The Road Less Traveled

"Twenty years from now you will be more disappointed by the things you didn’t do than by the ones you did do. So throw off the bowlines, sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover.” – Mark Twain
~ Wednesday, December 12 ~
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Patagonia

I have been delaying writing this post because I honestly do not know where to begin. How can I pick which details to tell you or attempt to summarize 5 days of hiking through the most pristine and breathtaking place I have ever been? 

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I was very excited to begin the trip because it was the one place I was determined to visit when I decided to study abroad in Santiago. With my 5 friends, we took a sunrise flight to Punta Arenas, the southern-most city in Chile, and then a bus 2 hours north to Puerta Natales, the town closest to Torres del Paine, the National Park in Patagonia. Foreshadowing more happenings to come, Sara’s wallet was stolen from the seat next to her when we all fell asleep on the bus. We spent the afternoon and evening going to an orientation (we got a little frightened by warnings of extreme wind and weather and sub-zero nighttime temperatures), renting equipment, and organizing our packs. Our hostel was really adorable. It was owned by a man from Oregon and managed by his friend, Julie, who we loved. 

The next morning, after a anxious night’s sleep, we received a great breakfast before getting on the bus to Torres del Paine. During the ride, I saw flamingos and guanacos, a South American animal similar to llamas. At the park entrance, we watched a video about the rules of the park and paid the (Chilean!) entrance fee. We walked out of the building to find that our bus was not there! After finding out from a park employ that “no, this never happens,” we ended up getting on another bus, but were really worried that we would not get our packs from the our bus. When we arrived at the Catamaran, our bus was there. Of course, the driver just shrugged and none of the other passengers had said anything even though they knew we weren’t there! We took the Catamaran across the lake and met some Israelis that we continued to see for the next 5 days. The moment we were on land near the Refugio and trail head, everyone split! We realized that even though we had a plan, everyone else was one step ahead. After some organization, we started the day’s 4 hour hike to Refugio Grey.

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Our packs were heavy, but the hike was so spectacular we forgot after a while. We stopped at the first river to experience our first drink from nature. (The water is so pure that it is possible to drink without boiling or iodine). We saw glaciers including the largest, called Glacier Grey, and the landscape was beautiful. We climbed and descended hills, mountains, cliffs, and rivers. The first part of the hike was charred from last year’s fire (http://www.huffingtonpost.com/2011/12/30/patagonia-forest-fires-close-park_n_1176327.html) but gradually we saw more green. The was also the windiest part of the 5 day hike. At times I had to use my poles for balance because the wind was blowing me over. When we arrived at camp (a paid campsite with a cooking area and bathrooms), everyone was already cooking or relaxing. We struggled in the wind to put up our 4 person tent and then went to cook dinner. After one of the cookers caught fire, we were told to move our tent because it was in the direct path of the wind and would “go to sh*t” in the night. After pasta, we crawled into our sleeping bags. The first day had been quite the adventure and a learning experience and we knew the next days we would only become better! 

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The second day we re-traced our steps (we were at the top left of the W) and continued on 2 more hours. The landscape was again burnt, but the last hour of the hike was stunning. We were hiking with a view of the lake and the campsite (a free one without any provisions) was right next to a huge running river in the mountains. We set up much faster and Miranda made a great dinner of couscous, almonds, raisins, and cinnamon. After chatting with our Israeli friends at dinner, we cleaned up and went to our tents. I fell asleep to the sound of the river rushing past the campsite.

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view from campsite

I woke up the next morning to the sound of rain hitting our tent. We packed up everything even though the next part of the hike was without packs. Then, we realized that wasn’t smart because we needed to put our packs somewhere dry. We re-pitched a tent and then headed on our way up to a summit. This hike was a favorite of many. Taking a 360-degree look, it felt as though we were in multiple different biomes. There were mountains, waterfalls, forests, and a lake in the distance. It was unbelievable. We enjoyed the path and the rain. Unfortunately, a little twinge in my knee from the previous days turned into a stabbing pain when climbing or descending. However, I sucked it up and we all had a great time. We met some Chileans from Santiago and Valpo on our way down and the took to calling us “gringas locas” for the next few days. We grabbed our stuff from camp and headed on to the next campsite. The trail was again above and along the lake. The best moment of the day, and after group reflection— of the trip, was when the path brought us onto the beach next to the lake. We took off our packs and laid down right next to the water, soaking up the sun. The rocks felt like a massage. After a long break, we arrived at the Refugio in awe. The site was a the bottom of the mountains and there was a waterfall visible. It was also right next to the river. Also, there were platforms to put our tents! They felt like a plush mattress after 2 nights of sleeping on the ground. We had green tea and noodle soup for dinner and then curled up in our tents. 

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view from campsite

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After our daily dose of oatmeal, we continued on our 4th day of hiking. The trail felt like the countryside. We crossed many running rivers and muddy areas. Sara decided that walking straight through was the best option at one of the them, but it definitely was not. It was like quicksand and she got mud up to her knees. We saw wild horses and passed many travelers. It began to rain when we were about 2.5 hours from camp. By the time we were at camp, we were wet and cold. The temperature had dropped and we rushed to set up so we could cook. The site guard asked us if it was our first time setting up our tent. We told him it was our 4th. He then asked if we need help and Tess responded sternly in Spanish, “We don’t need help!” We ate pasta and the smores we had been saving and were snuggled in our sleeping bags by 7:30 PM. We finally went to bed at 9 with our alarms set for 4:30 AM. 

