witnessed on Friday, the fourth and final day of our excursion.  We left around 10am and drove to Parque Nacional Lauca, one of the largest nature reserves in Chile, which includes Lagó Chungará (Lake Chungara), the highest-altitude lake in the world. The only complaint about the entire part is that we didnt get very close to any wild alpaca, event though they roam all over the park.  After an hour or so in the park we drove through the small town of Parinacota, a typical town of the altiplano area, and then headed to some termas or hot springs.  All of it absolutely exceeded my expectations.  Anybody can go to a big foreign city, but who can say they got the experience to eat guatia in a small diminishing village and spend time in the outskirts of the Andes talking with Aymara community leaders?  I feel like the luckiest girl, and am trying to soak in all these experiences as much as I possibly can.

I think that about sums up my week!  Next week I head to Peru but I'll try to do another post before then.  Also, I reached my limit on flickr already (frustrating), so I created a new picasso page - my pictures can now be viewed here:  https://picasaweb.google.com/100575919417646923485.

Chao,
Brittany

northeastern chile 1.0: photo version

Here's a few photos from my absolutely incredible excursion to northeastern Chile - Putre, Belén, Parinacota, Lago Chungará, Parque Nacional Lauca and everything in between.  Text to come soon!

recap, ISP, healthcare, días de patrias

So, I apologize that I've completely neglected this blog for the past two weeks.  There really isn't enough time in the day to do everything and then recount it as well!  And by now it would take way, way too long to talk about everything that I've done/learned/experienced in all that time, so I'm just going to talk about a select few.  But, to serve as a quick recap, here's a top 10 list of all that's happened (or that I can remember, in no particular order):

1. Hung out at the port with some sea lions
2. Visited a rural health center (posta), local health center (centro de salud familiar), and hospital
3. Went to a few discotecas (which I suppose would be roughly translated to "dance club")
4. Researched my ISP/discovered a (possible) topic
5. Partook in many wine-filled barbecues (asadas) with my family
6. Ate empanadas on the beach
7. Tried manjar ice cream for the first time
8. Shadowed a Chilean nurse
9. Cooked charquicán, a traditional Chilean vegetable stew with my madre
10. Began celebrating los días de patrias, Chile's 4-day weekend of celebrating their independence day, 18 de septiembre (September 18th).

Yeah!  I think that's a pretty well-composed list of what my past few weeks have been like.  A lot of class (5 hours a day typically) intermixed with hanging out with my family, pasantías (essentially field trips to different health centers), and getting to know the city.  Arica is a really chill place where everything is relaxed and friendly, but I'm really itching to see more of the country.  A frustrating part about SIT programs is that while you do travel quite a bit with the program, they highly discourage any other sort of travel.  So while I'm enjoying my time in Arica, I'm very, very ready to see more! Luckily I will be able to do that come Tuesday when we leave for our first excursion - more on that later!

Two weeks ago we had an assignment where we really had to crack down and start researching our possible ISP (Independent Study Project) topics seriously.  The ISP is a self-designed research project that each one of us individually designs and carries out during the month of November; anywhere in the country, about any topic concerning pubic health, traditional medicine, or community empowerment that we want.  To say the least, I've been struggling to find a topic that really inspires me.  I came to Chile thinking I wanted to research some aspect of tuberculosis among the indigenous populations, but that isn't really speaking to me anymore.  Now, for the past week or so I've been doing some research on acute respiratory infections (bronchitis, pneumonia, and bronchiolitis) in children under age 5 with adolescent mothers. In certain areas of Chile (particularly in the South), child mortality rates due to ARIs (primarily pneumonia) are very high.  In these areas, teenage pregnancy rates and poverty levels are also elevated - in the Araucania region in particular, where inequalities are the most extreme.  I've always been very interested in social determinants of health, so searching the correlation between these different factors could be very interesting.  I'm not completely set on it though.  Just today I thought about researching linguistic accessibility to health services.  Chile has a large indigenous population - both Mapuche and Aymara - and while the majority are bilingual, not all of them are, and language barriers are not an uncommon thing.  I have no idea what my focus could be on this, but the universality of it peaks my interest.  Language barriers exist all over the world - which means it's research that I could continue here in Chile, at home in Minnesota, or anywhere in the world.  I'll definitely have to look into that one more.

