Friday, December 8th, 2017: Five months ago today I made my way to the airport and boarded a plane to Copenhagen, Denmark, beginning this incredible journey I am on. Two weeks from today I get to welcome Mom, Dad, & Mary Kate to Chile, and one month from today I will be stepping foot into Thailand and celebtreating 6 months on the road! That alone is some awesome stuff. How am I doing, you may ask? Honestly, really great, and that feels so great to be able to say! Ever since that first little dip in my first month in Chile, things have seemed to continue to trend in the positive direction and I am so happy to be able to say that to you guys, and it feels even better to say this knowing what I had planned two weeks ago when I last wrote to you all, was completely turned upside down with a change of plans (something I am learning is quite the norm). To have changed so quickly and still feel so good about where I am and what I am doing gives me confidence and hope. For the same to have happened four months ago, or probably even one for that matter, would be a different story.
So whats been going on?
Week 8: (November 25 – December 1)
On my first day of the week I spent another day observing with SAMU, alongside a different crew of people. As Saturday’s tend to be in other walks of life, so was this Saturday at SAMU’s base – a little slow. Talking about it with the medics and paramedics on call, I learned that weekends are often a little slower because there is a known lull in the hospitals, and many often wait to call until the week unless it is something truly urgent. Even with the lull, we got to run a few calls. Reflecting on my time in the ambulance in Denmark, I feel the same rush when we pull out of the station, flick the lights on, and speed down the road, but there sure is something that adds to it when you look out the window and see all the traffic you are weaving through. In Denmark, based off of the station’s location, we often traversed quieter roads.
Initial plans for the most of Week 8 consisted of beginning my trip down through the South of Chile, or my “South Tour” – I had it all planned: Concepción, Temuco, Villarrica, Pucón, Panguipulli, Valdivia, Puerto Montt, Castro, and ultimately a return trip to Santiago the day before family arrived. As I sit here in El Parque Bicentenario, 2 miles away from my apartment in Santiago, you can see how these plans have clearly changed. On Monday, the 27th, I took a bus from Santiago to Concepción, located about 6 hours south of Santiago along the coast. I was picked up by a guy close to my age who I had met on Couchsurfing. He offered give me a ride and tour of the city. I met back up later with him alongside one of his friends to watch a local showing of a movie about an American Missionary who became involved with Revolutionaries during the Pinochet Dictatorship. It is called Cabros de Mierda. Even though there were times I definitely did not pick up on all the words, the message rang loud and clear, and it felt good to have learned a little more of the history here.
That Tuesday I attempted to get in touch with the hospital in Concepción, but was met with a few regulation barriers I had not encountered before and was more or less turned away. Leaving, I was wary that I may be running into similar barriers in some of the other places I had planned on going to. Changing plans that day I took a bus out to visit Ramuntcho, a fairly hidden, but beautiful beach about an hour outside of the city. That evening I got to speak with Alvaro’s (the friend I had made) mother, who works in internal medicine at a smaller hospital outside of the city. My last day in Concepcion I explored a little more with Alvaro and then hopped on an evening bus to Temuco. At this point I had already made some adjustments, canceling some cities and deciding to just go ahead and hop over to Pucón, and thus my stay in Temuco consisted mainly of a quick bite to eat and a bed to sleep on before catching the morning bus over to Pucón. I had planned Pucón to be set aside for a little time adventure-tourism. Arriving in the city, my hostel host helped me find the right tour agency and I quickly signed up to climb El Volcán Villarrica. The Volcano that overlooks the city sits at just over 9,300 feet and is currently the most active in South America. That following day, December 1, I awoke for a 6:30 am departure. Our team was small, a German, two Brits, two Chilean Guides, and I set out towards the mountain loaded with gear for the day. We summited around noon and managed to pass some larger groups also hiking, which gave us some extra time at the top. On one side opened up a vast landscape of blue skies with volcanic peaks spotted around, and on the other a giant crater, billowing with smoke and the occasional lava spurting up! Thinking back on it, I realize I have never seen lava before, let alone stand on top of an active Volcano! It was so cool. What took us 4 hours to climb managed to take only 40 minutes to get down, as we donned thick pants, a slick diaper apparatus and a sled strapped between our legs. We raced down the mountain through carved out channels using our ice axes like a kayaker would paddling on a river to stabilize and brake. Maybe it reflects the success I faced in a Kayak, but I had my share of close encounters and one full-fledged wipeout (yes, I got it on camera).
