Earthquake in Chile

On Friday night at 3:34AM an 8.8 magnitude earthquake hit Chile 200 miles southwest of Santiago, closer to the city of La Concepción. I was sound asleep after returning exhausted and a bit ill from a trip around noon that same day when the shaking woke me. Even though I had never experienced even a small tremor before, my innate human instinct for survival must have recognized the earthquake as a dangerous event because despite my deep sleep I was instantly alert and I knew right away what was happening. I got out of bed. Although things were really shaking, I had no trouble standing up. (I was on the first floor of the two-story house where I live. People on the 4th and 5th floors of buildings told me that they fell trying to go down the stairs. Someone on the 25th floor said it was impossible to stand. Of note, the majority of people in Santiago live in high-rise apartment buildings.) However, at this point my survival instinct (and/or my lack of any earthquake experience or education) failed me because I had no idea what to do. I was thinking..."ok, it's an earthquake. Shit, what do you do in earthquakes?" I remembered being taught in school to kneel down in a ball on the floor and cover your head, preferably under something secure or against a wall with nothing above you, so that's what I did (although there were really no earthquake-friendly spots in which to hide in my bedroom.) Apparently, however, every Chilean knows that you are supposed to leave the building immediately if possible. Oops. The power went out. Next thoughts: "this spot doesn't seem very secure...why isn't it stopping? How long is it going to last? Are things going to start falling? Shit, what do I do?" I've heard in varying news reports that it actually lasted anywhere from 1.5-3 minutes, but I assure you those 90-180 seconds felt like an eternity.

After it stopped I was really freaked out. I'm not sure if I was more freaked out than other people because I had never experienced an earthquake before, or less freaked out because I had never experienced an earthquake before and therefore had no idea that I had just felt an 8.8 magnitude one. Most likely the latter. From what I figured at the moment, this was how those normal and frequent earthquakes in California go. Therefore trying to think logically, I decided A)that I was silly for being scared, B)that calling my parents in the middle of the night was a foolish idea especially since no one outside of Chile or Santiago for that matter would even know that a small earthquake had happened the following day, and C)that earthquakes are random events so now the danger was over and I had nothing left to fear. So I got back in bed to go back to sleep.

Since it was actually a Friday night, many people around Chile were out carreteando(partying). People who were in clubs have various reports ranging from thinking it was a party trick, or that they were suddenly really drunk and maybe someone slipped something in their drink, to not even noticing. Here at my own house Salo (the 21 year-old Chilean daughter) was the only one home (her mother and brother were on vacation in Brazil), and she was drinking with 5 friends on the patio. (I'll also add that she had been on vacation since I arrived in January until a day or 2 before and then had been away from the house all day Friday, so I had never met her at this point.) After the earthquake they got concerned about me being alone and came looking for me. This turned into quite an adventure because they had all been drinking, one of the girls was really drunk and completely hysterical, and they insisted that I join them in sitting outside in the freezing cold because they were scared to go back into the house for fear of it collapsing with an aftershock and figured I should be scared too. Cell phones weren't working and everyone was really worried about their families and unable to contact them. We were able to listen to radio reports from one of the cell phones and learned the magnitude and epicenter of the earthquake but not much else was known about the state of destruction. Although I then realized it was more serious than I had thought, I still didn't realize exactly how bad it was since everything around us looked completely normal (sans electricity). I again put on my logical thinking cap and concluded that if literally nothing had fallen in the house with the original 8.8 earthquake, and aftershocks were by definition less forceful, then the house should be able to withstand the aftershocks too. (Having no engineering or geology background I'm not sure if that is technically correct, but it makes sense to me.) Therefore after consoling them for awhile I went back to bed. (Aftershocks were still strong enough to wake me up again that same night and the following morning.)