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Waking up at 4:30 AM to complete darkness, freezing cold, and the sound of pouring rain was not encouraging. We debated for about 10 minutes and then decided we didn’t want to miss the sunrise over the towers (the 2 mountains the park is named for). We hiked 45 minutes up and arrived at the end of the W trail. Unfortunately, the day was very cloudy and we couldn’t see the sunrise. However, it was vale la pena (worth it) because it started snowing!! The way down was awesome. The path went back down the mountain and through the forest and the snow made it feel like a winter wonderland. My knee was bothering me so I took my time and it was great to have some time to think alone. We gathered our things at camp and decided to keep moving to stay warm. Luckily, the weather improved and we hiked to where we had planned to take the shuttle to the park entrance. However, we arrived there 3 hours early and just decided to hike the 7.5 extra kilometers to the entrance. We were exhausted, but exhilarated. It was an unbelievable moment to know we had hiked the entire trail, 51.3 miles in 5 days. 

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We slept the entire way back to Puerta Natales and after struggling to find our hostel, I took my first shower in 5 days. The water pressure was horrible and the water was scalding hot, but it felt like the best shower ever. We celebrated the end of our adventure with avocado, pizza, and wine. It was so fun and perfect. We had a room to ourselves so we climbed into Michele’s bed to look at pictures. Then we reflected and went to sleep. The next day, after narrowly catching a bus to Punta Arenas and being entertained by the deaf bus attendant, who luckily Tess could communicate with, we arrived in Santiago (with our Chilean trail friends). 

It was an incredible trip—I learned so much about myself and my friends, the best way to deal with difficult situations, etc. After my knee bothered me, I took a moment to be thankful for health and wellness because as a young person, I don’t appreciate my body and health until it is not perfect. It was truly a growing experience as we all realized how strong our bodies as well as appreciating the great company and the experience. It was also a blast! We laughed often and loved that other hikers thought we looked young enough to be in high school and called us “las gringas locas.” We met people from all over the world and formed a resemblance of community with fellow hikers because most people follow the same path and we saw the same people day after day. I LOVE being outside and being active and it was the most breathtaking, spectacular place one could ever hope to hike. 

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~ Wednesday, November 21 ~
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Ultrasound

Upon showing up at the hospital, we were again confronted with the fact that the hospital and employees still had not worked out agreement, and therefore, there was still a strike. Luckily, I was supposed to be in Ultrasound which was still treating patients, just less of them.

I was paired with a young, female doctor who was very smart and talkative. She was in her first of three years of residency. Before the first patient arrived, I found out that she participated in an exchange program through La Católica and Harvard last year and did a medical school rotation at Mass General Hospital. For anyone that knows me well, you know that my dream is to work there. Therefore, I immediately had a million questions for her and we talked about her experience for quite some time.  

One of the most interesting things she noted was that there are so many more resources in the US. We were talking about the differences in between the public hospital (Soltero del Rio) and La Católica and the US. She mentioned that she was SHOCKED we the surgeon at Mass Gen used 4 sutures on someone’s abdomen and repeated the process 2 times after making a mistake. She said she was taught with 2 sutures and that mistakes could not be made because there were not enough materials. I had never thought about the wealth of resources we have in hospitals in that context before. 

Next, I observed while she did ultrasounds on a variety of patients. It was really fascinating because at first everything looked like shades of black and white, but by the end I could pick out the ovaries, uterus, or the baby’s hands and mouth. There was a variety of patients from an older woman with fibroids, to a teenager with stomach pain, and some expecting mothers. One mother needed an ultrasound to see how much her baby weighed because they realized that it was growing very fast. At 30 weeks, the baby was already 6.5 pounds! 

The most interesting and heartwarming case was a recently pregnant woman who had a baby at 9.5 weeks gestational age. On the ultrasound, I could see the head which was the biggest formation, the formation of the hands, and we could hear the heartbeat. It was so cool! The doctor told me that the baby was 2 cm!!! How tiny!!

That was my last round for clinical and I have really enjoyed the experience. This program is a large majority of why I picked to come to Santiago and be in my program and I am glad that I have learned so much about a different health care system. I feel that I now understand how hospitals function without the resources we have in the US (not well, most of the time) and the distinction between public and private care. I also feel more informed about our health care system and now have ideas about how we could improve it. 


~ Monday, November 19 ~
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Valparaíso/Viña del Mar de nuevo and Half Marathon #2

On Friday, we caught the bus to Viña del Mar ($10 roundtrip). Viña is a tourist destination with beautiful beaches and nice cafes. Unfortunately, we didn’t look at the weather very closely and when we arrived it was rainy and cold. We walked to a cafe, ate our packed lunches, and ordered hot chocolate and cake. Then we headed to the mall and went to the movie theatre on the top floor. We watched Ruby, the girl of my dreams (not recommended) and then by the time we exited the mall, the sun was just peeking through the clouds! We go to relax on the beach for a few hours which was so great! Then, we took a 20 minutes ride to Valpo where our hostel was. 

