January 2013 Archives


1_31082011_15536_museo550.jpgOn Sunday afternoon, a few day prior to our departure, we visited the Museum of Memory and Human Rights, that illustrates the attempts against life and dignity against Chileans from 1973 to 1990. Whiling touring the museum we were filled with emotions of sadness, anger, fear, and sympathy for these innocent people. The museum depicted the 3185 executions and disappearances that were related to the new found dictatorship and political unrest.

One of the early exhibits that we saw was large a map of Chile made of stone lying on the ground.   Throughout this stone were many markers with pictures of current memorials to honor and remember the people affected by violation of human rights.  It was shocking to learn and visualize that human torture and political imprisonment took place throughout all of Chile, not just in one area.

We learned  about the history of Chile while touring the museum.  On September 11, 1973 La Moneda palace was surrounded by soldiers, tanks, and helicopters as the Military demands President Salvador Allende’s resignation.  With President Allende the military opens fire and many people die or are captured and disappear forever.  President Allende was found dead and the Military Junta takes over control of the country. It’s interesting that 9/11 is a significant day in other countries as well. 

The new Government Junta, a dictatorship, sets new laws in which strict curfews were implemented for the Chilean citizens, the approval of the death penalty, closing of Congress, and prohibition of all political parties. Civil liberties were restrained under this new government, and fear among Chileans grew as persecution, torture, assassinations, and covert burials increased.  There were exhibits about the use of electrocuting beds, drowning related to cement blocks being attached to people, and shootings just as a few examples. It is unbelievable what people went through.  Additionally, thousands of Chilleans were kidnapped, exiled, or expelled from the country. A quote from a relative of a disappeared detainee states, “It’s terrible when somebody is executed, but you see it happen.  You can bury him or her, take flowers to the grave and be in mourning.  But in the case of those arrested and disappeared you don’t know where he is, you don’t know what happened to him, whether he is cold, hungry or if he’s really dead.  This is something for the entire family to go mad.”  Thinking about this quote, one can only imagine how devastating it must have been for a loved one to just disappear and know nothing.

Age was not a factor, as thousands of children observed their parents being kidnapped and tortured, or their homes being searched.  Many children were forced into exile and hundreds were tortured, assassinated, or disappeared.  One of the exhibits was pictures and quotes by the Chillean children during this horrible time.  Art therapy (a form of therapy we have used during our psychiatric nursing rotations at home and observed here in Chile), was used to help the children express their feelings. Some of the pictures showed fighting between the military and residents, people being taken away by the military, and people behind bars. There were pictures of cemeteries, and people caring for those injured.  The faces on the pictures showed fear and sadness with tears.  There were no happy pictures displayed in the exhibit.

The Military dictatorship lasted 17 years.  During that time the Chilleans did all that they could in terms of protesting to restore peace and human rights.  Other nations and human rights originations became involved in the fight over time, and helped expose what was occurring in Chile.

The most memorable exhibit is a mural that is 3 stories high and the length of a very long wall that displays photos of the victims who did not survive the dictatorship.  Throughout the display are empty frames for additional photos to be added and account for those still missing. There were electric candles placed as a vigil to help remember and denounce the loss of these people.  It was mind-blowing to learn that something like this happened for so many years, and for us to be in college and just learning about it now.  Reading some of these peoples stories and quotes, and watching short movie documentaries was heartbreaking. Words cannot describe how we felt.

~Sara and Mariah

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Val in Valpo

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On the Monday before we left Chile, we spent the day in Valparaiso, a coastal city about 2.5 hours from Santiago. The city is made up of many steep hills and valleys, much like San Francisco. Even here, there was definite evidence between the rich and the poor. Some homes had eccentric architecture, built on top of the hills overlooking the water. Others were more noticeably poor, with rusty tin roofs and walls made from mismatched wood. Graffiti was everywhere, though much of it was actually quite beautiful.


Professor King had downloaded a book on her kindle that gave a step by step (no pun intended) tour of “Valpo,” complete with anecdotes about the historical buildings and landmarks. We walked around the city, admiring the landscape, architecture, and view of the ocean. One of the unique hallmarks of Valpo is the sight of funiculars going up and down the side of the steep hills. Funiculars are railways on which rides a small wooden boxcar that can fit around 10 people.  This wooden car moves along the railway, up and down the hills, giving peoples’ legs a break but still allowing them to reach their destination. The funicular we went on was at about a 60 degree angle and very old looking (yikes!), but gave us a beautiful view of the city as it went up the side of the hill.   


As we walked around the city, Professor King told us a brief history of Valpo. In the 1500’s and 1600’s, Valparaiso (meaning Paradise Valley) was the site of the Chilean navy. Later, still before the Panama Canal was built, Valparaiso was an essential stop for food and water for large boats rounding Cape Horn. Currently, it functions both as an important seaport and tourist destination.


Valparaiso definitely rivals the other places we saw in Chile in terms of beauty and charm. My only complaint? That we did not have enough time to see everything the city has to offer!

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A local women selling herbs and beans and vegetables.

I'd like to make a blog about FOOD. I don't just love food, I'm IN love with food. Being in Chile for 2 weeks though, I realized that I didn't crave that much american food. Sure, there's no refrigerated milk, but on the whole, I was pretty satisfied with the food I had in Chile.
During the two weeks that we were there, I was hoping to try out authentic Chilean food. Surprisingly, it was actually quite hard. Empanadas (stuffed bread more or less) were everywhere, and every other meal consisted of an empanada for the last two weeks, but we were only able to eat good authentic Chilean food a handful of times. One dish in particular that I really enjoyed was "Pastel de Choclo" which consists of ground meats topped with a crust of sweet corn and cornmeal. If you look it up on Google, pictures do not do it justice. The sweetness of the caramelized corn dough compliments the savoriness of the ground meats hidden at the bottom. It's a perfect blend of sweet and savory that made my taste buds jump for joy. It reminded me of a Spanish Shepard's Pie since the dish was in layers. 
Eating Pastel de Choclo.jpg
I didn't really crave american food since a lot of the foods that you'd see in America were also in Chile. Hotdogs, pizzas, KFC, McDonalds, and many other fast food places were abundant even in the most rural areas. The condiments on a hotdog were not just mustard and ketchup, it consisted of a thick layer of guacamole and a giant helping of mayonnaise. A lot of burger joints were seen in the malls and along the streets as well. Again, these burgers were topped with a heavy heaping of mayonnaise, bacon, and guacamole. Every food item had a side of fries as a meal. I couldn't escape fried foods. The amount of trans fats and calories made me worry that I'd gain a ton of weight during these two weeks (luckily I didn't). 

