Halfway through Chile (and 1/3 through this year?!)

Buen Día! Hi, hello, how are you? I sit here in the center of Santiago, realizing I have crossed over my halfway-point in Chile, and am looking forward with much excitement. I too am looking backwards to my time here thus far: the ups, the downs, the stalls, and the incredible moments I have had in the midst of it all. In our short list of guidelines, our pamphlet titled, “Getting it Right?” there was one point I wasn’t sure when or how it would occur. The header reads, in bold, “Maintain your independence,” followed at the end by, “Recognize style signs off project avoidance (it happens) and find the source.” In the time since we last spoke, I found myself in a low point. Before leaving for this year, I reflected on what “Project Avaoidance” may look like. In my head, I often thought it meant living the “touristy” life, traveling without thought of what you were given the chance of doing with a year away in the world. What I didn’t realize in May or June during my preparation was that “Project Avoidance” can happen anywhere, even when you are waking up in the same place. So, to be honest, amid Week 3 / Week 4 here, I found myself pretty avoidant, frustrated with my direction, and frankly, a bit lost. This had me fairly agitated with myself; wanting to break free of a cycle that I felt I had put myself in. And now, two and a half weeks later, it feels so incredibley good to say that I have been there, and to know that I have worked in a way that has (or at least continues to) bring me out of that place. This moment, which came right in the middle of my last blog post to you all, has also helped open my eyes to something I originally was trying to deny: these feelings likely will come and go in each new country I travel to. Leaving Denmark, feeling like I had faced many challenges of adjustment, I felt like I had moved past the road block phase. Hitting halfway in Chile, and hitting road blocks about the same time I hit them in Denmark, I now see it is likely I will face these again. But, with each moment I experience, I also move forward with one piece more of experience, and growth that helps prepare me for the next challenge I may face. This is growth, and I am thankful for it.

So whats been going on? Well, I’m going to save you (and myself) from writing out each day; instead, I’ll give an account of each week. My first post updated you all with Weeks 1 through 3, see below for Weeks 4 – 7!

Week 4: October 28 – November 3:

Week 4 was where I hit my low. In the week prior, I had come up with a new idea to explore my project. I began to think about how cool it would be to see Chile by bike, using biking as a mechanism to get from place to place, and exploring the context of my project in a new way, different than before. I started planning hard at the end of week 3, through the weekend and into week 4. I went bike shopping, started doing research on places to go, making a budget, etc. It all seemed really good. Reflecting now, biking through Chile is still something I want to do, but in the time since this idea, I have come to a better realization that I may be spending too much time biking alone, and not enough time with the people of Chile. Reflecting more now, this intermitant period of searching for a bike came out of what felt like a lack of success in pursuit here in Santiago, and a diminished motivation because of it; however, things took a turn near the end of the week and I felt like I had flipped the switch, finding myself back on track.

I spent a day with Ambulancias Santiago, a private ambulance agency here in the city (more thoughts on this to come below). I officially booked my tickets to thailand, setting a final date here in Chile, and a beginning day for Thailand, and I began the Visa Application for Thailand. Introduced myself to more people in the world of EMS here in Santiago, and learned more about a company called ACHS. To finish out the week and begin the next, I took a bus to Valparaiso, a beautiful town about two hours west along the coast, which is actually listed as a UNESCO World Hertiage Site!

(Oh yeah, and I celebrated Halloween here in Santiago! Using what I had, I managed some sort of Cowboy/Indiana Jones look, but ended up still being asked if I was McCauley Culkin (or Kevin McAlister) — apparently that movie is a favorite down here, and once my last name is discovered, the joke never ends!)

Week 5: November 4 – November 10:

The start of Week 5 began in Valparaiso, or Valpo, full of beautiful graffiti art and friendly people. A friend I had met in Santiago offered a free bed in his house where he lives. Meandering through the streets, the weekend was mostly spent wandering, wondering, and appreciating where I was. Returning to Santiago, I switched up housing once again continued my work from the previous week. I had a few meetings with people at Hospital Soltero Del Río, the largest public Hospital here in Santiago and at SAMU, the public ambulance agency for Chile. At Soltero del Río I actually found myself featured (briefly) in a promo video! You could call me an, “extra,” and I definitley felt out of place but was happy to join in!