Valpo is known for its colorful houses placed on steep hills, its street art, and its bohemian people. It is a port-city and is the poorest city in Chile. Our hostel was really cute and we got a room to ourselves! After getting a little turned around in a not-so-great area, we found the restaurant that was recommended. I had fettucine alfredo with shrimp and we ordered empanadas to start with. Since, I planned to run a half-marathon the next day, I was glad to be getting my fair share of carbs! 

Saturday, we took a 3 hour walking tour of Valpo. It was called tour-for-tips, so it was free except whatever you want to tip at the end. It was really fascinating and the guide was from Valpo so he knew so many facts and interesting pieces of history about the city. We rode a funicular, which the city is famous for and stopped at a home-made Alfajores store. After a empanadas from a bakery, we caught the bus to Santiago.

so true on all accounts. 

Upon arrival in Santiago, I checked the race website that we had all planned to run and realized that we missed picking up our shirts, numbers, and time-chips. We arrived at the race early to find that there were about 6,000 people there and they were out of shirts. We were pretty disappointed because they were really cool, but I somehow found my number so I could run the half-marathon and thats what really mattered. My friends were all running the 5K. The race started at 8PM and everyone had on neon and we were given glow sticks and light up arm bands. It was awesome. The start of the race was so crowded so I jogged with my friend Haley for the first 2 miles or so until the half split from the 5K and 10K. I felt good the entire first 10K and somehow ended up pacing with an older, thin guy. He really picked up the race at the beginning of the second loop and I didn’t want to be alone in the dark so I kept with him. I knew we were moving pretty fast. At some point, he stopped to hand his glow sticks to some little kids and I lost him, but about 2 miles later after passing some others, I found another guy who’s pace I liked. I stayed on his heels, but I am guessing we were at about mile 8 and the course was slightly inclined and I was a little tired. However, after the water station (there were only 2 the entire race!!), I passed him and ran the rest alone. It was slightly inclined the rest of the way, so I was getting tired, but I kept pushing. There were so many people cheering so that was great! I knew when I passed my street that I was only over a mile away and I looked at my watch and it said 1:42! I picked up the pace, but the entire time I was panicking that what I thought was the finish line wasn’t really it because my time was so fast. After passing a Pizza Hut that I knew was really close to the Plaza, I really started running and crossed the finish line at 1:50:06! I am really proud of this time. Not because it is anywhere near competitive, but just because it is faster than I ever imagined. This time is also 30 min fast than my first half! It was so great to run a half marathon in Santiago! I had so much fun and my friends were there to support me at the end! My brother and I signed up yesterday to run the St. Jude’s Country Music Half Marathon in Nashville in April! : )

Unfortunately, I spent literally ALL (9AM-11PM) of Sunday working on homework because this week and next week I have finals and projects. I can’t believe I am at this point and that Thanksgiving is almost here! 


~ Tuesday, November 13 ~
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Kinesiology at its finest

As is everyday, today was an adventure and a learning experience all rolled into one. I am grateful that I have grown into a person that can recognize this because I am not sure I appreciated this aspect of life before my time in Santiago. 

I headed to my rounds at Hospital La Católica this morning and on my 30 minute walk to the metro I happened to run into my friend Sara and her sister, who is visiting! Que suerte!  I was excited to talk to them and have someone to walk with. We arrived at the hospital to some ruckus and disorganization. There was a huelga (or strike) and all of the non-medical personnel were outside protesting. Basically, the hospital was having a tough go of it. They were turning away patients and some departments had to close. We were split up and I was paired with a Physical Therapist, who was very nice and knowledgable. He explained the strikes always happen at the end of the year when contracts are being renegotiated. He mentioned that although they had more work to do without their secretary, she wasn’t vital so the department was running fine. 

I spent the morning shadowing him, although there weren’t that many patients so he showed me how the equipment worked by testing them on me. It was funny and entertaining! There were many electrical therapies like ultrasound and TENS, heat therapies, water massages, balance balls and pads, weights, and elastic bands. The electrical stimulation made my finger move up and down when placed on my arm muscle and at one point, he put my hand in Pariffin wax or parafina to show how it holds in heat and I had to peel wax of my hand for quite some time. We saw a patient who had a tumor removed from her leg and was prescribed electrical stimulation therapy, muscle strengthening, and stretching. Other than those activities, he fed me cookies and gave me a diet coke and we talked all about his schooling, what types of patients he sees and for how long (all patients come 10 times whether they need less or more because of insurance), insurance coverage of physical therapy (FONASA covers most, but not all and ISAPRE usually covers all of it), and of course the health care system. 

I finished early and decided to walk from the center of town to Campus Oriente for art class even though it is almost an hour walk. It is a nice, but warm day and public transportation just isn’t worth the time, money, or the stuffiness. At some point in my walk, I realized I hadn’t stopped at a single crosswalk and I was humming Simon and Garfunkel to myself. Everything seemed to be going my way! I felt like Joesph Gordon Levitt in 500 Days of Summer. What a great feeling! This Campus is beautiful and now I get to enjoy the weather, eat my lunch, and listen to music for an hour before my class. 

Abrazos y besos a todos! 

Excuse the self-photo…it was a joke with my brother. ; ) But here I am at the beautiful campus!