Week 9: (December 2 – December 8)
To start off Week 9 and finish my last day in Pucón, I met up with the two Brits from the day before. We planned to trek out to Las Termas Geométricas, these awesome Thermal Pools we had heard about. Trying to save some money, we tried to get there on our own instead of with an agency, only to end up probably spending 1000 pesos ($1.50) more after our last bus connection was privately run by a few people who clearly knew they had a monopoly on the transport (our bargaining did not work), but we enjoyed an incredible day in the 20 different pools they had, which ranged from 35 – 45º Celsius (95 – 113º Fahrenheit). The water is collected as it flows out of the mountain and collected into pools which then uses gravity to fill up the rest of the pools below the collecting tanks. To meet the right temperatures, they mix the thermal water with the creek that runs through the canyon. Apparently, as it comes out of the mountain, the waters temperature ranges between 70 and 80º Celsius (158 – 176º Fahrenheit) – more than enough to cause some serious damage if you touched it. Even at 45º C, you can only manage a few minutes before needing to leave.
The next day I took a bus from Pucón to Puerto Montt where I continued onward that day on a second bus to Castro on the Island of Chiloé. I met a woman named, Angélica, who was a mutual friend of someone I met here in santiago. She offered for me to stay with her. We shared a meal and explored the city by car at sunset. The next day, my plans took one final change, I heard back from some of the doctors I had worked with in Santiago with SAMU. Having permission to work with them more, I knew that I both needed and wanted to return for more chances to observe, work and learn. Knowing my time in Chiloé was cut short, I took the day to see the city and hopped on a bus that would last for 15 hours en route back to Santiago.
Wednesday I went to work with SAMU, and spent a full day with them, hopping on a few different trucks when a new call would come in across the radio waves. I returned again on Thursday to do more of the same, but with a different crew. Having returned to the same base a few times now, I have begun to feel much more comfortable there, and it is clear that others now recognize my face, and at least have an understanding of why I am there. This has definitely helped being able to ride (and talk) with more people! It sure does feel good.
And today I am writing to you. Having had a nice morning, I ran through this beautiful park, returned for lunch and now have walked back out here to sit in the same place, write, and reflect. It’s a good day.
(Up-Ahead) in Week 10:
Coming up ahead I will go back to SAMU on the Sunday and Tuesday (and hopefully be able to confirm some more time later in the week as well. On Wednesday I am going with on of the doctors I worked with to another group he is a part of, AireRescate, a private helicopter rescue service. So, there are more good things to come, and I look forward to I sharing with you all!
Standing at the center of the beach in Rampuntcho, an awesome cove to find.
At the very end of the beach was this island with one tree still standing on it, I loved it!
My last day in Concepcion, we ran across a kid in an ECU sweatshirt. He said he didn’t know what it was, but cool for me, as that will become home for the next 4 years!
My first night in Pucón, I got to sit by the lake and watch the sun set against the Vocano I was about to climb.
You can tell, I was quite happy to be there.
Starting our ascent, we stopped for a first round of photos.
Below us were other groups making the same trek.
Standing on top of the Volcano, we peaked over the ledge into the smokey, gas filled crater.
On one side the crater, and the other, a beautiful view.
Selfie with our awesome hiking team!
Our guides captured one last shot of us on the rim of the crater before descending.
At the bottom, I had to throw my hands up in excitement and accomplishment.
A few hours later in the day I looked back at the same volcano I had just climbed and saw this!
And at night, I was able to capture lava in the crater illuminating the smoke above it (Glad I already climbed!).
Entering Las Termas Geométricas, we were blown away at its beauty.
Red, wooden paths weaved through the canyon taking you ever deeper (and warmer) to more hot springs.
Steam rose from below us in the collection pools of 75ºC Water.
At the end was a pretty awesome waterfall (which was most definitely not heated!).
In Castro, I walked along the Ocean Fjord and gazed at the palafitos, houses built out over the water on stilts.
As I come out of traveling a good bit and seeing new places within Chile, while also managing to have the time back here in Santiago with SAMU, my thoughts from my last post continue to swirl in my head. In Concepción, I bounced some of my ideas off of Alvaro’s mother, who worked in a more rural hospital, while living in a larger metropolitan city. She too recognized the differences between small and large towns but wouldn’t go as far to say what the relationship between health and community may be in these places. She recognized though, that at times it was easier to communicate with patients and families where she was because often there may be a little more time, which she maintained is important in establishing a significant line of trust. She spoke about how from her experience in larger, more busy hospitals, this can be hard, and that although you are providing care, the decreased amount of conversation with both patient and often family can be a challenge.