With all of these fast foods that could be bought at a cheap price, it raised my concerns of obesity in Chile. Surveying the street, I'd safely assume that most Chileans looked fit. A lot of people were biking and walking around. No one seemed overweight, but with all of these fast and fried foods, I'm sure that the rate of obesity will slowly increase as the years progress. With the increase of obesity comes complications such as heart problems, high blood pressure, and high cholesterol. After doing some research, I noticed that Forbes voted Chile to be the 23rd most obese country in 2007. We did see some actions done by the government that promoted healthy living. On our way to a beach in Constitucion, there was a public gym that had an elliptical and various exercising machines that was out in the open.
exercise park.jpg
I wanted to try out more Chilean food, but with the copious amounts of fast foods, and difficulty of finding a nice chilean restaurant, we resorted to eating pizzas and emapanadas. Every restaurant that we've been to also has a large selection of italian pastas! All in all, it my stomach was pretty satisfied. I still craved my biweekly helping of sushi, and there were a lot of sushi shops around, but I didn't want to risk getting an upset stomach while on the trip!

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To Javi with LOVE

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It is very important for myself and the students at UMass Lowell who traveled to Chile to thank Javier Cifuentes. He is the son of Manuel Cifuentes who works for UMass Lowell.

Javier is a student at BU and a previous resident of Chile before moving to the United States at age nine. He is fluent in Spanish and knows Chile. This young man took upon the huge responsibility of being our liaison and translator. He willingly gave up his own semester break to travel with us and listened to our many questions such as "what does this mean," "can you tell me how to ask the patient (bus driver, waiter, banker etc.)" and a million other questions. 

He is a kind, generous and joyful person to travel with. This trip challenged him as well as us and we thank him for his invaluable assistance.

Thanks Javi! 

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Adios Chile

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Today is our last full day in Santiago. Many of the students are tired and I am sure would like to sleep in. I have decided to go to Valparaiso and have invited anyone who would like to come with me. I am pleasantly surprised that instead of hanging around the pool today they are willing to go to a historical site. 

Javier overlooking the port of Valparaiso.JPG
I have done some reading on this city that used to be a bustling stop for cruise ships and other shipping prior to opening of the Panama Canal, as the ships would have to pass by here before rounding Cape Horn. For the last century there has been some decline in this port city and it has only been recently that it was declared a UNESCO site and there has been much attention given to it.


Many areas are being renovated while preserving the artistic and architectural elements. There are old buildings and 1940's era electric cable cars juxtaposed with sleek buildings and gas-powered city buses that crowd the streets. It is like San Francisco in some respects and can best be visited by foot (and we certainly did a lot of walking yesterday).

After visiting other cities affected by the earthquake, we wonder how this city fared in 2010. The precarious buildings and location of homes on the steep hills would seem to be a recipe for disaster.

Many photos are taken (see our gallery for some great pictures) and after 3 hours of climbing roads of cobblestone and riding up one of the 15 funiculars (ascensores) that are scattered throughout the city, we are ready to find our way back to the bus terminal. 

We have become a well trained travel pack as we make our way through crowded streets and city buses. Despite the crowded conditions, the people of Chile are not rude and pushy. I am impressed with how many people use the city buses and actually respect and follow the rules of crosswalk signs. We know that this would not be the case in many urban cities in the USA.

Our time is short so we do not have time for a real meal before we take the bus back to Santiago. We have become pros at visiting the local Lider (food market) and find some food. It must be a subsidiary of Walmart because we see these stores all over Chile and they carry the same Walmart private label "Equate" and other familiar products from USA. I guess Walmart has moved into every city even beyond the borders of America.

The energy level of the students is obviously waning as they think about home and the approaching start of school. The seniors are anxious about pending placements for their Precepted Practicums and the upcoming HESI exams. The juniors have new clinical rotations starting and a big drug calculation exam in the first few weeks of the semester. Our one Sophomore has learned a lot about what to expect in the next two years and is very excited about finally taking some nursing courses. She (Sarah) is very fluent in Spanish and has been so valuable during our trip. The people of Chile are drawn to her as she often stops to chat with taxi drivers, hotel staff and others.

Many of us are very hindered by our lack of Spanish fluency. We are all trying very hard to work on our vocabulary, but it is frustrating when sightseeing and also when trying to communicate with patients. We are developing a keen awareness of how it must feel for our patients at home who are not fluent in English. On this trip we struggle to determine if we are ordering shrimp (camarones) or by mistake we are getting clams (prawns). It makes a big difference if you hate clams but love shrimp (believe me...I made this mistake). I can now imagine how frustrating it is for patients to try to communicate with their nurses to tell them about their symptoms or other information that is vital to their recovery.

So although we have left Talca, which was our "academic week" we continue to learn about factors in the health care system and how we can take that knowledge with us to make us better nurses. A few of us took a final walk around our hotel  at 11:30 last night and realized how "familiar"  this part of the city has become for us. We know exactly how to get to the metro and are finally figuring out which direction to take the subway. We have seen some familiar faces at the food market, metro and hotel complex. Although it makes our day a bit easier having this familiarity, we long to see our families. Tomorrow we only have a partial day here in Santiago and then off to the airport. 

It has been a good trip and we have learned so much. I continue to be impressed by the students' description of their experiences and I urge you to read their blog entries. I have told them to continue to write a few entries upon their return back to Massachusetts.