The next day when I woke up the power was back and I immediately checked the news to see if there was any report (and was still not entirely convinced there would be). When I realized that the earthquake was front-page on every American news provider, I called my parents. It turns out they had heard a few minutes before and had been unable to contact me. (Phone lines would remain jammed with intermittent service for the next 2 days.) When I went looking around my neighborhood, literally everything was normal. No houses or buildings had collapsed. Normal normal normal. There's a tiny bit of damage to tile roofs (not a good building material for earthquake zones I've concluded) that you can see in the photos. All the photos of the outsides of buildings are from my neighborhood. Now having talked with coworkers and friends, there are cases of people's homes being destroyed enough so that they had to leave. Mostly this is due to something like the hot water being out of function or a leak, and some areas were without electricity for nearly a week. According to a friend who is a civil engineer here, some of the buildings look normal on the outside but are partially collapsed on the inside. The pictures I posted of the cracks on the inside of the buildings are all from the hospital where I work, and look very similar to a coworker's photos of damage to her apartment. There are cracks running through the middle of walls, and lots of corners and junctions are separated by an inch or 2, including the entire old and new building in the brick wall photo. However, no one I know knows anyone here in Santiago who died or was injured. According to news reports 30 of the 700 estimated dead were in Santiago.

One of the big disruptions was to travel. Several bridges fell, cutting off highway travel between Santiago and regions to the south. There was also fairly extensive damage to the airport terminal in Santiago and the airport closed for several days. February is typically vacation month for all Chileans, but school and work was supposed to restart for the majority the week after the earthquake and many people were en-route back to their homes in Santiago and were left stranded around Chile and the world. My house mother (Mónica) and brother (Andres) were two of those stranded in Brazil. They ended up having to spend the night in the airport in Brasil for 3 or 4 days before getting back to Santiago (the temporary Santiago airport is in a tarp apparently). When they first found out about the earthquake, someone from Santiago called them and said there was an 8.8 magnitude earthquake and then the call dropped. Before they were able to reconnect to get the rest of the information, Mónica says that she heard 8.8 and remembered the destruction of an 8.0 earthquake 25 years ago, and immediately assumed that Santiago was leveled and everyone she knew was dead. Creepy thought.

Life since the earthquake has been eerily normal. The fact that so little damage or death actually happened is testament to the success of Chilean building codes, and is even more impressive given the potent comparison we have so fresh on our minds of the recent destruction in Haiti (where the actual earthquake was 500 times less powerful). However the destruction and chaos in regions to the south is the only thing on the news here, and accounts of where people were when the earthquake hit or of people they know whom it affected are nearly the only topics of conversation. The feeling here is one of solidarity and nationalism, and many Chilean flags are suddenly taped to the outsides of buildings and homes. An overwhelming outpouring of local people are donating money and food. The barrier for these resources getting to people in the south is certainly a lack of organized distribution rather than a lack of people willing to give. Many people are organizing small donation drives and projects but I'm not sure that they have the means to know where the most need is or to get the items there. There are also many people, like myself, who want to go and volunteer but don't know where to go or what to do.

An interesting dimension of the disaster is that Chileans are very traumatized by the military after living through the 15-year military dictatorship which only ended in 1990. That is likely the reason that President Bachillet delayed so long in using National Guard resources to respond to the emergency and to the anarchy. Since the earthquake, helicopters have been flying intermittently over Santiago and I have heard people make comments about how they hate hearing that noise because it reminds them of the dictatorship.

The chaos and anarchy itself (in the south, not here in Santiago) reminds me of New Orlenas post-Katrina. Given their strong national pride, Chileans are quite disgusted to see their fellow citizens acting that way. I think they may feel even more of a bond with the people perpetrating the anarchy than US citizens felt towards people in New Orleans, since during Katrina's aftermath many expressed the sentiment that New Orleans was an island of culture distinct from the greater United States and that such barbarity wouldn't have happened elsewhere. However, it may be a lesson that when groups of people experience extreme situations together, regardless of their nationality or location, they resort to means that seem absurd and desperate to those of us not experiencing the extreme emotional and psychological impact of the disaster and its subsequent mob-effect on people's behavior.

Medically speaking, there really aren't many earthquake-related injuries to treat. The majority of the deaths came from tsunamis that hit the coast and carried people out to sea entirely rather than leaving them injured. In Santiago there are almost none. The hospital here did nearly close for 4 days while operating in emergency mode due to the President's declaration of a state of catastrophe. This meant that all the patients able to leave were discharged and all elective non-emergent patients were canceled to make room for the arrival of emergencies. However since nearly no one arrived, this actually meant that the hospital was nearly empty and all the staff were standing around talking to one another with nothing to do, an impressive waste of resources.

