Chile's rural nurses / Isabel Ringeling & Gerardo Herrera

8 Chile's rural nurses lsabel Ringeling & Gerardo Herrera Our visit to Tit Tit confirmed the immense professionalism and enthusiasm of the public health nurses working in the remote countryside of Chile. 0 bserving the work of a rural nurse within the }1ealth system of Chile is a real challenge for anyone who wants to understand her role and her contribution towards improving the level of health of the rural population. Til Til, a traditional Chilean vi llage 30 kilometres from the nearest town, is where two such nurses, World Health • September-october 1992 Francis Molina and Jessica Pinto, At the health post, the nurse monitors the nutritional status of young children. work. To reach it involves crossing a beautiful valley rich with farms, grazing herds and even mineral resources (though they are very little exploited). The drive to the village is on dirt roads and crosses the River Polpaico, which in rainy winters regularly leaves a large part of the area isolated. The community has 12 677 inhabitants within an area of 650 square kilometres. Some 4500 people are concentrated in the village ofTil Til itself, and another 3600 in several small communities with no more than 600 inhabitants each. The rest of the population is scattered. The indicators reveal the vulnerability of the population to major health risks: 11 % are ill iterate, 10% live in extreme poverty, 19.4% of children aged under six years are at high risk from disease and 12.9% of the same group suffer from malnutrition, 34.6% of pregnant women are underweight, and 8% of all children were born with low birthweight. All these indicators are higher than the national average. To arrive at the Hospital of Til Tit , we cross the village, which does have electric lights, a sewerage system, drinking water and telephone, thanks to the programmes of rural development which the government has carried out with international support. The people live principally from farming, which has been modernized and diversified; so they have switched from growing mainly fruits such as olives and prickly pear, which thrive on the dry soil, to cultivating grapes and other fruits for export. This labour generates seasonal employment with all the advantages and drawbacks which that signifies for the eco'nomic stability of the families. They also work as miners, either individually, in the constant hope they will strike it lucky, or for a large extracting company involved in producing cement and stones. The Til Til hospital performs mainly primary health care activities, also serving other remote areas . The main health problems in both children and adults are respiratory diseases in winter and digestive problems in summer. Cardiovascular disorders are also important in adults. During her rounds of the local neighbourhood, Jessica undertakes regular visits (weekly, fortnightly or monthly depending on the distance) to the health posts, together with the doctor, the matron and the dentist whenever possible. In each post an auxiliary nurse lives permanently, hard at work and coordinating her activities with the other sectors concerned with community development. The work done by these rural health posts conforms to a national programme which puts special emphasis on the focal points of hazards to health, and is supervised by the nurse. The rest of the team contribute by overseeing specific activities. To meet the health needs of the communities with less than 300 inhabitants and of the scattered inhabitants, Jessica has to go out to meet them at the so-called rural nursing stations, which are places World Health • September-october 1992 arranged by the community as consulting rooms, usually in the community hall or in a classroom of the local school. One sunny day in the month of August we went with Jessica on her rounds to the posts of Polpaico and Huertos Familiares, some 15 to 25 km from Til Til. In the far north and far south of Chile, where people live in extremely isolated conditions, the health posts and rural nursing stations are so far apart that to make the rounds involves using a variety of means of transport: light aircraft in Aysen, motorboats to cross the channels and reach the many islands of the south, or four-wheel drive vehicles to get up to the villages of the northern altiplano. In such cases the rounds can last five days or more and the nurse has to sleep overnight at each place. In the posts that we visited we could appreciate the work that the nurse does: acting as a team with the auxiliary nurse, diagnosing the total health situation of the community, paying special attention to health promotion, prevention and treatment of diseases, treatment of chronic patients, epidemiological surveillance Til Til Hospital serves a large rural area in Chile. of communicable diseases, education of the community, home visits to families, and coordination with the community organizations and local institutions. We were shown sketch-maps of the community on which all the houses of the sector were identified; different colours showed where families lived with different grades of risk (e.g., latrine close to a drainage ditch, an unprotected well, a chronic invalid, an illiterate mother and so forth). The numbering of the houses on the map coincided with the numbers on such official forms as the family survey, the summary of family surveys and the classification of family risk- basic tools for planning the work of the nurse as well as the auxiliary nurse. As we watched, Jessica set to work checking the growth rate and development of children, vaccinations, delivery of milk and all the corresponding educational activities. We saw with what care she filled in the registry forms and noted down each individual and family who had had attention. The knowledge that nurses who work in the rural areas have gained of 9 the problems faced by the community encouraged them to contact certain nongovemmental organizations and initiate a new educational project which is contributing positively to integrated rural development - that of hydroponic farming of vegetables, which will permit families to improve their diet. Our visit to Til Til was highly rewarding, and we were able to confirm, once again, the immense professionalism and enthusiasm with which the public health nurses of Chile are carrying out their work in the remote countryside. • Mrs lsobel Ringeling and Mr Gerordo Herrero ore nurses working with the Primary Health Core Deportment, Ministry of Health of the Republic of Chile, Mac lver 54 I , Santiago de Chile, Chile . In the waiting room, educational posters "talk health" to the patients.