Thanks so much to our families and friends and also the people at UMass Lowell who have helped and supported us in our journey to Chile. There are so many people to name, but I need to particularly thank  Fern MacKinnon and her staff at the Study Abroad office, Michael Pueschel and the web/communications staff, the faculty, Dean and staff of NURSING and S.H.E., Manuel Cifuentes for being our "point person" during this whole adventure, and who was my first conspirator in developing this trip, and lastly to the Manning family for their support and vision in recognizing that global health experiences can truly enrich a nurse's education and make him/her a better nurse.

Adios Chile

Psyched to Be Here

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students at the beach in Constitucian.JPG
The past few days have been a whirl wind and it has been hard to find time to blog. That being said, this entry is about our events on Thursday morning. 

Thursday morning was our chance to see the last treatment stop psychiatric patients make on their way to recovery. The facility we went to was a lovely house, which was built after the earthquake demolished their old building. The workers here (which included psychologists and social workers) helped to give the patients independence by teaching them a skill that they could then use to get a job. Examples included baking, knitting, and gardening. In fact, the breakfast they served us included bread and berry pastries that the patients had made themselves. They were delicious! 

Earthquake damaged home in Constitucion.JPG
Earthquake damaged home in Constitucion, Chile.

Both the workers and patients were so kind there. One of the patients spoke a little English and she sat and talked with me in English for a while. I was so impressed that she put in the effort to speak with me! We all fully realize now how exhausting it can be to try to talk to someone in another language! 

We can all safely agree that whatever Chileans lack in medicinal psychiatric care, they make up for in compassion. Every place we have gone, the workers have been a team who do everything they can to get the patients back on their feet and out in the community again. However cliche is sounds, it really is such an inspiration the way these people dedicate their lives to help people who are less fortunate.

More on life in Chile later!

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Friendly dogs and coke paste

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Katerina Kafkas with Luna  the pet therapist.JPG
This is Katerina Kafkas... writing from Henson's account.

The trip thus far has been amazing. Everything here is just different, including the water. A large portion of the bottled water here is "con gasificada" or "with gas" which is basically a seltzer water but is not appealing when it's warm or when you are parched. Stray dogs are everywhere on sidewalks and even beaches. We try to keep a safe distance, but every now and then a friendly stray joins us for one of our walks. The people here are very welcoming and kind. We are greeted with a hug and a kiss on the cheek from everyone including the psych patients. It's been a great opportunity to travel around Talca and see just about every aspect of its psychiatric system.

Many stray dogs on the streets of Chile.JPG
One of the facilities we were able to observe in Talca was an outpatient drug and alcohol clinic. We were greeted outside by stray dogs and inside by a security guard. The waiting room is crowded with patients waiting to be seen. We were educated by a tech and psychologist on what kind of patients they saw and their therapies. The illicit drug they primarily saw in the region was cocaine. They have various forms of it including a "coke paste" which is a concoction of cocaine and other drugs, like rat poison. This paste is available for the same price of a pack cigarettes, 500 Chilean pesos or about $1. 

This facility, also works with children since there has been incidences of children as young as 10 using inhalants, like computer spray. All patients get therapies from a team consisting of a tech, psychologists, social worker and psychiatrist. No nurses were involved in this program due to funding, but it was relayed that they wanted nurses. The therapy they provided to patients was very comprehensive and individualized to the patient.

Unfortunately the building itself wasn't the greatest due to the earthquake. Multiple patients receive counseling in the same room and the only thing separating these therapies is a divider that resembles the wall of a cubicle. This eliminates the confidentiality. This would make it difficult for an individual to come forward with a drinking or drug abuse problem. In addition, the facility did not include AC since its a "temporary" location after the earthquake, which was about 3 years ago now. This may seem like a minor issue, but when we went to visit the facility it was 97 degrees outside and felt even hotter inside. I find it difficult to have a therapeutic environment for a patient at a temperature so oppressive. 

Much more to blog about in Talca. We have had poor connection in the hotel and will try to keep everyone posted. Stay tuned. 

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On Friday, we went to a city called Constitución. We traveled via train from Talca and that was the first exciting part of the trip. All of us were expecting a large modern train but we were all surprised when a tiny, old, rickety train pulled up to get us that had to date back to the early 1900s. It was a loud, bumpy train ride and the conductor honked an extremely loud horn throughout the trip that made many of us jump with surprise even after hearing it several times already. 

The train ride was filled with beautiful views of mountains, rivers and large fields of different crops. Sometimes, the train even went between a clearing between two cliff edges making a small tunnel. The seats were small and uneven, but the experience made up for it. 

Halfway to our destination, the train stopped in a small village in the middle of nowhere with food vendors of homemade goods and a small, family-owned shop with snacks and water. The locals of this rural town looked us up and down in awe but they were very welcoming to us. 

Some of the houses we saw along the train ride were very small and run down, like shacks. I found myself wondering throughout the trip how much access they have to food, healthcare and other basic needs to sustain life since they lived in such a rural part of the country. 

As we got closer to our destination, I noticed more and more poverty. I saw homeless people laying alongside shacks in old ratty clothes on cement or grass with shabby old blankets. When we got to Constitución, I knew it was the poorest place we had visited in Chile so far. The train station we arrived at appeared unclean and people immediately started begging us for money. We then began to walk to find food. Our journey began on uneven sidewalks alongside abandoned, earthquake-damaged houses. The sidewalks crumbled beneath my feet and I couldn't help but worry for the safety of the community and wonder how any handicapped person could get from point A to point B in this city.

We made our way to a street with tons of markets and vendors selling used clothing that were thrown about in piles, with people scavenging through them, desperately searching for something to buy. Street vendors also sold food. To our surprise, we saw whole, cooked chickens sitting out in the hot sun for sale. I saw hundreds of rotten strawberries sitting out at a fruit stand for sale, and we also saw eggs for sale that were not being refrigerated. 

Overall, we noticed there was little attempt to repair earthquake damage whereas in Talca we saw a ton of construction and less damage due to the fact that many buildings had already been repaired since the earthquake. 