I did have one patient in Santiago who was directly injured by the earthquake in a mountain town an hour or 2 away. Apparently a wall fell on the patient who had various broken bones including a skull fracture. In addition a huge cut stretching across the entire forehead had been hastily stitched up in what I can imagine were less than ideal conditions, and the cut was infected (which compounded with the skull fracture basically provided direct access for the bacteria to enter the brain, hence an emergency). Neurosurgery took the patient to the OR to clean the wound and repair the fracture and plastics then closed the wound. However, when we opened the wound we found a huge stone close to the size of a ping pong ball stuck in the skull! Obviously when whoever had sewed up the patient, they didn't have the time or perhaps even light or water to explore the wound well and had sewed it up with this rock still inside. It was crazy. When I figure out how to get the photos off my cell phone I'll post them. Care for this patient did make me think a lot about the resources that are needed in disasters like this, and the patients that are going to start returning to the hospital with infections and other complications from injuries that were not able to be properly treated in the immediate aftermath. Many patients who are injured by things collapsing on top of them are severe trauma patients needing ICU care, ventilators, and several surgeries. They will probably continue to need revisions of their surgeries for months to come. Usually traumas happen on a small scale like a car accident and injure only a handful of people at a time, and ICU and trauma care are definitely limited resources. Therefore a big influx of need concentrated in one area like occurs with the earthquake presents a significant problem, especially when the roads are cut off limiting transport of victims out of the area to other trauma centers.

I also had one patient here who's from one of the coastal regions hit by the tsunami and his entire village got washed away. Everyone he knows is dead. (And he himself said it just like that, as if it hadn't sunk in yet.) The only reason he's alive is because he was here in Santiago for a scheduled plastic surgery which he sold all his possessions to finance (all those former possessions are also washed away to sea so ironically he would have lost them all and all of their value had he not sold them for the surgery).

Finally, patient #3 has a bunch of stitches in a cut about 8 inches long on his leg from a piece of furniture falling on him during the earthquake, but no broken bones. That about summarizes all the patients I've personally seen with earthquake-related experiences. And it's not for lack of seeing patients, I'm seeing plenty. They just don't have earthquake problems.

Just this week the Universidad Catolica began organizing groups of doctors to head to the affected regions to provide medical support. One group of 14 left Tuesday and I am on a list to be called when the next group departs. However, the groups are waiting to get requests for help before departing, and those requests seem to be scarce. Most of the need is for engineers and psychologists. I spoke with a friend who's working with the first group currently and apparently there are very few earthquake-related patients even in the south. With the chaos in the region there is a physician shortage to carry out normal work like managing chronic disease, so this is more the type of need the first group is alleviating. If I do end up going, I'll update with a firsthand account of the conditions.

Timely for my post of the earthquake report, this morning two strong (7.2 or 6.9 depending on the source you look at) and lengthy aftershocks hit within 5 minutes of one another while I was working on the 2nd floor of a very busy clinic. It was quite different to experience it in the middle of the day amidst the mass hysteria and panic of others. People were screaming in the hospital and running out of buildings and refusing to reenter. At this point whether the first earthquake directly affected people or not, we all have frightening scenes and images in our memories from the news, and then it only takes one or 2 people panicking to start a mass group psychology effect. Again, I'm really experiencing the power of other people's panic to infect those around them and create a mob that's reduced to the level of the reaction of the most extreme individual within the group. Also while I didn't run screaming, I felt quite a bit of anxiety and fear after the tremor so I must admit that I have more PTSD from the whole experience than I thought.

Patagonia/Torres del Paine National Park

I just finished (arrived back in Santiago on the morning prior to the earthquake) a 5-day trekking and camping trip through Torres del Paine National Park in Chile's southern Patagonia. The towers (Torres) are iconic, you have probably seen the photo before without realizing it. I got into the airport at 2AM, but due to waiting for the rigid bus schedules it was 6PM before I started hiking in the park. Somehow lack of sleep and long days of travel can make your legs feel as tired as when you have been working them for days straight! I set up camp at the base of the Mirador (lookout) over the Torres just as it was getting dark. The next day I was rewarded for rushing into the park with what I am told was the 2nd perfect weather day of the whole season (since October). I got to see the Torres without any cloud cover perfectly reflected into the small lake below. It was amazing. Some crazy German actually got in the lake for a swim (it was no more than 40 degrees air temp). I was trying to decide if I felt colder or warmer watching him.

