By Leigh Brissenden, Public Health in Chile, Summer 2011
As a part of our Public Health in Chile course, we took part in several clinical observations. Each augmented our understanding of concepts that were discussed in class, but more than that, I know these observations were the most moving – and will be the most lasting – part of my education in Chile. While the in-class lectures gave us the intellectual understanding of the Chilean public system, the clinical observations made such understanding meaningful. One can compare numbers and statistics, but without actually seeing the hospitals, one’s understanding is incomplete.
We learned in class that those in the lower socio-economic class inevitably get pushed into the public sector along with the old and the sick, placing a disproportionate amount of need on the public sector while concurrently lacking in sufficient funding to keep up with such need. On paper, the differences between funding, types of care, and health outcomes in the public and private sector are quite notable. However, the most striking characteristics that distinguish the public system from the private are not necessarily apparent through explanations of the funding sources of ISAPRES vs. FONASA or the list of conditions guaranteed free treatment by the government (GES). Even such a seemingly superficial thing as infrastructure shows great disparity. The private health clinic that I pass everyday on my way to the IES Center, Avan Salud, looks modern, clean, and with the exception of its Spanish name, indistinguishable from a health clinic in the US. In striking contrast, the public hospital we visited, Sotero del Rio, is contained in a old, weathered building that looks as if it has not been renovated since the fifties. The insides of these buildings differ little in appearance from the outside; the private clinic, clean and modern, and the public hospital, crumbling and antiquated.
Such visits make me doubt how equal these two systems are, as my host mother tried to say when I inquired about the differences she saw. She insisted that the level and quality of care was indistinguishable although the public hospitals perhaps look a little older – an understatement so extreme, I had to bite my tongue in order to maintain the attitude of deference I had assumed for the sake of politeness whenever questioning my host family about their country. My host mother’s ignorance of such striking differences only illuminated to me that even though the disparity may be readily apparent to anyone who really looked at the two, many do not take the time to notice, let alone call to reform such an unequal system. Overall, it is clear that these clinical observations are the reason I decided to study public health abroad because these are experiences that would not be possible in the classroom setting back in Evanston.
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