We then went to a restaurant, which was just a kitchen in a market with four women cooking traditional Chilean food in front of us at tables right next to them. This was honestly my favorite dining experience in Chile overall. Many of us got homemade pastel de choclo; this dish is a casserole with ground corn, chicken, ground beef and hard boiled eggs, and it is served with sugar on top. It tasted amazing and sweet. 

Next we ventured to the beach. On the way there, we came across a park with different stations to workout and get physical activity. There was a sign with directions on how to use each of them, how long to be at each station and how many sets to do on each machine. They had equipment to train cardiovascular, flexibility, strength and conditioning. We thought this was awesome that they promote a healthy lifestyle in this city. We also saw some of these in Santiago. 

Finally, we arrived at a beautiful, cliff-side beach with breathtaking views of rocks and caves, turquoise water and black sand. Along the beach were small shacks and concession stands selling snacks and drinks. We were amazed because in the U.S. this type of beach would be lined with multi-million dollar beach-side homes. It would probably be inhabited with rich, upper-class citizens. This beautiful beach however was very humble. The only other odd thing we noticed was that right next to this beach there was some sort of industrial factory with enormous piles of sand and construction vehicles outside. We thought it was odd to see that right next to this beach, on the water. 

Overall, we saw the most poverty and earthquake wreckage so far in Constitución yet I think it was the most fun and culturally-enriching experience so far for a lot of us. 

Adios Amigos

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Hospital de Dia in Talca Chile.JPG
Who would ever think you could become so connected with a group of people in such few days?  We were amazed by how close we became with these patients and workers in the Hospital de Dia, where we spent the majority of our time. Despite multiple communication barriers (sign language and Spanish) we really formed a lasting bond with these individuals. 

These people were more than happy to take us in with open arms upon arrival, greeting us with hugs and kisses on the cheeks. They invited us to join them in breakfast, and included us in all daily activities such as coloring and morning exercises. The staff wanted to take photos with us and made our coloring pages into a book to help them remember the time we spent together. The patients faces lit up when they saw us either in the facility or out while doing their daily business. In one instance a patient was at a local food store purchasing groceries and saw us passing by. He yelled and waved to us and then we ran over to say hi and see how his day was going. We were thrilled that we made such an impact on this young man's life just by connecting and spending time with him. 

When it came time to say good bye on our last academic day we were all emotional. Many of us had to fight back tears as we hugged our new friends goodbye. The thought of potentially not seeing them again made it tough, but still being able to keep in touch via email helped ease the pain.

These care providers really inspired us to go above and beyond for our patients and showed us that the nurse patient bond is truly built on trust, respect, and compassionate care. We learned that despite communication barriers people can still connect if they are willing to take the time and effort into trying. 

<3 Mariah and Sara

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The Team Approach

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It is hard to believe that we have been here for a week now.  The experiences have been varied and challenging.  I have just read the student blog entries for the last few days and I am impressed with their ability to capture the moments.  

Students walking through Talca doing a community assessment: examining roads, buildings, pubic services & people. 

The people of Chile have been so welcoming and warm.  I know that when we walk down the street we look different and we collect some stares. We are a funny looking group of nine as we walk through the streets of Talca with our backpacks and stop to take pictures or to watch a stray dog. There are lots of stray dogs and it is interesting how this interests the students. 

Talca is also a city but of course not as big as Santiago. It is has taken us a few days but we are finally getting a sense of direction. The streets are laid out in a grid so the streets are either parallel or perpendicular with an occasional rotary. Transportation is readily available but we are finding that our clinic locations are walkable so we have been walking and exploring a bit in the last few days.  

Hospital de Dia in Talca Chile.JPG
Yesterday we had some great experiences that the students blogged about at Hospital de Dia.  We were able to watch multiple patient evaluations by the multidisciplinary team. Half of the student group was in the room with the patient and the team and the other half was behind one way glass wall. Patient permission was obtained to have the students present. It was a bit difficult to follow the exact conversation due to language barriers and translation but what was so apparent to me and the students is that the team of health care professionals care deeply about these patients and each use their own skills in helping to address issues. 

Mid way through the day we have "breakfast" with the staff, students and doctor.  We are all impressed by these people but today we are  especially impressed with the doctor who describes his passion and involvement in the movement in Chile to address the delivery of psychiatric care and make it more community based with varying levels of care that depend on the acuity and disability of the patient illness. He takes that time to draw a schematic so that the students can see the relationship between the various types of care and the multiple "safety nets" that are designed to prevent hospitalization of the psychiatric patient. He is also very appreciative and respectful of the nurse's role in the care of the patients and truly partners with the nurse to improve the care. He was very generous with his time to explain various points with the students. 

After a lunch we went to the outpatient evaluation center which is actually only a few blocks away. The facility was small with a crowded waiting  room. There was a nurse who manages a special government sponsored program for anti-psychotics but she was the only nurse. This facility seems to employ more therapists, social workers and psychologists. It is small and crowded and we were surprised to see children in the waiting room. This is the first time we have seen children as patients.  

All of these agencies have had to relocate or renovate due to earthquake damage. Some are still in temporary quarters and waiting for the new hospital to be built or for resources to build or rent a permanent home.
Earthquake damage to a bridge in Talca, Chile.
One question I have asked at multiple locations is to what extent the earthquake had on the incidence of mental illness or exacerbation of current known patients. Surprisingly many of the health care workers respond that they do not feel that there was a significant change in the number or severity of mental health patients post earthquake. This seems to be contrary to what one might expect. It is a very interesting commentary on the Chilean Health care system. 

Overall I am impressed with what I have seen for mental health services in the public health system.  We have not seen any private health care but it makes us feel good that the most vulnerable in the system seem to be getting good care. 

The students will have more to BLOG about tomorrow so I am going to let them tell you some more.... 
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My First Post

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UML students at the Hospital de Dia.JPG

Posing outside the Hospital de Dia which is a day program for psychiatric patients in Talca, Chile.

