una rosa e una rosa!

im back! mamma mia, or "dios mio" rather (im switching my italian vernacular for espanole). I am again bursting at the seems with excitement and I will try to calm down enough to type a little. To add a little detail to my running out of steam, I was actually laying in my bedroom with the lights out praying i would fall asleep because I couldnt wait for the following day, its really a problem bc things go much later here which is great for me but then we go to hospital in the morning,,,,so the answer is..more cafe! and by the way, im quite a fan of the cafe down here - there is no hating on nescafe. and i love that Dottora Paulina and Sandoval routinely make coffee for our resident and interns!

Yall who know me know that I am a flight of ideas, I will try to be organized but just join in for the ride! I have so much to say about the differences between the chilean health care systems and ours in america. Also I am astounded at the medical work going on here in santiago. I started my week at Ospedale Sotero del Rio. To get there i hop on line 1 of metro at belles artes, transfer at vincent valdes, and then go to the sotero stop. in the metro its normal to cram in and wait patiently, its hot and people are close and no one is offended or feels entitled to their own space. i love it! (side note (be prepared for my steam of consciousness..i cant help it)... there is no AC really anywhere..hospital included....and people make do...i think its a good example for us back home..just saying..) My first day at Sotero I went with Carina, my sweet friend from here. I met the chief Lorena (actually chief for the month, for their program the chief is a 3rd year who does it for one month, its not a separate year), and also Dr. Manchega, my director at Sotero. He is A-MAZING! He is friends with Dr. Gutierrez from UAB (and by the way, showed me old pics of Dr. G!) He took an hour to talk w me about the health care system (so interesting, will blog about this later), and then a tour of hospital.  sotero is a public hospital so all free care (pretty much), and limited resources. the residents OWN the hospital. WOW - its amazing to see! they have all units there, ER, PICU, NICU, adolescent (18 beds), lactantes (infants..literally means 'one who drinks milk), surgery (including neurosurgery...only surg they dont have is cardiac and transplant), childhood wards, subspec. outpatient. I am on the "lactantes" service. Its me, 3 interns, a resident and 2 attendings (they alternate days and some days they are there together). Interns are Javier, Pablo and Hernan and they are awesome. They are acdtually 6th year med students and so in your 6th year here you are an intern on every specialty (kinda like "transitional year" in the US). Now remember, in chile - and rest of the world - you go straight to medical school, there is no undergrad - so they have the same training as a 3rd or 4th year med student. Carolina is the 1st year resident who is team upper level - its just her and I tell ya what, Carolina means business! She was "post call" the day i came on and she was there till 530 like it was no big deal. Im amazed that no one really complains here in their residency (im sure there is some of it and im just seeing things with rose colored glasses, but its different i promise ......) There is no 2nd or 3rd year on the team so this is really the first time carolina has done straight peds. As carina tells me, interns are left alone so much that you really learn to manage things on your own because you have to......I guess I could throw an IJ (for my non medical readers - internal jugular) if I had to ...right ?! wink wink) Then attendings on the team are stylin and profilin, and very competent/smart at the same time. Every morning I look forward to seeing what kind of shoes they are wearing. Mom - remember what I have been saying.....pack nothing!! empty suitcases!!! The team has some very interesting cases. I see a few patients a day with the interns. I am out at sotero by myself right now and Im learning some spanish - they are happy when i try and i carry my spanish book with me everywhere! There is one patient who had a cardiac arrest during her 2nd aortic stenosis surgery and now is neurologically impaired (very hypertonic and ? blindness), Dr. Paulina made sure that I was able to see her and learn from her exam. I saw roseola, ex 30 wga with BPD with resolved septic shock, meningitis, a few febrile UTIs actually (my job today was to look up the renal ultrasounds and their labs! thankfully there was no hydronephrosis! in chile they are not doing routine VCUG for utis. we pulled up the AAP guidelines today! Yesterday afternoon I was with Dr. Manchega in his clinic (let me stress - he is AMAZING, wears lots of different hats around the hospital). He has multidisciplinary adolescent clinic for suicide ideation, eating disorders, teenage pregnancy, addiction. There is a psychologist, nutritionist, social worker, nurse. He is very caring and I told him about my interest in the eating disorder population - It is encouraging to know there is work aimed at helping these women out of bondage even in other countries!! We saw a patient who was being discharged from the long term psych unit and talked w her for about a half hour and she has done very well. The only thing the psychiatrists help with are pathology such as schizophrenia, bipolar etc - but things that we tend to keep in our ER, they have a special building for them and lots of counseling.

Back to some thoughts about the wards and healthcare system. Chile has very good rates of infant mortality and good healthcare outcomes, but uses not as many resources. An example, most of the patients on wards were getting NG feeds (not much IV fluids at all), and for the NG feeds, I saw a nurse filling up a bottle and then they squeeze it for a feeds (makes sense huh - i guess we dont need pumps that make those crazy noises after all). Also, there are big rooms and about 5 patients to a ward room, everything is in the open and there is no HIPPA (hooray!..dont get me started :-) ...) One of the moms was breast feeding while we were talking about her baby - definitely no curtains anywhere. The cribs are totally sufficient, nice and colorful. Their isolation gowns are plastic which I bet cuts down on the cost. Another difference is the wards nurse is frequently coming into the rounding room (that is on the same floor as the ward), and bringing new labs, vitals, info, asking questions. She is very helpful and its like clockwork that she comes in at the same time each morning. Rounds dont start until noon...but...its not like rounds back home. In the morning everyone gets work done and sees patients, comes up with plans, at the same time. So the interns write their notes while they go in the morning and by the time rounds happen the note is done and attending hand signs it. The consulting teams come by every morning and f/u on things and ask if there is any new business - so there is no calling consults because everyone sees each other every morning. I realize this isnt possible at a huge hospital, but its refreshing to see. This week at Sotero has really opened my eyes to a part of me that wants to work with limited resources and with the needy. I absolutely love it there -

As you can tell, I have alot to say!! I want to keep typing all night long (actually...i want to be out but i promised my mom i wont go out at night alone...dont worry everyone!! so i am gonna hit the sack). Im cooking a chilean meal for my sweet friends down here in santiago tomorrow night so I will go to the fish market before work!

Oh by the way, crazy story about airplane man huh? Who knows....... JK!!!

besos XOXO
marta!

ps...im realizing that i have a ton more to talk about (going to top of san cristobal, markets and "consome di mescado", getting invited to yoga with instructor ricardo from buenos aires (dont worry he knows NOTHING about me....)...stay tuned!!!!