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~ Friday, November 9 ~
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Thursday is the new Friday

Thursday is a great day in my weekly schedule in Santiago because I usually either have my clinical observation or it is the beginning day of a trip somewhere. Yesterday, I had my observation in Recuperación or the recovery area next to surgery. We were told to arrive at 9, however the surgeries here don’t start until then, so there obviously weren’t going to be any patients. What a difference from the US, where my rotations in Surgery and Pre-Op usually begin at 6 AM! I think that definitely shows the difference in culture. When we arrived, we were told to come back after the head nurse had returned from a meeting and there might be some patients. When we returned, we met a different nurse named Marisol, who took us under her wing and showed us around. She was tiny, young, and so peppy! She was really great for our time there. We watched patients be wheeled in from surgery and wake up groggily and disoriented. Since I was in surgery on Tuesday, it was interesting to see the transition to recovery. The pediatric patients were placed in rooms with doors and were allowed to have their parents come in because they tend to be upset. One little girl was wailing and kicking for a good 30 minutes. The adults seemed very calm and sleepy, however anesthesia has different effects on everyone. The team of nurses, techs, and an anesthesiologist checked vital signs, responsiveness, and pain levels among other factors. 

My most interesting interaction of the day was a conversation I had with the anesthesiologist. He had seen me standing waiting for the next patient to come in while the nurse was filling out paper work and came over to have me shadow him. He was a baby-faced, 26 year-old who had graduated from medical school the previous year. (Remember that I said that the system is different here and they complete 7 years of school directly after high school.) He told me that he had a 3 year residency in anesthesiology to complete and that it was a difficult field to enter; there is an examination and interviews for specialization in the last year or two of medical school that is very competitive. We talked about the US medical education system vs the Chilean system and he reiterated to me how expensive medical school is in Chile. To try to put a number to the word carísimo (really expensive), he converted the price per year in his head and then said it costs $13,000 USD. I just nodded in agreement with him and kept the conversation going, but in my head I had two reactions. My first was laughter at the price! The only place where a medical school is that cheap is Mississippi. I would love if college cost me that much! My second reaction was sadness because that is truly a small fortune here and just as in the US, students can’t afford an education and have to take on SO much debt to have the chance at a future. He told me the price is always increasing and I asked if incomes were increasing too. He shook is his strongly. He mentioned the student movement and protests and I said that we have the same problems in the US on a possibly smaller scale. A least there are opportunities for merit scholarships and government aid, but unfortunately, we don’t have the student movement that Chile has. 

It was nice to have some insight into the life of a Chilean doctor. He also gave me the typical doctor warning. He said he didn’t have much time for a social life or other interests in medical school and now in his residency. “But you are happy?” I asked. He said he would not want his life any other way. 

Thursday night, I met Tess and Grace in Plaza Ñuñoa to go to a Mexican restaurant. We have been craving Mexican food lately and Grace suggested this restaurant in a really trendy area. 2 of Grace’s friends from the Notre Dame program met us there and we had a great time talking and eating. This food and drinks were delicious! Everyone ordered something different. On our table we had a chimichanga, tacos, flautas, a burrito, and an enchilada along with Mango Sours and Margaritas. I really enjoyed meeting new people and chatting over good food! 

The weekend is just beginning and I only have 3 left so I am going to try to explore and make the most of it! 

Side note: This morning I woke up and realized I had been dreaming in Spanish. They say that is how you know you are beginning to think in Spanish and it is a step towards fluency (which I am far from). It was such an accomplishment, but so bittersweet! 


~ Tuesday, November 6 ~
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Surgery: Developing Nation Style

Most days I forget that Chile is not considered a 1st world country, (probably because I am living in Santiago). However, today was one of those days where I was shockingly reminded that it is just not quite there yet.

I had my turn in pabellón (operating room) today at Hospital Cliníco Universidad La Católica (a modern, newer hospital) and the process in the beginning was the same as the US. I had to change into special scrubs, put on booties, a cap, and a mask. Then, a friendly nurse showed my partner and I around the area. There were 14 operating rooms (2 brand new), a waiting area, and a recovery room. I then was placed into the room where the Doctor was doing Gynecological surgeries.The doctor was funny and entertaining. I watched the end of a removal of an ovary with a tumor. They did the surgery laparoscopically so it was interesting to see the minimally invasive technique. The only notable difference between the surgeries in the US I have seen and that was a slightly lower level of technology in some cases. The anesthesia equipment and viewing screens were new, but some other things were a bit outdated like the gowns for the surgeons, the table, and the computer. 

The next patient was having the same surgery but this is where my story gets interesting! First, there were 12-15 people in the room at any given time in these surgeries because in Chile students go straight to medical school for 7 years after HS and they observe and practice in the hospitals during their last 2 years. So, for every speciality in the room there was a student (scrub nurse, nurse, medical tech, surgeon, anesthesiologist, etc). Side note: I don’t know which process of medical education is better, but I like the idea that the medical students learn medicine from the beginning, have opportunities to observe and practice, and finish school sooner. However, there is not really wiggle room to change careers here. Continuing on, the surgery was going smoothly, the doctor had the scope inside the patient, and was looking at the screens for the video from the camera until de repente (all of the sudden) the lights went out and all the equipment turned off!!! You can only imagine the look of horror on my face! (Good thing my mask was hiding it!) Luckily, all of the anesthesia equipment and intubation functions without power. I don’t know why or how; I wasn’t asking questions. The most surprising moment was when everyone in the room continued laughing and having a normal conversation. The doctor just left the scope and stepped back. About 40 seconds later the power came back on. However, all the screens weren’t working so some technology workers came in to fix them. 5 minutes later, the power surged again and turned off. This proceeded to happen repeatedly for the next 25 minutes. After the 4th or 5th time, the doctor finally got frustrated and asked people to find out what was happening. The nurse told me that all of Santiago lost power (which I later found out was not true). I couldn’t believe that the hospital was not on a generator!! After the power came back and stayed on, he continued with the surgery and I left. I think I am still dumbfounded by what happened today. 