Today was a long and tiring day. We went to the same outpatient facility as yesterday and we sat in on psychiatric appointments which involved a psychiatrist, a nurse, a psychologist, a social worker and a paramedic (similar to an LPN in Chile). 

Patients were interviewed about their symptoms and after a discussion between the patient and the healthcare team, a plan was made and medications prescribed. Some patients proceeded into the exam room for injections of longer-acting psychiatric.

There were a few things that really captured my attention today. The psychiatrist, Dr. Sjoberg, told us he likes to work with the nurse and social workers, etc. as a team because they can work as a cohesive unit making suggestions to each other with the notion that someone might miss something and the other provider can point those things out to their colleagues if something the patient says or does goes unnoticed. 

I admired the team effort and attitudes of the people I met today. I also liked how welcoming the staff was at the clinic. They were understanding and patient with me when I spoke slow, broken Spanish and they really tried to get to know me and the other students. 

We all sat down and ate a mid morning snack including the psychiatrist. I was surprised that as a doctor he took the time to sit down with us and happily answer any of our questions. I feel like that would rarely happen in the U.S. 
Hospital de Dia in Talca Chile.JPG
Students with new friends from the Hospital de Dia.
Today, like every other day we have been here in Chile, we were forced to challenge ourselves and use the little Spanish we know in order to communicate with our new friends at the clinic. They reciprocated this effort to us by trying to speak some English (those of them who knew any). I feel that psychiatric health is a priority here in Chile and I am happy about that. The staff at the sites we've visited seem very passionate about what they do and caring toward the patients. 
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quake damage.JPG

Allison Read and Sarah Post pose next to earthquake damage in Talca, Chile on their way to the clinic.

Today was our second day of our Talca psychiatric experience. First stop on our list was an out-patient psychiatric clinic. Our expectations were to observe multiple meetings between doctors/nurses and patients, however there was much more depth to this facility. At first we arrived at the wrong clinic (story of our trip). However it gave us the chance to explore and observe another area of Talca. We walked a few blocks to the correct location, and saw sidewalks made of crumbled stone with high curbs. Although it was good that they had sidewalks, they were not safe or desirable for those handicapped. We also noticed some buildings and houses that were more wealthy, as well as many that were poor and/or damaged from the 2010 earthquake. There were cracks in homes and chunks of walls and roofs missing.

earthquake damage in Talca church.JPGEarthquake damage to a church in Talca, Chile.

So far every facility we have been to has been temporarily moved due to their previous location being destroyed in the earthquake. The staff mentioned how it took a while to find somewhere, and until then they were giving care on the street outside of their damaged clinic. Despite the deconstruction, there was signs of hope that the community will rebuild. We observed a few construction workers. We also observed a playground/park. It was very clean and well maintained. We saw a woman watering the garden. We were comparing this playground to some of the not so well maintained playgrounds in the United States.

Initially we thought our destination was a house (which it was previously), and we thought we were once again lost, however we saw the nurse wave at us confirming we had the right location. We met the staff and some of the patients, and took a tour around the facility. We noticed a pool, and at first we were concerned for the patients' safety. We also noticed a courtyard, kitchen area, dining hall, main gathering hall, exam rooms, intervention rooms, and even met their clinic's therapeutic dog and kitten. The facility was very clean.

We joined the patients in morning exercise, which nine patients and two staff members attended. The nurse says they usually have 10 - 15 patients there each day for their daytime activities. Some patients come every day and stay all day, some a few days a week, some occasionally, and some come only for their medications or meetings with the psychiatrist.
The exercise was an energetic way to start the day while focusing on range of motion and deep breathing. After exercise the patients had breakfast. A part of the routine of this facility is to involve the patients in daily activities and management of the facility. The patients all have rotating each day. Some assist the staff members with cooking breakfast or lunch, some help clean, and others may help take care of the dog. There is a wide range of duties. The nurses, the social worker, the psychologist and other staff members stress the importance of the patients being involved as well as rotating the duties to ensure and promote independence, confidence and meaning to their days. 
Katerina Kafkas with Luna  the pet therapist.JPGKaterina Kafkas with Luna the "pet therapist". 

After the patients' breakfast, the staff graciously organized a tea time gathering for us students and our professor. They were very generous and welcoming. After getting to know everyone better, such as their professional roles and responsibilities, we moved the the main lounge where one rotating staff member (the facility really enjoys rotating the duties among the patients and staff) debriefs the patients on the day's work. This is where they decided their daily roles, as well as discussed upcoming events including their field trip to the beach. From here the patients had some art therapy involving newspaper clip outs, drawings, writing, etc. We joined the patients during their activity and were able to get to know them better.

We had a great morning at a great facility. The staff members were incredible and well-educated on the aspects of patient and staff relationships and patient well-being. They deeply cared for their patients and worked hard to provide individualized care to each patient and their families. It was a great experience overall. We gained a lot of respect for the facility and staff. 
Sorry for the delay of blogs, wifi is sensitive here in Talca. Stay tuned to hear about our trip to the University here and another day of psychiatric experience!! 
Sara, Mariah, and Sarah (the mariah sandwich roomies)

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Talca Nursing 101

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Sarah Post and Sara Pietila in the anatomy lab.JPG

Sarah Post and Sara Pietila in the anatomy lab.

n Tuesday afternoon we were very fortunate to meet and talk to the Dean of Nursing at Universidad de Catolica. We learned that their nursing program is 5 years and there is a HUGE focus on science... and we complain about our 4 year program. We discussed the curriculum and learned that they have similar clinical rotations and that their 5th year is a unpaid nurse residency. Currently there is no nationally recognized nursing boards but it is in the developmental stages. Class size is small with a max of 35 students in a (large) lecture, and there is a 1:4 faculty to student ration during clinical. We toured the classrooms and were surprised that they had simulation models due to the expensive price. The rooms were also equipped with smart boards and lecture capture technology. Come to find out the nursing department received a large government grant. 

