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.

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 orrenovatedue 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.

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. Surprisinglymany 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 interestingcommentaryon 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….