Hiking the Volcano I got to talk with the guides about rescue operations on the mountains that they guide. One of the members on our team asked why our guide was carrying a metal pole, and he shared that it was to create a tether in case there was a need to perform a rescue from a fall through a crevasse. I later learned that in the instance of a medical emergency, it is up to the guides to perform the rescue operations, and that there would not be more help coming except for when they had returned from the mountain. For this reason, every guide must pass a certain certification to be the guide on the mountain, which includes training such as high angle rescue, but also basic first aid. In one sense, it seems like care is not really there, or at least it’s not “covered” by the town, local service, etc., but thinking further, I came to realize that the care is still being provided, but rather just being deferred to each agency by the rules and laws that are set in place. I was happy to be able to tell so clearly that my guides knew exactly what they were doing. That was reassuring, and speaks to the success of their service. Pucón has an extremely large tourist base, both of local Chileans and foreigners who come for the Volcano and the many other outdoor adventure activities nearby. With such activity, also comes risk for injury or accident, which is why I found it to be interesting that it was the guides who were responsible for providing medical intervention when necessary. I never saw an ambulance in the city, though there was a local hospital. I saw the fire station, which consisted of volunteers. There was a central station, but firefights lived in their own homes and would report in the case of an emergency. It reminded me of Sewanee, and many other small towns in the States that do the same.
Back in Santiago, my past two days with SAMU have been really great – both in learning more about what rules and regulations are in place and for more direct observation and experiential learning. On the systematic side of things – I have mentioned before how many different agencies I see around the cities, at hospital entrances, and through researching online. It’s hard to tell exactly who does what. SAMU always and will always be the main resource when it comes to responding to medical emergency. There are other services, such as HELP that respond to emergency situations, but only to those who subscribe to their service. HELP ambulances are easy to pick out, as they are all the Box-Style large trucks you may find in many cities within the U.S. SAMU uses the van style, like Denmark, and also many like the ambulances that work in and around Sewanee. One of the paramedics I worked with yesterday reiterated to me wheat I have heard from others. He said that SAMU does really good work (and that is something I have been able to tell), but there just arent enough trucks running at a given time. Another told me yesterday that in their opinion, other private services may come with the bells and whistles of fancy equipment, vehicles, etc, but SAMU and those who work within it, are strong and successful because of their experience. When it comes to emergency care, namely prehospital care and interventions, you are given a limited amount of resources on an ambulance, (no one is about to start surgery in the back of a moving vehicle), which means that the care given though useful and helpful with the right equipment relies much more on the competencies of those who work in the trucks. I asked about the drawback the service faces with a limited amount of trucks in service. What happens if there is a really busy day, or a very large mass-casualty incident where the public service meets its capacity. One would hope that private agencies in these moments wouldn’t focus on profit, but you never know. I learned that there is a mandate in place that requires private agencies to assist when called upon. The same mandate goes with the helicopter services. There are some private and some public, but when called upon, the private services step in as well.
In the past two times with SAMU I have been able to respond to car crashes, chest pain, falls (some major), elderly care, and even a helicopter rescue (though I didn’t get to ride in the helicopter, just assist in the transfer form helicopter to hospital). All of these things have been so good to see and be a part of. This year, the big questions I ask myself and seek to discover are ones such as:
“What do ambulance services around the world look like?”
“How do they operate?”
“In what ways do they give care?”
“In what ways do they not?”
“What’s the relationship between these services and the community?”
“What is the community response like?”
Its not as if the patient lying there on the stretcher is about to look up at me and tell me all the answers to these questions, (although I definitley at one point thought it might look this way). For me, I am learning more and more every time I get to step inside another ambulance, in a new place, with new faces, and new surroundings. As we speed away to different scenes, its interesting to take note of the faces of bystanders – some nonchalant, others who seem to be disturbed that you are there, and of course, still others who breathe a sigh of relief at your arrival. I have felt a mix of feelings while being on scene, at times feeling like I may be getting in the way, and at other times feeling like I am actually being of really good use, but at the bottom line, I know I am learning through these experiences.
A photo of the first ambulance crew I worked with at SAMU!
Base 20: Where I work and observe is located in the center of the city and adjacent to the Emergency Hospital.
Our Doctor loaded into the helicopter to pick up a critical patient.