In addition to all that ISP garb, I'm learning a TON about the Chilean Health Care system.  Learning about the system is very interesting because we're also getting the experience to view it first-hand.  The health system here consists mainly of two components, FONASA (the public system) and ISAPRE (the private system), and then there are also special, smaller systems for military members and those of indigenous descent.  Anybody employed under a contract is automatically enrolled in the public system through a fixed 7% deduction out of their salary.  Those who elect to can opt out of the public system for the private system, in which they pay the 7% plus an additional percentage based on their income, health risks, number of dependents, etc.  Anyways, I could go on and on about everything else I've learned about the topic, but what's particularly interesting are all of the government-sponsored prevention and promotion programs, such a Chile Crece Contigo (Chile Grows Together).  CCC is a program that supports and sponsors women through pregnancy, childbirth, and provides resources for the children and families from birth through childhood.  When we toured the hospital we got the opportunity to talk to a nurse who works who assists mothers through the program, and she showed us the "care package" that goes home with every single newborn child born in the hospital, which included a pack-and-play type crib with sheets, a nursing pillow, a sling to carry the baby in, and clothes ranging from newborn sizes up to 6 months.  Along with this comes training on how to breast feed and also referrals and information on when and where to get vaccinations.  It's been really, really interesting to learn about and even more interesting to see in person.  

Enough with the healthcare garb now (I highly doubt it's interesting to anybody except us public health nerds), this weekend is Chile's independence day!  18 de septiembre (Sunday) to be exact, but you would never know it wasn't actually a four-day thing.  The celebrations started Wednesday for us when we had our own little fiesta de patrias in Spanish class, which included traditional songs, dance, games, and food.  It all felt a little preschool-y, but was a nice break from class and ended with an amazing "buffet" of typical Chilean cuisine.  We split up 15 or so different dishes - salads, entrees, and deserts - and split them between the 24 of us.  I made charquicán with my mom - a (mainly) vegetable stew made of squash, potatoes, corn, fresh green beans, peppers, garlic, greens, and a little bit of meat that's served with rice.  It was soooo delicious - very fresh and definitely something I would make and eat again (I'd probably leave out the meat next time though).  In addition to our class fiesta, all the main stuff downtown started yesterday.  There's a really big fería or fair (market) full of great artisanal products and also a carnival-like thing called las ramadas where there's lots food and games (such as the classic knock-down-all-the-cans-with-a-ball game, but here in Chile you don't win a stuffed animal for knocking down all the cans -- you win a bottle of wine). Today I spent all day in the sun in el centro with some girls from the program checking everything out - it was an absolutely beautiful, sunny, relaxing day. Tomorrow I'm going to my grandparents house in the Valle de Lluta again (they insist they're going to teach me cueca, Chile's national dance), so that should be interesting, haha, and Sunday there's going to be lots of parades and dancing and music (and drunk people) all around the city.  Very, very exciting! 

Tuesday, after our four-day weekend of celebrations, we leave for Putre - an Aymara town about 3 hours east of Arica.  We'll be there for four days learning about traditional Aymaran medicine and community empowerment.  I'm super excited for this excursion, both because it's the first time getting out of Arica and because I think the topics will really, really interest me.  Also, we get to go to beautiful Parque Nacional Lauca and Lago Chungará!  We will be a few thousand feet above sea level in the altiplano though, so it's going to be pretty cold at night, but that'll be okay (I'll just have to layer on the very few warm items I do have -- I reallllly wish I could go back and pack differently).  

That's all for now, I'll try really hard to write a post about the rest of weekend of celebrations and the trip to Putre next weekend!

Chao,

Brittany

p.s. lots of new pictures are up! www.flickr.com/photos/bliebhar

siesta, empanadas, bistec a lo pobre, etc.