Jenna Connolly checking out the nursing lab.JPG
Jenna Connolly checking out the nursing lab.

nursing lab.JPG

We continued our tour and ventured to the anatomy and physiology lab where we were once again shocked by how advanced the labs were. The labs contained numerous models and diagrams, but what was most surprising was the adult cadavers and fetuses. The anatomy professor was very accommodating and enthusiastic. He was more than happy to go through a brief lesson of anatomy with the cadaver, and then allowed us to touch and explore on our own. The upper classmen taught Sarah (a sophomore) and Javi (our interpreter) how to put on sterile gloves. 

human cadaver prep in the anatomy lab.JPG

(l-r) Sarah Post, Sara Pietila & Mariah Wentworth prepare to examine a cadaver.

We wrapped up our tour and headed back to our hotel on the city bus. Although we did not have the opportunity to interact with the students we still felt integrated in the university.
Overall we were very impressed with the university and curriculum. The faculty we met are very compassionate, knowledgable, and personable. We felt welcomed and would love the opportunity to strengthen the bond between university and possibly someday have an international nursing exchange program. 
<3 Sarah Mariah Sara (the Mariah sandwich room). 

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Henson Phan plays with Luna.JPG

Henson Phan plays with Luna who is the "pet therapist" at Hospital de Dia.

After spending the day in Talca and visiting a psych hospital; I have much respect for these psychiatric nurses who are taking care of these people.

Our first visit involved an inpatient psych facility that housed A LOT of patients. We were supposed to arrive at the location at 9 a.m., but ended up being there at 8:30 a.m. I learned that it was rude in Chilean culture to arrive early, but the staff welcomed us with open arms. A security guard welcomed us by opening the gate that led to the facility. After coming inside the gate, we were welcomed by 3 or 4 patients who were getting some fresh air. All of these patients were most likely above the age of 60, but they all shook our hands and gave us kisses on the cheek. The first thought was "I am in a psych facility. You aren't supposed to touch the patients; we were told not to in America," but these patients were so kind that I didn't feel an ounce of danger. Besides, kissing on the cheek is a way of greeting here so its not like they're intending to invade personal space.

Earthquake damage at a historic church in Talca.JPG

Earthquake damage at a historic church in Talca, Chile.

After, we met with more patients, younger patients who have been in the (temporary) inpatient hospital for more than 30 days. The earthquake destroyed the main hospital so this inpatient hospital is actually temporary. Many of these younger patients' ages ranged from 20-50 and they suffered from depression. Regardless, everyone was interested in talking to us and asking us about the American culture such as music (they all thought that Lady Gaga was "loco") and movies. The patients seemed to have a good relationship with the nurses. The patients sat in this large recreational room/dining room on these black couches with the nurses sitting directly next to them as if they were friends. This bond that I saw between the patients and nurses did not match what I saw back in the U.S. during my psych clinical rotation. From my experience in the U.S., it seemed like the nurses and psych patients always kept their distances. The depressed patients were always quiet, and I would always struggle to get a word out of them. Finding out that these Chilean patients were admitted for depression surprised me since many were smiling and talking up a storm. 

Later we went to a different part of the building where they held many of the geriatric patients. Most of these patients did not have family who visited them, but according to the staff, Chilean nursing students and others would voluntarily come visit the patients on their free time. All of the geriatric patients were very kind and I probably shook about a million hands within a period of 15 minutes. All the patients came up to us holding our hands, putting their arms around our shoulders. Every one of the patients had the biggest smiles plastered on their faces. "Momma" Val even made a new friend when one of the patients followed her around for an hour holding her hand and calling her "mami." The most amazing thing about this is the fact that there is only ONE nurse taking care of these 80-something patients. ONE. How? I don't even know. Maybe the Pisco Sours here in Chile gave this nurse super multitasking powers, but I would never be able to handle over 80 patients every day at work. Somehow, the nurse working in this facility makes it happen, and for that, I applaud him.
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Bienvenidos a Talca

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Welcome to Talca! And clinical! A lot in 24 hours, right? We arrived yesterday a little after 5 p.m. and headed straight to our hotel, which looks like something out of a 50's Humphrey Bogart movie. It was hit hard by the earthquake a few years ago and is still recovering. We are one of the only people here!

quake damage.JPG

After we got settled, we walked to a famous local restaurant for dinner. Well, after walking the diameter of Talca, getting lost several times and being followed the entire way by a stray dog, we finally arrived at our destination. The food was delicious and cheap too!
Today, we went to the psychiatric hospital for the first time. The facility looked surprisingly similar to psych hospitals in the U.S. We sat and talked with several of the patients and then sat in with a doctor doing his walking rounds. Later in the day, we went to the geriatric psych section and got a tour from the charge nurse. We were all very impressed with the care of the geriatric patients at the hospital. Out of 81 patients, only one of them had a pressure ulcer!
Today was exhausting (between walking around the psych facility and attempting to translate Spanish), but it was definitely one of the most interesting days we've had so far. It was so cool to be able to see how other countries handle mental illness and patient care. We cannot wait to go back tomorrow!
P.S. This blog was supposed to be posted on Monday, but the wifi at the hotel stopped working... 

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Oh The Places We Go

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santiago chile.JPGOn Sunday we packed our bags to begin our departure from Santiago to Talca. After spending a few days in a developed city we were eager to experience a developing community in Chile.

We liked Santiago, and there were differences, but it felt like a city from home. Although we were experiencing a lot of cultural aspects of Chile our hearts yearned for a community in need. Before leaving the USA we spoke so much about the destruction that remained from the earthquake in 2010, however, for the most part Santiago was rebuilt and we did not truly see any remaining aftermath of the earthquake.

After our 3 and a half hour bus ride we were more than thrilled to stretch our legs and explore the community of Talca. Leaving the bus terminal was an eye opening experience. Right away we saw a difference in the economic status of the citizens. The people of Talca were no longer dressed in suits and business attire but rather everyday, blue collar working clothes. The buildings were smaller, and more simple, but there is a bit of wealth throughout the town.