On Wednesday the 8th, (my 4 month Watsoversary!) I received an approved Thai Visa and I headed to the airport! A result of last week left me taking some initiative on travel plans, and I had booked a 10 day trip down south to Punta Arenas, Puerto Natales, and Torres Del Paine National Park! I planned for the first half of this trip to be some time off in the park, and the second half to be used exploring some other health systems in the smaller, more isolated towns of Southern Patagonia, Chile.

I had planned a 5-day, 4-night trek in Torres Del Paine, on a trek called, “The W,” which consists of the front half of the Park’s trekking Circuit, “The O.” On the 9th of November, I spent my day preparing. I need to reserve two campsites that I couldn’t online, rent a camping stove, some trekking poles, and buy food (plenty of food)! In the midst of all this, I met a guy named Juan, a Venezuelan who was also traveling through Patagonia. We came to find that our trekking days lined up, and we ran into the same reservation issues. Soon enough, it became unspoken word that we would be trekking together.

(These next days I will give you a play-by play, just because they were so incredibly awesome. Each day I also found myself hiking with a thought in mind. Some were thoughts that just came to me, others were quotes that returned to me as I hiked. I’ll list each days thought here too.)

On the 10th we took a bus into the park, followed by a ferry ride across Lake Pehoe to El Refugio Paine Grande Camping site. Given the reservation trouble, I had two nights reserved here. Setting up camp, Juan and I settled in, fixed lunch, and prepped for the days adventure. We then hiked along the “W” trail up towards El Refugio Grey Camping, where we had intended to camp had there been space. Instead, we took some time admiring Glacier Grey from afar, and then walked back to camp to fix dinner (and have a hot shower). We ended the day totaling around 30km. – “Tell me, what is it you plan to do with your one wild and precious life?” – From “The Summer Day” by Mary Oliver

Week 6: November 11 – November 17:

On the 11th, we woke up trying to decide what to do knowing we had another night in the camp, and we ended up going back up to Grey (and a little bit beyond) as we heard there were some incredible swinging bridges to cross and a very up-close view of the glacier. Safe to say it was worth it. The night ended with a beautiful view of the mountains surrounding us. Another 30 km in total was covered. – “May you always remember the paths that bring you back…back to the important places.” – From The Important Places, by Dad to Forrest, 1986

On the 12th, we packed up camp for the first time and carried our gear to the next campsite about 10 km away, called Campamento Frances. It was a little rainy and we were worried about our hike later in the day. After setting up camp we trekked upwards to Mirador el Británico. The trek brought us up along El Río del Frances and inbetween Cerro Paine Grande and Cuerno Principal finally upward 900m to Mirrador Británico. On top of the lookout, we found ourselves almost completely surrounded by incredibly immense mountains, and were overwhelmed at their grandiosity and beauty. Hiking back down, we finished an incredible day back at Campamento Frances, eating and talking. We finished the day at 25 km. – “Today I walked among Giants,”a thought that seems like it may be a quote from somewhere, but one that stuck with me as I fixed my eyes above me.

On the 13th, we packed up camp and headed along the trail to our final campsite, Campamento Central. What ended up being a long 16 km hike up and over hills, we finally arrived at camp with beautiful weather. The next leg of my day was solo, as Juan decided to stay back to address some blisters. I headed up the mountain to take a look at Mirador de las Torres. A strong hike upwards along Mt. Almirante Nieto and alongside El Río Ascencio I arrived at the towers. Albeit half covered in clouds, these looming giants were an incredible sight to see, and I was blown away at their size. Hiking back that night, I realized how taxed I felt after a long day. At camp, Juan and I ate food and shared the last bit of Pisco we had brought with us along our journey. I quickly slept. The day totaled 38 km. – “Know that whoever God prays to, he asked them to help him make something of worth. He made you. He made you and was happy, you make the Lord happy.” – From “Closer” by Anis Moijgani, though directed in his poem to people, these were my thoughts to the mountains before me, the Giants I walked with.