Later that day I teamed up with McKay, my hiking partner from the previous day, and detoured off the typical "W" trek into the Valle del Silencio where usually only climbers go. We got the trails almost to ourselves (a real luxury since most of the trails on the W are crowded due to the route's international popularity) to see perfect views of the mountains along the valley and the back side of the Torres. The trails back here were fun since they climbed over boulders, loose smaller stones, and sometimes lingering snow patches (a few of which you could sink thigh-deep into!).


The next day the route followed sky-blue Lake Nordenskjold with beautiful reflections of the hills and mountains to the base of the middle prong of the W: Camp Italiano. The weather was a bit overcast today and seemed to be promising rain by the afternoon, with some fast-moving and threatening clouds covering the peaks and some high winds. The Cuernos ("horns"), probably the 2nd-most-famous site in the park, did finally peak out of their afternoon cloud cover for a nice view though, and after parting with McKay at Los Cuernos lodge I made it to Italiano with some Australian friends without any serious rainfall.

The next morning I got an early start to head up into Valle del Frances. It has a bunch of glaciers and snow-capped peaks, but today it had strong winds, gusts of rain, and some light hail...fortunately by starting out early I managed to get a brief glimpse of most all the peaks at least once as they peaked in and out of the clouds. By the time I was leaving the valley, most of the people who were going to start up the valley were giving up and turning back because of the worsening weather. Finally I moved camp over to the windy Paine Grande on the shore of the Caribbean-teal Lake Pehoe with views of a glacier-capped mountain and the Cuernos, where despite all indications otherwise my tent made it through the night without blowing away.

The park is actually amazingly well-serviced for a national park in the ostensible wilderness. Along the popular W and circuit routes you can actually hike from refugio to refugio and stay in beds with meal accommodations if you so desire. There's even a 5-star hotel in the park, although not on the main hiking trails. I had decided to camp, but the last day brought me to a paid campsite on the property of one of the refugios (Pehoe) rather than an independent campsite like where I had been camping up until then. After 4 days of cliff bars and peanut butter sandwiches, I was starting to think that the exorbitant price of $20 for a camp dinner at the refugio might actually be worth it. I went inside to see what they were serving, and saw an unidentifiable square that I assumed was meat (the menu said turkey) on top of a pile of vegetable slop and decided that my sandwich actually sounded more appetizing. Now it's just pathetic that they take such advantage of their monopoly and let their quality drift so low that a starving camper doesn't even want their hot meals, especially since they're located at one of the spots in the park that's linked to a well-traveled highway/boat supply chain and should be perfectly capable of bringing in fresh ingredients for $20/pp.

On the final day I did decide that since breakfast included eggs and only cost $11, it would be nice to start out a day of hiking with some solid energy. I then set out to hike the last prong of the W to see Glacier Gray, a huge glacier that flows off several mountains and breaks directly into Lake Gray, which consequently has some icebergs floating in it. I was able to get fairly close, and it was definitely impressive. However, at this point the blisters on my heels that had started on day 1 were definitively painful and I abandoned some former ideas about continuing on to the John Garner pass to see the glacier from behind and instead decided it was time to end the tour. I also realized that my stomach was feeling a bit funny, which I can only contribute to the runny green eggs that I paid a small fortune to eat for breakfast. I should have listened to Dr. Seuss.

Even though I was completely exhausted and not feeling well and thought I didn't want to see any more of the park, I still got excited on the Catamaran ride out by the perfect views of the Cuernos and Glacier del Frances from the lake. It really is a stunningly beautiful park.



