Chile was one of the first countries on the South American continent to significantly reform its health system in the 1980s. Thomas Bossert, Lecturer on International Health Policy, led a group of HSPH students to Chile to see ongoing reform efforts in action.
On January 16, Chile, a socially conservative country, elected its first woman president. Physician and former Health Minister Michelle Bachelet won on a platform that included the promise to give a greater voice to women and indigenous people.
The election coincided with a trip to the country by HSPH students interested in health care system reform. The students went as special guests to the National Election Headquarters, where the votes were counted and where Bachelet's win was announced to the press. Outside, a massive crowd of supporters waved banners and chanted before and during her acceptance speech.
"It was amazing to feel that energy," said Elizabeth Kurs, a master's degree student in health policy and management. "The country still has scars of dictatorship, but people sang songs about freedom and democracy." During the trip, Kurs focused on factors that have led to a less-than-ideal supply of trained physicians in Chile. "Not enough Chileans are interested in becoming physicians," she said, and that will have an impact on the speed and quality of reform.
The election was a highlight in a trip that brought the students from urban Santiago to rural areas, from the hallways of the Ministry of Health to the homes of indigenous Mapuche.
The health status of the Mapuches was of special interest to two of the travelers, MPH students Shirley Carter and Quetzalsol Felipe Lopez. The Mapuches were never conquered by the Inca empire or the Spaniards. Now a marginalized group that lives on the fringe of a largely affluent society, the Mapuche are working toward increasing their civil rights, gaining equal access to health care, and getting back their traditional lands, Lopez said.
Lopez and Carter talked to Mapuches living in and around Santiago, and then traveled outside the city to get a rural perspective. The students reported that many of the Mapuches to whom they spoke felt that they received poor care because of their ethnicity. Some also expressed confusion over filling out forms and figuring out which medical services are free and which are not. Mapuches often barter for services that require payment.
"It was an amazing experience," said Lopez, who has taken a year off from medical school at Stanford to earn his MPH. He believes that he now understands more about the Chilean health care system than that of the U.S. "Tom Bossert had good connections, so we got in-depth explanations from people at the highest level," he said.
From l to r, Lili Beit, Josh Vessey, Liz Kurs, Rita Patel, Amie Shei, and Mary Bing stand in front of Fonasa–the funding arm for health insurance in Chile
Lope Barrero, a fourth-year doctoral student in environmental health, was the teaching assistant for the WinterSession class. Trained as an industrial engineer, he is now more interested in physical exposures in the workplace and the risk of developing musculoskeletal disorders. In Chile, he was given access to data collected for a national health survey.
"The data that I was interested in were untouched, meaning nobody had checked that section before, so there was a great opportunity to do something useful and original," he said. Barrero and classmate Mary Bing studied information about occupational health and injuries, then conducted statistical analyses of the prevalence of low back pain among several occupational groups. They provided a copy of their analysis to the university.
The students met with four HSPH graduates living in the region, each of whom spoke on behalf of the organization they represented: Maira Inez Romero of Catholic University, who offered a class on Chilean epidemiology; Jaime Sapag, another member of the faculty of Catholic University; Miguel Navarro, from the staff of the president of Chile; and Marco Nunez, former regional governor and current director of a regional health office.
In addition, students met with the minister of health, who gave them a two-hour introduction to Chilean health reform.
HSPH Lecturer Thomas Bossert organized the trip. He has spent many years traveling back and forth to Chile and feels that the Chilean government has made some real progress in providing quality health care to its people over the past 25 years. He notes the development of new models of social insurance, an increase in private sector health providers, and the decentralization of public health services. According to Bossert, Chile is "a leader in promoting community-oriented health systems."
"This WinterSession course-now in its third year in Chile-was a great opportunity for students to meet with the principal architects, critics, and observers of the innovative health reforms being adopted and implemented in Chile," explained Bossert. "It also involved field visits to hospitals, health centers, and health posts, many of which are implementing a new 'family medicine' approach to delivering services."
—PHC
Copyright, 2007, President and Fellows of Harvard College