On the 14th, Juan and I woke up at 2:30 am, ate a little bit of food, packed some meals, and set out on the trail by 3:00 am. Our goal: make it to up to Mirador de las Torres by Sunrise. With about a three hour trek in front of us, we hiked mostly in silence through the dark. With one hour to go, and with the first break of dawn, we began to hear the world wake up. We turned off our headlamps, clearly saw the trail ahead of us and listened to the birds as the world came back to life. It was something special to witness. Ascending to the base of the towers just as sunrise officially broke, Juan and I nestled in among some rocks to combat the wind. Las Torres were in full view, as intermittent fog and clouds swept through. It was cold, but the two of us were too mesmerized to move. We stayed for almost two hours. Hiking back, we had a pretty easy day afterwards, sitting in the sun drinking coffee, we finished a 22 km day. A tired bus ride back to Puerto Natales brought us to the end of our trek. I returned my gear (got a 10% discount because the rental guy thought I looked like McCauley Culkin and he wanted a picture – we agreed to take one with a discount! … No Kidding!) In the evening, Juan and I met at the one local brewery in town. We ordered a Kilogram (that’s 2.2 pounds) of fries, topped with bacon, chicken, cheese. Some would call it gross, we would call it the best thing we’d ever eaten (the beer was good too!). Parting ways, I couldn’t help but reflect on the how grateful I was to have hiked with Juan, for a new friend made along this journey, and for his wisdom that he shared with me. I’m already starting on his book reccomendation, Extremes: How Exploration Transformed Medicine in the Twentieth Century by Dr. Kevin Fong. – “Look to the Dawn, let the sunshine carry you. As long as your heart is pure, you will never make a mistake.” – Advice from Gerald Smith to my sister, later shared with me.

The remainder of my week was split between Puerto Natales and Punta Arenas. I spent the next two days at the Hospital. I got the opportunity to spend time in the Emergency Department at the one Hopsital in town. Although an isolated place, this public hospital was really nice. It excited me to spend time there, especially knowing I was returning to some time in the Santiago Public Hospital System.

During my one day in Punta Arenas, I signed up for a Penguin Tour. A boat ride out to Isla Magdalena, I got to walk through the island and look at thousands of little Penguins. You couldn’t ask for better. On the boat ride back we saw two whales traveling together! A late-night flight brought me back to Santiago, concluding an incredible 10 days, both for my project and personally.

Week 7: (pt. 1) November 18 – November 24:

Now this week has only just begun, but it has gotten off well. After taking the weekend to re-adjust, I spent Monday at Hospital Soltero del Río in the Emergency Department. It was quite the contrast to what I had seen in Puerto Natales. Tuesday I began this blog posts, and Wednesday I spent the day with SAMU, the public ambulance service in Chile. Today is Thanksgiving! I nice morning off, and an afternoon finishing this post, I am going to share a Thanksgiving meal with Cory and his family who are in town. Though it will be different not being with family, I am thankful to spend the holiday with others. No matter where I am, there is much to be greatful for. Saturday, I have another day planned with SAMU!

Picture time! (These will mostly be of my trek in Torres Del Paine)

Views of Cerro Paine Grande on the Ferry Across Lake Pehoe, Day 1Views of Cerro Paine Grande on the Ferry Across Lake Pehoe, Day 1

A fuller view of the mountains from Lake Pehoe, Day 1Mirador Lago Grey, very windy, and very awesome, Day 1.View from above Swinging Bridge #1, Day 2Juan and I in the middle of Swinging Bridge #2, much longer and higher! Day 2View from our final lookout near Glacier Grey, an excellent spot for lunch, Day 2Campsite Views at Refugio Paine Grande, our tents are the two most left orange ones, Day 2Panoramic View of our hike up towards El Británico, Day 3A beautiful view of Cuerno Principal in El Británico, Day 3Standing within El Británico, surrounded by Giants, Day 3El Británico, looking out of the valley we hiked through, Day 3Sunset outside of Campamento Frances, I am rocking Day 3 trekking hairJuan and I set out on Day 4’s Trek to our final campsiteSolo hike up to Mirador de las Torres, although half-covered, they were incredible, Day 4Juan and I are hunkered down at sunrise. With the wind we think it was somewhere in the low 20’s, Day 5Cold, but proud and happy to be where I was, Day 5My epic pic from Mirador de las Torres, Day 5The clouds began to break as the sun continued to rise, Day 5But more clouds would always roll in. A farewell selfie, with the final thought, “I will see you again,” Day 5Penguins in Isla Magdalena!More Penguins, they were so awesome! This guy (or gal) popped out of their nest to grab grass to fluff up the nest for their eggs. We learned that each penguin shares an equal load.