After observation, I somehow made it from one end of the city to my art class near my apartment in an hour and a half taking the metro, 2 buses, making a pit stop to buy flowers for a reference to paint, and changing into shorts at my apartment (I was so hot!). I felt pretty accomplished. After my 4.5 hour class which passed quickly today, my friend Tess and our new friend Grace, who is studying abroad through Notre Dame, went to Plaza Ñuñoa to try a heladería (place that sells ice cream). My host mom told me that this place was her favorite, better than Bravissimo, the usual favorite here, and that I needed to try it. I was so excited to see that they had Pistachio, my favorite flavor! I think I was a bit too excited in general because I got 3 scoops: pistachio, cheese cake with fruits of the forest (literal translation..I think this means berries), and Tiramisu. It was awesome! Our friend Michele met up with us and we hung out and talked about the election and our day. It was a great outing.

One of the things I will miss most is the trips to try food, see museums or landmarks, or just do fun things after a day of classes. A day of stress doesn’t end until I lay my head on my pillow at night during the semester (and even then I sometimes have dreams about classes). There is a never ending flood of work or commitments during the semester normally but here, it is so nice to have time for an hour of reflection on the day and to catch up with friends. I am going to enjoy this while I can!! 

Well, for the rest of the night I am keeping my eye on the election counts to see if I will want to return in December or make this move to Chile permanent. 


~ Monday, November 5 ~
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Mendoza, Argentina

This weekend was a holiday weekend, so with Thursday and Friday off for Dia de los Muertos (Halloween), I headed over the Andes and across the border to Mendoza, Argentina. After an unfortunately long 10 hour bus ride due to holiday traffic and customs, we arrived in Mendoza around 6PM Thursday night. After checking in to our unfortunately cramped hostel, we set out in search of a Tenedor Libre. Literally translated, this means free fork, but what it is an all-you-can-eat buffet. My friends had a recommendation, so we walked to the Plaza to kill some time before it opened at 8:30. We ate there for a good while. The food was good, but to be honest (sorry), I was a bit disappointed. Argentina is known for its meat and the meat was not the best. The other dishes were ok, but my mom definitely cooks better! My favorite dish was a ricotta and spinach stuffed zucchini. 

Friday morning, we took a bus out of town for about 30 minutes to vineyard country where we rented bikes and got a map of all the bodegas. We picked 3, 2 for wine and 1 for olive oil. We had a great time biking to the vineyard, getting a tour, and tasting wines. I really enjoyed the olive oil fabrica. We tasted extra virgin olive oil, balsamic vinaigrette, sun-dried tomatoes, olives, and golden raisins (my favorite!). We also learned the difference between extra virgin, virgin, and pure olive oil— the time the olives are picked and about the process to make balsamic vinaigrette (from wine!). After our day of biking, drinking, and eating, we ate some pizza and alfajores (traditionally from Argentina, but found in Santiago too), played some cards, and went to sleep. 

Saturday, we went on a 2 hour horse back ride towards the Andes. It was so beautiful and fun. I love horses, so it was a great trip. The paths wound up and down the hills and were narrow at times. It was a little tough! After lunch and some money and planning problems, we decided to try to get to the hot springs. We were going to take a taxi to the bus station to try to catch a bus, but the taxista told us it would cost 120 Argentine pesos (24 USD) to get there, so we just decided to take a taxi. Unfortunately, that was his estimate and as he didn’t drive there very much, it cost us 10 extra dollars. However, he was very nice on the way there and very apologetic about the price and ever lowered it 10 whole pesos (2 bucks!). The hot springs we so cool! There were over 10 pools with different temperature water in the Andes. There was also a lazy river. It was a warm day and we were so happy to be relaxing there. It was really fun and so picturesque. After, we ate dinner at a parillada, an Argentinian meat house. The guys said the meat was good, so that was successful! After dinner, we bought some ice cream (also traditionally Argentinian) and relaxed. 

Sunday, we caught the bus in the morning back to Chile. It was an hour shorter, but still longer than it should have been. It wasn’t horrible though because I slept most of the time and the views of the Andes were beautiful. 

Today was my first day running since my injury and all is well! It is technically spring here, but 90 degrees is summer to me! The heat with the smog makes the air really gross! I definitely miss clean air (among other things). I can’t believe I only have a month left; it is very bittersweet. With tomorrow being election day (so nervous!), I will leave you with an anecdote that shows a pretty common political viewpoint of many in Latin America. 

During our drive to the hot springs, we somehow got on the subject of politics with our taxi driver. Don’t be surprised; that is a common topic. We asked him what he thought about the election and he said he hoped Obama won. He said he wished we had a better option, but that “your government is influenced by corporations and all the Republicans want is to make a profit.” “George Doble-Vee (W in Spanish) Bush went to war for petroleum and for money. The Republicans don’t understand the public and the needs of the country.” I thought it was really interesting that a taxi driver had so much political insight. It always surprises me when people know about our government and election, but it shouldn’t. We should be more informed about other elections, as well as more informed about our own. 