We checked into the hotel we discovered it was far less lavish and the residents of Talca are more welcoming and friendly. After we unpacked we went on an adventure to find it first traditional Chilean meal. What was supposed to be a 15 minute walk, became an hour and 45 minutes. To be honest the extra long walk was definitely worth it. The walk gave us an incredible opportunity to observe the development of a town.

There were numerous homes and businesses with large cracks in the foundations, destroyed roofs, broken windows,and completely crumbled walls. The destruction was heart breaking. As we continued to walk we saw some incredibly poor homes hidden along the riverbank. At one point we saw a bridge that an entire section had fallen, but in the other direction there was a beautiful river, glorious mountains, and people celebrating.


Earthquake damage.JPGThese people know how to cherish life and be grateful that they are alive. They were more than happy to give us directions even if they were not accurate on the time it would take to get there. The road that led to the restaurant was an old dirt road compared to the cement sides walks we had been traveling on. We were told we needed to travel up the narrow hill that had no side walks and quite a bit of traffic. We asked yet another local and they told us we climbed this hill for nothing, because the restaurant was on the bottom of the hill next to the riverbank. We FINALLY made it to the restaurant and enjoyed an amazing traditional Chilean meal.

Instead of another adventure back we called a taxi so we did not half to walk in the dark. Overall our first day in Talca was overwhelming, but good. I truly made us appreciate all of the amenities we have at home.

<3 Sarah Mariah Sara (Mariah sandwich room). 

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Exploring the City

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Nursing students stand with statues for a photo op in Santiago, Chile

So far so good in Santiago, Chile except for my awful cold (thanks fellow sick co-workers). We have not ran into too many problems, beside getting lost...A LOT. However, we are getting much better with the buses and subways. I do not ride public transportation much back home, so I cannot accurately compare the two, but we have had an abundance of transportation available to us here in the city. The city reminds most of us of a Boston or New York. We are excited to travel to Talca today, to see how those in the suburbs live.

Yesterday while exploring the city we discovered a nursing store. It was closed so we could not enter, but we were peaking through the glass to see what they had. Across the street we also found an orthopedic rehabilitation center. We hadn't seen any of those yet, so that was nice to see. Throughout the streets we have seen a lot of people in wheelchairs, and several amputees. There has been a mixture of handicap accessible areas. The public transportation does a good job, but other local streets do not. 

Nursing students pose on rooftop in Santiago, Chile
We have also been enjoying using our Spanish  Javier, our liaison has been very helpful. My Spanish is decent so I have been enjoying using my Spanish skills with the locals. The other students at first were asking for help or translation with everything by Javier, Alli or me. However it has been great to see them gradually ask us less and try to communicate on their own.

Awaiting the bus journey to Talca, Chile

We are off to a 3.5 hour bus ride, where we are looking forward to seeing a contrast of Santiago. Our hospital experience begins on Monday. We are all eager but nervous for the hospital. We are not sure if we will have wifi or a computer yet, but we will see how it goes!!

We will try to keep you all updated!!

Sarah Post

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A history lesson in Chile

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I'm not going to lie, even though its only been a few days, I do miss my American burgers. We went to a small ice cream shop that reminded me of Friendly's. They also had "normal food," but their focus was ice cream. I had a cheeseburger with bacon. I know I can't really expect for the burger to taste the same as an American burger, but it still tasted alright. I still want to try authentic Chilean food, but many of the places that we know of so far cater to tourists, so it's not surprising to see hamburgers, pizza, hot dogs (garnished with avocados) and other foods that you would expect in the U.S. 

After eating, we decided to go on a free tour that was in the middle of a plaza. This tour lasted 4 hours, but our tour guide was amazingly entertaining. He was a chain smoker and probably smoked about 5 cigarettes within a span of 30 minutes, but he was extremely kind and personable. He spoke with a mix of an Irish/Spanish accent about the history and certain key areas of the city. We saw Plaza de Armas, which is Santiago's main square. They had people painting, dancing, singingand selling various knickknacks.
Plaza de Armas.JPG
We saw Municipalidad, which is Santiago's city hall. We also saw the old congress buildings and many other beautiful architecture. I noticed many cracks and chipped paint on the building due to the aftermath of the earthquake from February 2010. The earthquake happened on a Friday night at 3 a.m. in the middle of the morning. It was a 7.9 on the Richter scale in Santiago and an 8.8 overall in Chile. We finished the tour in the Barrio Lastarria at a cafe.
After the tour, we went to the flea market to buy souvenirs. I haven't found anything I like yet, but hopefully we'll see some things in Talca!

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Charlie on the MTA?

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charlie-mta.jpgAh .... transportation.

Often we don't think about it too much until something goes wrong or you are challenged by your mode of transportation. You will have to forgive me as I lapse into a bit of reminicising about transportation issues from previous nursing trips.

Here in Chile I am impressed with the airport and the cleanliness of the streets and metro system. It is such a refreshing change from some of our Metro systems in USA. There are bright murals and lack of graffiti or the tell tale smell (if you know what I mean). We have had a few adventures today as we navigate the streets of Chile with our wonderful leader, Javier C., who was born in Chile but now goes to school at BU.

Today we had to navigate the metro to the bus station, oops.. not the right station... we have to go a few blocks down to the bus station. We buy our tickets but get on the wrong bus. It worked out fine because we met our correct bus at the next stop.

Once we arrived in Vina del Mar for a visit to the coast (i.e read... "beach, sand, lots of beautiful Chilean young adults having fun). We have to take a crowded city bus but the system here is pretty good so we make it and enjoy a lovely day at the beach. The air is great but the water is pretty cold. At the end of the day, a long wait for empanadas almost caused us to miss the 2 hour bus ride back to Santiago. We arrived back around 9 a.m. (after a few mishaps on the Metro.. "did he ever return, no he never returned and his fate is still unheard"... Boston people will be humming along).