Finally I stayed at the Erratic Rock in Puerto Natales, a hostel so great I decided to stay 2 nights just to relax a bit after the trek. There I met Alex, a scientist who does research in (nearby) Antarctica who made me well-informed for my final tourist activity: a visit to Isla Magdalena in the Strait of Magellan to see thousands (seriously) of cute penguins! He was also great company for my numerous attempts to try the prevalent and inexpensive Centolla (Patagonian King Crab) which I really really wanted to enjoy, although the aftermath of those damn $11 eggs kept ruining my $5 king crab. It was still pretty delicious going down, even if eating made me feel sick afterward.

Public Hospital in Santiago

(OK so my blog posts got a little delayed and this happened 3 weeks ago but anyway...)

I spent 1 week with the Digestive Surgery team at the Sotoro del Rio public hospital in Santiago. This hospital felt more like where I worked in Peru than America, although I think it was a bit nicer than the public hospital in Peru. Basically it's a really really old building, which alone would make it feel dirtier and less state of the art than the exact same thing in a new building.

Some highlights:

All patients share rooms here. Interestingly contact precautions (where one patient has a very contagious and difficult to treat infection that you in theory would not want to spread to the other patients, so you usually try to isolate that patient from the others) do exist. However, they consist of putting a little handwritten sign above one of the 6 to 12 beds in a room designating that patient as needing contact precautions. However there is not an extra sink or alcohol gel dispenser next to that patient to remind doctors and nurses to wash their hands between touching that patient and the next. Just the sign. Even more hilarious, we had a patient in the ICU with active tuberculosis (a very contagious airborne disease, it's precautions generally require that the patient be in a room with negative pressure ventilation so that the air doesn't mix with the air other people breathe and that everyone who does enter wears a tight-fitting airproof mask). In the ICU there are only 4 patients to a room, but there was our patient with raging tuberculosis sharing a room with 3 other patients (but with a sign over his bed saying that he needed airborne precautions, so I'm sure the germs weren't reaching the other 3 since they had the sign to protect them).

All the patients know what's going on with all the other patients in their shared rooms. In a way this gives them a kind of support family, but it also ruins any chance for patient privacy, that golden ideal of American medicine. In one of the rooms we had 5 of the 6 patients, and all of them were on bowel rest and couldn't eat or drink anything. (Generally in GI/digestive surgery, patients have to be on very strict diets for several days or longer after surgery as their guts slowly recover function and are able to digest normally again. This is usually a somewhat rigid progression from nothing by mouth to only water to broths and jellos and then to bland foods like chicken, rice, and potatoes before being allowed to return to a normal diet.) In the public hospital anyone can wander in and out at random, and many people come in and sell things like newspapers and magazines to the patients. It seems a woman was also coming in to sell homemade empanadas (fried bread filled with cheese, red meat, and grease--generally on the far end of the diet spectrum for a post-GI surgery patient, like they probably should wait a couple weeks to eat one). Well we come in for afternoon rounds and discover that all our NPO (nothing by mouth) patients are buying empanadas on the sly from this lady. Then they all start denying their guilt and pointing fingers at the other patients. One of the patients had a huge swollen belly from pancreatitis, and another one was emaciated and skinny from a long bout of illness. The skinny guy points at the guy with the swollen belly and goes "look at his belly, he's fat from eating all the empanadas! He ate them all!"

Finally, sanitation is also questionable. Just like people selling things can wander in and out, so can animals and bugs through the open doors and windows. I saw a stray dog in the cafeteria one day. Someone told me that a pigeon--those rats with wings--had once flown into the OR (what we want to be a super sterile and germ free environment). We also had 2 patients in the same room with open wounds (their wounds had gotten infected so they had to be left open to heal from the inside out), and I noticed numerous flies buzzing around that room which I can only guess were landing in their wounds, definitely not contributing to the clean healing process.