Chau! 


~ Sunday, October 28 ~
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health care, exploring, and hiking

This week has been a bit busy. Well, by that I mean to say that I have been having too much fun to sit down and write descriptions and feelings about the week. 

On Tuesday, I went to the public health care center for La Pintana, a poorer community in Santiago. It was quite the experience. Only patients with FONASA, public insurance, are seen and they are triaged and divided by age. The building was outdated with people overflowing in the waiting room. (Also, the center had a Ruka, described in an earlier post, which I thought was cool). We were shown around by a nursing student from La Catolíca. He was very knowledgeable and had a great outlook on patient care. The first patient I saw was a diabetic patient with what they call “diabetic foot.” (If you get grossed out by medicine, you should skip to the next paragraph now). Both her feet were red and infected and open wounds. Also, her toenails were very long and deformed. The infection was moving up her leg so an antibiotic needed to be prescribed. The nursing students spent about 30 minutes unwrapping all her bandages and cleaning her foot thoroughly. Then, the scraped off the infected skin and wounds and then rewrapped both her feet. I asked how often she had to come to the clinic for this and they told me everyday. This was sad for me because she was brought in by her daughter who probably should have been working and also because no one wants to go to the doctor’s office everyday! We spent the rest of the time seeing patients with the nurse. He explained to us that he wanted to be on an equal level with his patients. He wanted them to feel that they could talk to him and ask him questions. He didn’t like the idea that he was in any way superior, which I thought was a great way to view the doctor-patient relationship. He focused on prevention with his patients although unfortunately, many already had hypertension and/or diabetes which is prevalent in Chile in general, but especially the poorer areas. It was very interesting to see the poorer, public side of medicine in Santiago. 

Friday, my friends and I made smoothies with lots of fruit! They were delicious. Then, we went to an area called Patronato to shop and walk around. We also ended up trying the “best” terromoto in Santiago in La Piojera. This bar was CRAZY! People were standing everywhere and it seemed like the “Friday-after work” crowd was beginning their weekend. The atmosphere was unbelievable, but overwhelming for me. We then headed to get chorillanas in an area called Bellas Artes which is called hipster because of its trendy bars, restaurants, and cafes. We searched for a bit and lucked out on some chorillanas. They are french fries covered with meat, onions and eggs. However, it is possible to get them without eggs and with avocado and other vegetables which is my plan for next time!

Saturday, I went to another Ruka but this time with my Anthropology class. We were fed unbelievable food: sopapillas, mini sandwiches with chicken, sweet bread made from bananas and coconut, chicken, olives and salad, tea, etc. We also talked more about the history of The Mapuche people, the current state of affairs between the government and the group, and rituals used by el machi. In the afternoon, I rode bikes with a friend to Cerro San Cristóbal and walked up. I saw the sunset and got to see the city lights at night which was cool. 

Today, Sunday, I went on a hike with my friend Henry. We took the metro, a bus, and a taxi out of the city towards the mountains. We hiked Cerro Ponchoco and it was a difficult “hill”. My running shoes are pretty worn out and there was not a defined trail, so the loose dirt and rock made (well, thats my excuse anyways!) for a record 8 falls for me!  It was 2 hours to the summit and 2 hours back down. We thought the first peak was the top, but little did we know there were multiple more peaks to climb to the actual peak. The view of the city and the Andes Mountains was incredible. Santiago is so big it is hard to wrap your mind around. At the bottom of the Cerro, there was not any taxis. Henry boldly stuck out his hitchhiker’s thumb to some hikers in a car who were some people we had talked to at the top. They graciously gave us a ride all the way to the metro! So nice! After a nice lunch and watching election news (today is Alcalde, mayor, elections) with my family, I went on a nice walk with Sara. We always end up walking through Lider (owned by Walmart) and looking at the mix of Chilean and American products. Such gringas!

This week I only have 3 days of class because Thursday/Friday are a holiday, Dia de los Muertos (Halloween). I will be heading to Mendoza, Argentina on Thursday which is exciting. 1 month from today I leave for Patagonia and in 1 month + a week, I will fly home. How strange! I feel like I am just getting my groove and my spanish is on the up-and-up. What a shame! Well, thats all from the Southern Hemisphere. ¡Que te vayas bien!  


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~ Thursday, October 18 ~
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Emergency Rooms, Hospitals, and Medicine

Ironically, in the same week that we (my clinical class) began our rotations in the hospitals here, I experienced my own visit to the emergency room as a patient. The pains that I thought were cramps that turned into leg swelling over the weekend became extremely painful on Tuesday after walking during our visit to a clinic. My leg was extremely swollen from the knee into the foot and the pain began radiating from the calf to the hamstring.