(In this last statement, I am going to talk about my last call which describes my experience of watching a patient in Cardiac Arrest. Though I think what I will share is more than appropriate, I just want to disclaim that in writing, I am trying to reflect as best as I can the events I observed – but if this is something you’d rather skip through, then scroll on to the bottom for some sledding videos going down the Volcano!)
My last call I took part in yesterday was the helicopter response. Sitting in the base, one of the paramedics hopped out the door and said, “Vamos, el paciente está in PCR.” Meaning, “let’s go, the patients in CPR.” I should note, however, at the time I didn’t know what PCR was. The ranslation of the acronym didn’t click for me, but I followed along and soon we were really picking up our pace. Running up stairs and down corridors we entered the final one to the helipad. In this hallway, our ambulance crew joined a large team of what looked to be a mix of doctors, nurses, and technicians. In this chaos I was beginning to recognize that the situation was rather grave. As we exited to the helipad, the helicopter was just landing – some took to climbing the ladder and others went around on the ramp. The pilot waved one of the paramedics to come out and help open the door and get the patient out. It was then I realized what was going on. The patient had gone into Cardiac Arrest and CPR was being administered. As best as one can, with all the people around trying to aid the patient, they transferred them onto the hospital bed. Quickly, there was a doctor on top of the patient continuing compressions and we were wheeling away. It’s a hectic scene: things get in the way, a bag falls off the bed, theres a scourge of people there, but only so many attending directly to the patient at a given time. Whisked through corridors, others look on, some enter the elevator and we walk around to wait at the bottom, whilst more onlookers, patients and health care providers look from afar at the scene until the patient is finally wheeled into the trauma room behind closed doors. More doctors enter and there’s probably over 20 people in this small room. We, the ambulance crew, back out and the door closes behind us. Their work was finished, care had been transferred, rather seamlessly, but simultaneously with great chaos. It was interesting to sit with the paramedics after. For someone who is in this line of work, these are not necessarily the newest of sights. With emergency care comes trauma; it’s inevitable, but it doesn’t mean that it becomes normal, or that it should ever become normalized. I could tell that through observation and conversation after that call.
For me, this was the first time I’ve seen a patient in this state. In training during my freshman year and while working for Sewanee EMS I responded to calls where patients had already passed away. The work of a medic in these situations, no matter what one tries, would in no way resuscitate life, but CPR is different. Here you have this body, this life, both living and dead in the same moment. Naturally, this patient is no longer living, but with external compressions, blood still flows through their body, and with puff of oxygen, that blood still provides the life giving nutrients a body needs for cells to survive and for the brain to function. These are essential, but also are at this point artificial, and at some point if a natural heartbeat does not return, then these artificial mechanisms will cease as well. The image to me isn’t necessarily haunting; to an extent, I can expect that there will be more of these occasions in my years of training and work to come. It’s not so much that we should expect death at any moment, but within this field of work, one must be prepared to step into the face of it when it arises, whenever that time may be. Life, at times, fails. That is life, and it’s the role of a health care provider to sustain, nurture and improve life. I could see that play out before me in yesterday’s events. The rush, the chaos, all of it comes as a result of the desire to sustain life. The frustration, the anger, or the sadness is not so much at what is seen, but at what one feels they cannot do.
My blog is titled “Discovering Life Amidst Emrgencies” and when I first applied for the Watson, my title was, “Emergency Calls: A Communities Reply.” In this year away, I departed hoping to see the intersection between Health Care Provider, Patient, and Community. Of course, there on that helipad, the community of Santiago is not going to be there, nor in the trauma room, but the amount of people I saw pour into that room in the hopes of giving even the slightest bit of aid, speaks volumes to me. Perhaps every place I go will have scenes like this, and if so I give thanks for that. For the people within the community that will pound on a chest for close to an hour because they believe that someone isn’t supposed to die that day. It is a somber thing to recognize that death occurs all around us, but it is also incredibly uplifting to know that there are those within our community, here and elsewhere, that are willing to do anything they can to nurture, sustain, and maintain life.
Thanks for listening to at times some rather raw reflections, as the holidays near, I hope that you all may find time to rejoice and give thanks for the lives we live, and for those out there each day working to sustain it.
Cheers and talk soon,
P.S. Enjoy these sledding videos (including my wipeout!)
An excerpt from one of my initial rides, at times the camera gets a little off course, but cool to watch the descent!
I hope you can all laugh with me as my excitement quickly turns into fumbling and one final snow covered flop! Happy December from a face full of snow!