Winding Down

I'm strating to think about the end, which is to say about grading final papers, giving good-bye presents and scheduling my taxi to the airport.

The six students here sit in two groups, one each at a round table. One table has the older nurses who work at a public specialty clinic, quietly absorbing and concentrating. The other table has the younger nurses working in acute care, wiggling and giggling and trying to speak English. The two groups being a small sample of the nurses in Chile. And both groups coming to terms with their assumptions about how to improve health and the role of the Ministry of Health in do so.

Each time I teach this course here, I struggle with this too. What is the "correct" balance between entrepreneurial health programs and social responsibility as administered through a government? I come from a country which has a history of favoring the private sector's initiative and business approach to achieving health for its citizens. But, where's the profit in helping the disadvantaged to gain equal footing or being compassionate with the dregs of the street who slap all outreached hands? Maybe because I just finished one of Anne Lamont's books, I'm feeling both more radicalized and spiritualized about health care systems.

Chile has a history of dictatorship which has left the boot print of oppression throughout its bureacracy. I saw this during my interviews with people in the Ministry. It was more like a bruise, still sore enough to limit mobility. There is a "system" in place for all citizens to receive health care, and the primary care clinics, called consultorios, are neatly placed throughout the contry. But where's the benefit of creating new options and programs when the resources are distributed centrally based on a plan that has no known origins?

Neither system is right and neither system is perfect. But I do see individuals in both systems who are stepping forward and into the murky waters of what is ethically and morally and socically needed.