Oh, and the waitlists I mentioned in a previous post: Somehow there is no real incentive to work in the public hospital. When putting in lab and exam orders, you have to go find a nurse or a tech and take them by the hand to make sure they actually do their job and the test gets done. Also most of the tests only happen 1 or 2 mornings a week, and the rest of the time the doctors who do them are seeing their private patients who pay more instead. Anesthesia also refuses to start a case beyond 1pm in the afternoon, so even if the surgeons are willing to squeeze an extra case into the day, the OR won't be working so they can only do morning surgeries. All of this results in many patients sitting in the hospital (see first paragraph for the cesspool of infection that's likely to be) for weeks on end waiting for procedures and tests that never happen. One guy got admitted with a bowel bleed and a blood count of 15% (has lost so much blood he basically should be dead), but couldn't get scheduled for a colonoscopy to look up there and see/fix what was causing the bleed for at least 2 weeks. However, patients are more likely to get the procedures done if they're hospitalized than if they're an outpatient, so they prefer to waste their time and the hospital's resources by sitting in a hospital bed waiting for the tests. One of our patients had a less emergent indication for a colonoscopy, but since she couldn't get it for another week either we sent her home to have it done as an outpatient. (Also even though she had less need than the first guy I mentioned, we couldn't trade their places on the first-come first-served list so she would have gotten hers first.) Since that kicks her off the inpatient schedule, she'll probably wait months to get it done, if ever.

Lake District Weekend

Before going to the public hospital, I decided to take a 3-day weekend to see Pucon in the Lake District of Chile. This is a region several hours' drive south of Santiago where there are multiple (surprise) lakes and many picturesque volcanoes. I got a recommendation from some American friends to check out Pucon, the "adventure capitol" of the Lake District sitting on the shores of Lake Villarrica with a view of the snow-capped Volcano Villarrica nearby.

I took a night bus out of Santiago on Fri after work. (P.S. the bus station I chose was the first time in Santiago that I felt like I was in a developing country. It was packed with people hauling around what appeared to be their whole lives' belongings making it impossible to move around or to find the right bus, and within the 30 or so minutes I spent there--way too long--I tried to help some man who was gushing blood from a head wound, tried to avoid a woman who was standing alone and literally wailing in a psychotic manner, and eventually and thankfully found sanctuary on my bus.)

I got to Pucon a little too late to catch the morning bus to the national park I was hoping to hike that day, so instead I decided to rent a mountain bike and go see the Ojos de Caburgua, supposedly twin waterfalls (hence "eyes") about 15km outside of town. I was thinking a little gentle cycling was just what I needed to take it easy before I climbed the volcano the next day, which everyone had said was a very strenuous climb. However I must admit that I have never really mountain biked before, and I now have a new respect for the sport. Going up those hills is freaking difficult. I made it to the waterfalls which were indeed beautiful. There were actually 3 of them flowing down 1 side and also a short one on the other side of the clear blue pool they flowed into. It was making it back to town that got a little questionable. Especially when my chain fell off the bike shortly after starting back to town and I couldn't shift gears anymore...

The next day I had to be at the tourist office at 6am to take off for the volcano ascension. I was rewarded for my previous day's efforts to "take it easy" mountain biking with very sore quads. We strapped on all sorts of fabulously stylish bright yellow plastic gear, helmets, and crampons, and started walking in a single-file line through the snow up the side of the volcano. I think this is the most popular activity in Pucon with nearly every tour agency offering a trip, so this was not exactly a one-on-one with nature encounter. Stretching above and below us were long lines of tourists which forced us into a nice easy pace. The volcano isn't within any particular mountain chain and is one of the tallest things in the area, so despite all the tourists around me I still felt pretty peaceful enjoying the great views of the lakes and other volcanoes in the distance and hiking through the snow. Apparently they often get rainy overcast weather, so we had lucked out with a perfectly clear day. By 11:30am we were choking on sulfurous fumes at the edge of the crater. Then came the fun part: we got to sit down in snow tubes and literally slide all the way down the volcano. We picked up a lot of speed on these but had our ice picks to throw behind us as brakes just in case. I felt like a little kid back in elementary school--another slide!? Pretty please! It was really fun! Finally, I finished off the afternoon with a nap in the sun on the lakeside beach. It was a lake, but there were blue waves and plenty of people sunbathing, kayaking, and boating to make it feel like an ocean beach.

My last day I made it to Huerquehue National Park to do a hike up to 2 huge waterfalls and 3 gorgeous lakes. Each of the lakes was a beautiful crystal blue-green. Oddly, the one named "Green Lake" was the least green of the 3. All in all it was a beautiful escape from Santiago, and I wish I could have stayed in the area longer.