It has been a long day but the students hit the store next door for some food to munch on and I leave them to relax alone. So despite the travel glitches I am recalling transportation in other countries like Ghana where the students traveled in Tro-Tros, which essentially are larger rusted out vans that have seen better days. Today we were a bit crowded on the buses and metro but all in all it was a safe journey. I think about the challenges in poorer countries where the transportation is not that easy or accessible. Two years ago I traveled with 2 live chickens and 25 people in a 9 person van while holding someone's sleeping baby on my lap.. This year I had some giggles about missing buses and going the wrong way on the MTA. So... this is a learning experience for all of us. 

UMass Lowell students pose for a group photo in Santiago, Chile.

Again, we often take for granted our cars and readily available transportation (and the ability to read the schedule and ticket details) at home. Here we are challenged a bit in that regard. So far this experience hasn't shocked us as much as previous trips, but the learning is still happening.

Today under the sunny skies at the beach I had some great conversations with the students about their life plans and how nursing and this particular trip to Chile fits in with their "bucket list" of dreams. We did discuss the relative comfort we have had the last few days and I hope to see other parts of Chile that may not be as "pretty," but will show us how the people of Chile live, work and receive nursing care.

I am anxious to see Talca and other areas that are closer to the area that was hard hit by the 2010 earthquake. That was a devastating and deadly (8.8) earthquake but I am told that the area has recovered fairly well. Our work will begin next week so in the meantime we intend to explore Santiago a bit more and learn about the culture and the people.

So... we continue with our transportation challenges throughout this trip. A few more laughs and eventually we make it home. 

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chile-flag.gifOne word. Stair-master. Had we known that we would walk so much, we would have brought more shoes. 

Our airport experience was less than satisfactory. Leaving Boston, we were stuck on the runway for half an hour due to heavy traffic in New York. Because of the weather, there was a lot of turbulence, but we arrived in sunny Miami at night. This flight lasted 3 hours and 40 minutes, but our next flight from Miami to Chile lasted 8 and a half hours. Most of us had trouble sleeping due to the cramped quarters, but at least the food was decent. We were given a choice of either pasta or chicken. The people who had the pasta said it was decent, but those with chicken said that it was pretty good. We arrived in Chile at 7 a.m., and our global health experience began. 

We hiked up a mountain called Cerro Santa Lucia and got a great view of Santiago. Smoking was very predominant, but the folk of Santiago love to clean. We saw people mopping sidewalks, washing windows, and providing excellent lawn care. Everyone here is super friendly, even though we have a language barrier. It's a good thing we have Javi and Sarah to talk for us. :) We explored the city on foot and metro.

Snow covered Andes Mountain.JPG

The view from Chile of the snow covered Andes Mountains.

We then went to the zoo (TONS OF STAIRS) and saw everything from elephants to penguins to a poor sick cheetah and sleeping kangaroos. By that point we were exhausted, hot and dehydrated, so we headed back to the hotel for a shower and a nap. For dinner we had a traditional Chilean meal with delicious food and service. 

Day two! We had quite anadventure on the metro and buses on our journey to Valparaiso. The beaches were beautiful as were the people. Street performers joined us on the city bus and treated us with to some beautiful guitar and drum music. Being future prudent nurses, we all used sunscreen and applied it often. However our pale winter skin lost the battle and we all got burnt... Ouch! Tonight is recovery and relaxation to rest up for tomorrow's adventures :)
Bye Mariah Sara Henson and Javier 

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santiago chile.JPGAnother nursing adventure begins with a trip to Chile.  

I am again supervising a group of undergraduate nursing students on a global heatlh experience. This year we have chosen Chile. I am traveling with 7 nursing students and one interpreter/liaison. We have a few students who have some Spanish proficiency so that is helpful. Learning to speak Spanish is on my bucket list so maybe I will get closer to that goal after this trip. I titled this entry compare and contrast because of some of the differences in this trip compared to previous trips.  

On this excursion we will be working at a hospital in Talca on an inpatient psych unit. This will be an incredible experience for the students, but the community nurse in me wants them to also see the aspects of community health and public health so they will be doing additional assignments related to some of these areas. We are not bringing large boxes of supplies to deliver to clinics or orphanages and the experience of dealing with large boxes, transportation and airline travel has been avoided on this trip. 

We had an uneventful flight. I was surprised that when I arrived at Logan that many of the students had already checked in and were patiently awaiting the arrival of the whole group.   Only one parent came to Logan, which surprised me at first, but then I realized that I am traveling with a very travel savvy group. I remember the large group that has met in Logan in the past with some tears and hugs and nervous good byes. As we navigated the airport and subsequent transfer at Miami I was impressed with the maturity of this group.
We arrived at Santiago very early this morning and I was pleasantly surprised by the cleanliness and efficiency of the airport. We transferred to our hotel, which is a complex of three large towers comprised of small apartments in the Centro section of  Santiago.  We were unable to check in this early so after dropping off our bags we proceeded to explore the city a bit. Most of us are functioning on few hours of sleep on the plane but we have no choice but to keep our feet moving.  
My surprise this trip was that in my 3 trips to Africa I never saw an elephant, giraffe or tiger. Well today I saw that and much more. We spent a few hours at Parque Metropolitan de Santiago. A great day. We had some lunch at SchopDogs, which featured a mix of Chilean and slightly German fare. Lots of options for food and shopping, which is a contrast to the poverty stricken landscape of Ghana that greeted me every day on previous trips.
My goal is to work on helping the students to see the aspects of health even in a beautiful country like Chile. They have assignments to work on and I am pointing out areas of interest like air pollution, water and land pollution (in some areas), but also the cleanliness of other areas and the lack of obesity of very obvious chronic diseases.
We did recall the words of Dr. Deidra Murphy who reminded us to look at the physical barriers that exist for people with disabilities and we did see some of that today at the zoo and other areas. The traffic is busy, but not the chaos of Accra and cars and pedestrians seem to obey the signs and crosswalk signals. 
This is just the first day of our journey but already I am a bit less worried about survival and concentrating more on providing a great experience for these students.  

I hope the students will also be able to give you a glimpse of their view of this experience. Please check back and read more... 

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