A larger view of the island; all their nests are little burrows. There are so many of them! As we departed by boat, we turned back for one more view of the island.

Project Time!

Coming out of weeks 3 and 4, some new thoughts and observations have come to my mind that I have enjoying thinking more deeply about.

First, a relflection of my time with Ambulancias Santiago. Early in Week 4, I spent a day with Ambulancias Santiago, a private ambulance agency based out of Santiago. I got in the ambulance with a Paramedic and a Driver, sitting in the middle seat up front with them, we headed out on the streets. As I would discover, the work these medics were doing were mostly making transports, rather than responding to 911-calls, or the equivalent. That being said, we barely took a break all day. The majority of our patients were individuals who needed dialysis treatment. Running between homes, hospitals, and dialysis treatment centers, the two guys I were with did their work. Perhaps my feelings were a mix of what I was seeing and what I had already been feeling in the week, but I was a little off-put. To me, it just seemed like a taxi service with a bed. There was not a whole lot of “care” being given, except with the help getting in and out of the truck. I did enjoy my time though, and many of the patients asked who I was, which I was happy to share with them who I am and what I was doing.

After my time in Torres del Paine, I spent a few extra days in Puerto Natales, the nearest town. I learned that a new hospital had just been built, and I decided to go see if the ambulance station was there — nothing was showing up on Google Maps! Arriving, I found the station in the back, it was the SAMU service for Region XII of Chile. Meeting the Director, I explained a little about who I was and what I was interested in learning – due to size and time limits, she took me upstairs to the emergency department to be introduced to some of the doctors there. I ended up spending my time in the Emergency Room for the afternoon and returning the following day for more time there. As I spoke about in Denmark, most who visit the ER are not what you see in movies, or Greys Anatomy for that matter. We attended to both children and adults – anywhere from potential broken bones, to larger chronic illnesses. I hopped around from doctor to doctor whenever a new patient came in, and listened to the way they spoke and worked with patients. Something stood out to me here; everyone took time to stop and say hello to each other. There was importance that lay in saying hello, a handshake, or a hug. No one was left un-greeted when I new health care provider entered the ward. Hospitals are always busy, and there almost always is a tension that runs through the air like radio waves. At least, in my experience, I have felt that tension – the buzz in the air. In Puerto Natales, that buzz seemed relatively minimal, if not non-existent. I liked it. To me, it felt how it should be – centered on interpersonal relationships, connection, and of course, giving care as best as one can.

Returning back to Santiago, and going to Hospital Soltero del Río, the largest public hospital in Santiago and in Chile — and likely one of the largest in South America, I was struck with many differences that left me thinking. Perhaps it is because one hospital was less than two months old, and the other has been around for decades, and perhaps too it is because one cares for 20,000 people, and the other 6.5 million. These things are surely to have an affect, but the tone was different. One thing that did remain at least, was the interaction among staff. Handshakes, hugs, and the typical Chilean greeting, a kiss on the right cheek was still passed around. Again, it seemed to me that it helped lighten the load and tension that filled the air. I spent most of my time in La Sala Reanimación, which is a room in the ER with patients who are in more critical condition.

Leaving, I had many thoughts swirling in my head. What made the far south of Chile so different than here? Was it purely because of the size? Is there more funding given to Puerto Natales because it’s the only hospital, or that there are many tourists who come south, and given that this is the only hospital, there needs to be sufficient levels of care? Does the aspect of community care reflect better in smaller places? In my mind, that seems to contrast with your typical notion of “Standard of Care.” For the most part, (not to over-generalize too much) small, rural towns are more often associated with less access to quality care, while large cities are often considered to have better access to quality health care. This is largely a reflection of resources, and is an ongoing debate in the medical community about how to better provide care to rural communities. This being said, in my experience, both before and during this year, I have begun to take note of the space and interactions within these large and small cities. It at least has been more apparent to me that individuals in smaller towns share a greater sense of community, while larger cities often come with a loss of community. Again, this is an over-generalization, and should in no way be taken as fact, but it is true that a community of 6.5 million looks different than that of 20,000 or less. In the Faroe Islands versus Copenhagen, I witnessed the same. In a large city, it is quite easy to feel invisible – I have felt it before, and perhaps you have too, but in smaller communities, your presence is more noticed, for good and for bad. So I am left asking, what’s the relationship here? Small towns typically share less access to health care, and in my personal observations, often a greater sense of community. On the other hand, large cities share more access to health care, but at times the loss of a greater sense of community. Surely, there is not a direct correlation between these two things, but it has left me wondering. Do the way communities associate with each other have anything, if at all, to do with the level of health care access? Most of these are just thoughts spinning in my head, and in no way do I have an answer to any of it at the moment, but I wanted to share. What do you think? Have you ever noticed the same in the places you have lived?