Well, my semester has officially started!  Classes are underway and a sense of normalcy has finally begun to sink in.  I have spanish class every morning from 9-12 and then a seminar every afternoon from 3-5 or 5:30.  Spanish class is broken up into two parts, one part focusing on culture and the other part focusing on grammar and vocabulary, with a different professor teaching each of the two.  Seminars in the afternoon are either the Field Study Seminar or our regular Public Health Seminar.  What I've really been enjoying is the 3-hour break we have in the middle of the day known as siesta, which directly translates to "nap."  Historically this mid-day break began because men working out in the mines would come home for a few hours to escape the hottest part of the day, and their families would take a break as well to spend some time with them.  The tradition held strong in many parts of South America, and here in Arica especially many people go home to relax, eat lunch, and nap.  Many businesses and stores close for these few hours as well. It's definitely a drastic change from the "always rushing" feeling in the US, but I think it's just great.

Monday night I was finally able to give my host family their gifts - a bag of saltwater taffy and an address book with different photos of Minnesota on every page.  I was a little nervous that it was going to be a really lame gift (it's so hard to know what to get!), but they absolutely loved it.  Luckas and Matias attacked the taffy like a couple of starving children and Giovanna poured over the photos saying "ayyy parecen cómo las películas!" or "ohhh they look just like the movies!" After that we watched an episode of "Quién quiere ser millonario" (Who wants to be a millionaire) which was really great too.  Most of the questions are focused on Spanish culture so I'm pretty bad at it, but it's fun nonetheless. 

pisco sour

The rest of the week has just been continuing on - the normal routine of walk to class, class, walk home, eat lunch/hang out, walk to class, class, walk home, do whatever.  It comes out to about 2 hours of walking a day which has been a really easy way to get some exercise in. Other than that, Tuesday night a group of us headed to el centro to hang out, get some drinks, and have dinner.  We wandered the streets and stopped in many tiendas along the way before choosing a nice restaurant with an outdoor patio area where we ate some absolutely amazing empanadas.  I swear, I could eat empanadas every single day and not get sick of them.  I also ordered my first officially legal drink there (woo!), a pisco sour, Chile's "national cocktail" of sorts, which was a little strong but not bad!  It was really nice to just hang out and decompress from all the stress of adjusting to a spanish-speaking life.  We hung out there for about an hour and headed down the block to another restaurant, T&T (or Tartas y Tortas), where we met the rest of the group for Happy Hour (they call it Happy Hour in Spanish too, it's quite funny) and dinner.  We ordered a variety of fajitas, salads, appetizers, and the real winner - bistec a lo pobre.  Bistec a lo pobre (which ironically translates as "poor man's beef" is one of Chile's platos típicos, or typical dishes, which consists of a mound of french fries topped with steak and fried eggs.  Two of the girls thought they ordered a single plate to share, but got brought the larger portion - which was way, way more food than anybody could possibly eat.  It was a great night of food, drinks, and company, and we decided to make it a weekly tradition that we fittingly named "Fat American Tuesdays." 

bistec a lo pobre

Another exciting thing:  yesterday afternoon we got our assignments for what kinds of medical professionals we'll be shadowing this semester (we do various outings to different health care facilities in these first two months and two of the times we have the opportunity to shadow), and I got assigned to a tuberculosis nurse and a matrona, or a midwife.  I'm really, really excited for both of these.  I think it'll be a really great experience and I'll definitely be able to learn a lot from both of them.  I'm not a pre-med student or anything (which I've already been re-thinking a lot during the first week of the program), but the international perspective from these individuals will be really beneficial to my future studies.  Also, midwives here in Chile don't only primarily specialize in birth as they do in the US (for the most part), but they also do a lot with prenatal care and reproductive health in general.  Definitely an experience to look forward to!

Next post: volunteering, hot water heater, salsa classes, aeroboxing, and Walmart.  There's not nearly enough time to write about everything!  Off to class for now.

Chao, 

Brittany

p.s. I put up a few new photos! www.flickr.com/photos/bliebhard