After making a doctor’s appointment at Clínica Santa María for 7PM, I planned on resting in bed for 4 hours until the appointment. However, I began skyping with my mom, a nurse, who immediately started thinking that a DVT (deep vein thrombosis, a blood clot) should be ruled out and needed to go the hospital immediately. Her other thought was compartment syndrome, which is not much better. DVT can result in death and both can result in the loss of the leg. After going through a few steps for my mom and convincing her (and myself) that I could wait, I called a friend to come to the appointment with me. Then, the clinic called me and canceled the appointment because the doctor could not attend. After that, I just decided to go to the ER, but for some unknown reason chose to go at 6:30PM. It was rush hour so it took waiting for 15 subways and 1 hour to get into the ER. We finally arrived and found our way to La Urgencía. The way the system works is the following. You take a number and wait to be called.  The first person you talk to is in charge of insurance. In Chile, everyone is required to have health insurance by law and you have to pay first for care. The insurance man and I had a funny interaction because he was trying to speak English for me, but his English was not great and when he asked for my insurance I handed him my card without realizing I should just pay with my credit card and be reimbursed later. He then proceeded to tell me that with my insurance, I would need to go through another process and get an e-mail sent, etc. I finally conveyed that I would pay and he sent me to the nurse who registered my symptoms. Then, Sara and I waited for 2 hours. They all kept asking if 2 hours was going to be alright, so we reasoned that the wait period is normally much shorter which is a big difference than the US. After Sara almost got her backpack stolen by some man who wandered in off the street, we played cards and talked until I was called in. The nurse immediately came in and got my vital signs and after he left the doctor came in. I really appreciated the rapid response of the health care team. The doctor asked me to explain what happened and 3 sentences in, he told me that I could speak in English. I was a bit disappointed because I have been learning medical terminology in my classes and wanted to practice and embarrassed because it is possible he was not understanding me. After looking at my leg, he immediately grabbed an ultrasound machine to look at my veins. He and my mom were on the same page. He did not find a blood clot and then deducted that I had a torn or badly sprained calf muscle and advised that I not exercise for at least 3 weeks. He left the room to write me a prescription for an anti-inflammatory and I turned to Sara and asked her if she realized that I never paid. When the doctor came back in, I asked him where I should pay and he said that he did not know anything about paying. How funny! The doctors only do their job and get their salary; they have no idea how the payment system works! I went back out to the insurance area (where everyone was gathered around a TV to watch the Chile/Argentina soccer game) and I talked to a woman and paid. It was a reasonably inexpensive visit for the ER and the pills only cost $8. Overall, the experience was pleasant (except that I am injured and had to go in the first place). The clinic was very modern and everyone was nice and attentive. My leg does not seem to be getting better yet, but I have not been resting very much. I know have a giant purple bruise across my calf. I am hoping the swelling and the bruise disappear soon. 

On Tuesday before this extravaganza, we visited Clínica Familia, a palliative care clinic. Palliative care is basically end-of-life care. It includes controlling pain, infections, and psychological and spiritual treatment. There was a large building for psychological and spiritual treatment as well as a chapel. I thought it was interesting that the chapel had Jesus Christ hanging without the cross because they felt the patients were experiencing enough of their own pain. There was also an emergency room for terminal patients that are cared for at home. The clinic has many volunteers to talk with the patients and listen and attend to their spiritual needs. When a patient is admitted to the clinic, there is a meeting with the patient, the medical team, and family to discuss expectations and wishes. The 8-10 rooms were arranged in a circle and their were on average 2 or 3 patients to a room. The doors and windows on the rooms were see-through so I felt as though I was invading the patients’ privacy at first. There were a few nurses, many nursing students, and from what I saw, one doctor. The patients had a variety of aliments ranging from testicular, breast, and mandibular cancer to encephalitis. There were 4 patients with either HIV or AIDS out of approximately 15-20. However, AIDS is what causes the patients to being ill with something like cancer and is not usually the terminal illness. We were a little confused because the nursing students couldn’t explain to us why the nurse kept using HIV as a blanket term for both HIV and AIDS when clearly some patients had AIDS and some did not. We also did not understand why there seemed to be so many patients with AIDS, where as in the US it is possible to receive drug therapy. The nurse explained that poorer people can not afford the treatment and that at least one of the patients was an addict who did not seek help. I also was surprised that the HIV/AIDS patients were sharing rooms with others who were sick because it seemed strange to put someone with a compromised immune system in that situation. 

The most shocking patient to me was a 28 year old man with no family infected with AIDS. He was the skinniest person I have ever seen living weighing no more than 50 pounds. His ribs looked huge compared to the rest of his body, which moved rapidly up and down with every feeble, laborious breath. The nurses said he did not speak but he seemed to understand, which according to some reading I have done, loss of lucidness is common among AIDS patients. He had a horrible cough that seemed to take all of his energy and oxygen. I felt very restless and extremely sad for this man. I talked to 2 other patients who were both lovely and said that they very comfortable and positive at the clinic. 