Lastly, a reflection on my time with SAMU yesterday. First of all, it was awesome. The funniest moment was when I responded with two medics to a car crash and one looked at me and said in Spanish, “Go see whats wrong with that guy over there.” And there I was, with a blank expression on my face, thinking – “what?” I did my best, but was thankful to have some help when it came. I hopped around on two ambulances yesterday, one was a basic life support, which had only a driver and a paramedic (which actually translates to a Basic EMT for those in the States) and an Advanced Life Support Truck, which had a Doctor, driver with paramedic training, and a third paramedic with a bit more advanced care training. The day ranged from responding full lights and sirens through the busy streets to the scene of a car crash to transporting a patient from the public to private sector. We took a patient with a suspected MI (heart attack) directly into a Cath Lab to find the blocked artery, and we witnessed the team of doctors, nurses, and technicians rejoice as they found the blockage, only to jump back into action when the patient began to downtrend. Leaving, the prognosis was not good; a cold, but truthful reminder of what occurs both here in Chile and around the world every day. Our finite resources ultimately are matched against an incredibly complex system, our bodies. The new book I have started is called Extremes: How Exploration Transformed Medicine in the Twentieth Century. Reading this book, and reflecting what I observed with SAMU & Hospital Soltero del Río, my last thoughts are these: To what extent can a Doctor give adequate care? To what boundaries do they reach? And what can they breach? In the last century we have pushed these boundaries further than we ever imagined we could; yet still, the medical community faces its limits. And lastly, with those limits, how does the role of the community or the family fit into the picture when we reach those limits?

As you can see, much of these are questions left unanswered, and many are open ended, but I believe it is a reflection of the many great things I have seen in the past three to four weeks, and how my mind is beginning to become more attuned to where I am, what I am seeing, and how it all fits together.

On this Thanksgiving Day, I have much to be thankful for. For all the absence of family and familiar faces that this year may bring, I have been given this incredible opportunity to witness and ponder the thoughts written above. This is something that I have great gratitude for. So again, thank you, Watson, and thank you, readers. Thank you to those who have helped bring me to where I am today, and thank you for continuing to support me along this road. I wish you the best of time with your family and friends. Eat some extra turkey for me!

One thought on “Halfway through Chile (and 1/3 through this year?!)

  1. Mary Kate

    WORST. SISTER. AWARD. I’m so sorry I’m behind on reading 😦 Catching up before our BIG catch up in person. Hoping to get to your second post later on today (it’s Camp Read a Lot) but for now, here are some thoughts on all you’ve just shared…

    I love what you write about “Project Avoidance.” Man, how much can I take that and apply it to my life? Where am I most avoidant? And to whom? This is great self reflection, Markie. Your final comments on reaching limits is super applicable to me right now, too.

    Some big and funny things have happened in Chile. I didn’t know you were in a PROMO video (LOL). I would like to see! I can’t believe you ate 2.2 pounds of fries. That is disgusting and I hope your arteries, Dr. McAlister, are fine. The pictures from Torres Del Paine are absolutely incredible, as are the quotes you paired with your days and I love that idea of hiking with a mantra. I did a running bible study at Sewanee and that’s what your mindset reminds me of. One of the campsites, I think the Refugio one, reminds me so much of a site on Kili! One that you will see this summer!

    Your observations of a small vs. big town are important and probably ones that you’ll come back to. What will this look like in Thailand and Tanzania? Some parts will be developed and others not so much. How does that affect the health care?

    Also, what is the different between private and public ambulance systems? Does it affect the level of care you are able to receive? On to your next post…



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