Today, I went to Hospital Soltero del Río with Sara M. to observe preparto y parto (labor and birth). The hospital is located in a poorer section of town and is a public hospital only accepting FONASA (the public insurance). The building was old, blue and definitely could use some renovation. The building was 5 stories, but there were many other smaller buildings on the extensive campus. The hallways were narrow and beige.  We were shown around by a lovely matron (midwife). He explained that there are 2 different sections. One that is an area for normal childbirth with epidurals and such and another that is part of an investigational program testing natural childbirth. In this area, the rooms were private and contained a stereo, aroma therapy, a jacuzzi, and an exercise ball. The other area was a large room with 8 beds and dividers. I was surprised by the lack of privacy given to the expecting mothers and the lack of technology. There were nothing to distract the mothers and everything was done on paper. The most obvious difference between medicine in the US and Chile is the lack of patient privacy in terms of information. Although I highly doubt it would be easy to access someone’s information, the charts were shown freely to us even though I never signed anything like a HIPAA agreement. After seeing the process of admittance and the different areas, we talked to 2 expecting mothers for about 2 hours. One of them was carrying fraternal twins and just as we finished our conversation, she was taken in for a C-section because the babies were not coming easily. I thought it was strange that the doctors did not seem to explain much to her and she did not ask any questions. I felt that there seemed to be a good deal of trust between the patient and doctor. The other mother was a very sweet, single, 25 year-old who already had one 5 year-old boy at home and was expecting another boy. When she was ready to give birth, she was moved into a more private room where there seemed to be more sterility. Another difference I noticed was the prohibition of family members until the moment the baby was about to be born. Right as the baby was coming, the father was called into the room. I won’t go into gory details, but I will say that I am a much bigger fan of the babies than the process of birth! After thinking about it, that was the first birth I have seen that wasn’t a C-section! How cool that it was in a foreign country! 

I am really thankful to be able to observe in Chilean clinics and hospitals and learn so much about the health care system and medicine. 


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~ Monday, October 15 ~
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Chiloé

This past weekend I went to Chiloé with a group from my study abroad program. I will try to cover the highlights of the trip which, I would like to warn you, will mostly include food.  

On Friday morning, we jumped in vans at 4:30AM to go to the airport and fly to Puerto Montt, a port city in the south. Next, we took a bus ride, a ferry ride to the island, and then a longer bus ride to Puñihuil. There we ate a delicious lunch of empanadas and fresh white fish. Next, we took a boat ride to visit smaller islands and see wildlife. We saw pengüinos, nutría (otters), and many types of birds. After some other activities like hiking and talking about the importance of ecoturismo to Chiloé, we left for Castro. 

In Castro, we stayed at a hostel/hotel that was part of the buildings that are called Palafitos, which are buildings on stilts built on bodies of water. It was so beautiful. That night we ate a dinner of a pink, native, fresh fish stuffed with tomatoes and cheese and potatoes. Chiloé has 400 types of native potatoes! The next morning, we woke up to a beautiful view and a healthy, great breakfast of yogurt, granola, fresh fruit, and homemade bread and jelly! I was in heaven! (I know my dad would have loved it, too!)

After breakfast, we went out of town and split into two groups to do talleres (workshops). One group went to a farm and my group went to a wood workshop. It was so fascinating! The women that worked there make things like tables and plates from wood and also ceramics. They find dead trees in the forest behind their house and then use them to make everything. They first fed us homemade bread and tea and then took us on a walk through the forest where they showed us many types of trees and plants. After the walk, we were privileged enough to be served a lunch of bread with pesto, chicken soup, fresh salmon (my favorite fish!) and native potatoes mashed, and a dessert pudding. The salmon was by far the freshest and best I had ever had! After lunch, we were taught how to make jewelry out of wood. I made earrings and after putting holes in them and staining, we were burned/carved designs into them. It was so fun!

After the workshops, we took a few hour bus ride to another town called Cucao. The hotel was ride of the river coming from the Pacific Ocean. It was spectacular. There were windows everywhere in the hotel and my room had a great view. Plus, the beds were so comfortable! After relaxing and enjoying the environment for a while, we were served dinner. And just when I thought the meals couldn’t get any better….we were served salmon again!!! The salmon was cooked in tinfoil with tomatoes, onions, oregano, and basil and was fantastic! I can’t say which salmon that we ate was better, but they were both the best I have eaten in my lifetime! We also had native potatoes and a large salad. For dessert there was a pudding like cake with a wine sauce. We spent the rest of the night digesting!

We woke up the next morning to a similar breakfast but just as great! We then were lead on a hike through the National Park. We ended up on the beach of the Pacific looking a wild horses. It could not have been more picturesque. After trekking some more through the Park and learning about native plants and trees, we returned to the bus to make the trip back to Puerto Montt. 

I arrived home last night to a birthday party for my host brother, Jose Tomás. My host mom and grandmother had cooked all day and made meat and cheese empanadas and bought so much food. Tomás had many friends over and they hung out outside on the balcony. I found a cultural difference that I really enjoyed. Every kid that came in greeted my host mom and grandma as Tia (Aunt) and gave them the traditional kiss. But the most interesting part was that although Tomás is only 17, my host mom did not seem to care that all his friends were drinking and smoking outside. Now, I know she does not condone smoking, but I think that the teenage drinking is much safer here. First because the drinking age is 18, it is not so taboo for a teenager to drink. Second, I think because it is more accepted, the kids weren’t getting hammered or anything in an unsafe environment trying to hide it from their parents. Also, because most people don’t have cars, there is not a fear of drunk driving. It just seemed much more relaxed, safer, and smarter. Luckily, not even half of the empanadas got eaten, so guess what I get to eat for the next few meals??! 

The trip to Chiloé was truly beautiful and I was able to learn and see so much! This week is very calm. This coming weekend I am signed up to run a half marathon with my 2 friends. However, the calf cramps that I thought I was having last week have now turned into a swollen leg from the knee the the ankle. I hope this heals very fast and a doctor is not necessary, but I will have to wait and see. Hopefully, I am able to run! That is all from here! Best wishes!