Health Making in Chile

Chile stands out as South America’s textbook economic success story: Long life average spans (81 years), 44th in the World Competitiveness Report (just between Italy and Greece), 30th in technology infrastructure, and some of the best skiing and surfing in the world. I was there for its healthcare system — a blend of public and private mechanisms that other countries aspire to achieve. It was the first western country to create public health insurance, which eventually led to the private-public blend offerings that most Chileans use today. Last summer, I spent two months in the country learning what happens when a Latin American country excels at reaching its basic healthcare needs (clean water, pharmaceutical supplies, essential medical devices) and enters its mid-life challenges of chronic disease management, lacking advanced supplies, and workforce development.

How do health makers behave in such a system?

We were staying in Santiago, home to about 45% of the country's population. The neighborhood in the north-east of the city where we were housed looks like Miami surrounded by the Andes. Actually it’s twice richer than Miami. With polo fields, steakhouses, French bakeries, and meticulously groomed parks, it was a captivating neighborhood, but somewhat detached from the city's broader realities. So I teamed up with Professor Jorge Contreras, who leads a nursing technology course at UDD, a local university, and trains nursing students in the largest public hospital just south of downtown—Hospital Padre Hurtado.

We were no longer on Park Avenue. This was the intersection of the boroughs of San Ramon, La Granja and La Pintana—some of the most vulnerable places in the city, a mix of working class and industrial neighborhoods. The temporary military field tent setup out front during COVID became a permanent triage center—like a small convenient peace dividend of the pandemic.?The closest thing to polo here are the knock off shirts sold by the street vendors at the hospital entrance. The nursing staff was curious about health making, so Jorge and our team hosted a pop up event where everyone could prototype their ideas. I was curious about what they were making.

Hospital Padre Hurtado is a teaching hospital. Jorge’s nursing students come to help and learn at the hospital every week. One minute while walking the halls, he’s telling me about his experiments using ChatGPT in the classroom, how long it takes for nursing student to learn Arduino, and the next, which side of the hospital has the most nursing traffic so we can camp out at a conference room and set up shop. Jorge’s class, now its third year, leads 40 undergraduate nursing students on how to design and make using 3D printing, interactive microcontrollers and software tools in AI and app development for nurse practice. He drills them on the importance of nurses as makers not just technology consumers. They are solution creators.

These are my people.

He is also passionate that creativity exists not only in private, well funded hospitals, but across the public health system, such as Hospital Padre Hurtado.

We took over a room in the Medical Surgical Unit and unpacked a MakerHealth kit: hand tools, materials, everything from from calipers and scissors to more speciality items like cobalt fabric, UV glue, and an library of sterile connectors and adapters. In 15 minutes we went from Powerpoint land to pop up makerspace. We call it a Pop Up Studio. In the background, the sounds of patient care —??medical equipment alarms and bustling of the frontline teams. Adjacent to us, the night shift staff's bunk beds a reminder of the dedication of clinicians and the 24-hour a day effort of patient care in the hospital.

Challenges and Ideas

The challenges in Padre Hurtado were a departure from foot powered nebulizers we made in the Nicaraguan highlands. Nurse presented the same categories of challenges we hear from our colleagues in the midwest. IV Line management and organization were common. We heard patient mobility and pressure injury concerns. One particularly unique idea came from a Speech Language Pathologist who prototyped ways to capture a digital signature from a stethoscope for a dysphagia diagnostics.

“Aqui tengo mi cuaderno"

Meet Macarena, a nurse armed with a notebook filled with 10 challenges and ideas, representing the voices of colleagues who couldn’t make it, but were caring for patients. Her own interest was gowns. Macarena is working on redesigning patient gowns for line and ostomy management, with a commitment to preserving patient dignity. The existing solution, a crude fusion of scissors and tape, was a quick fix, but easily ripped. Our shared goal was to craft a more dignified design. Macarena's first experiment for the reinvented gown involved testing buttons, Velcro, snaps, and magnets. With cutting, sewing, and taping in full swing, she dove into a 15-minute prototyping session, well on her way for the Macarena-revolution to the patient gown.

What’s Next

The MakerHealth Pop Up Studio at Padre Hurtado Hospital demonstrated the impact of health making in Chile in a real hospital setting with many first prototypes. It showcased the commitment of healthcare providers as active contributors to patient care solutions. As we move forward, the clinicians leading these projects will iterate through the next stages of designs and testing.

The prototypes are a testament to the power of health making at the frontlines and the clinicians' dedication to improve care delivery for all. The devices they create will leave an impact on patient care everyday. The people that create them, like Macarena and Jorge, are reinventing the way we think of healthcare practice.

Reference Links:

PAHO: https://hia.paho.org/en/countries-22/chile-country-profile

World Competitiveness Ranking June 2023: https://www.imd.org/centers/wcc/world-competitiveness-center/rankings/world-competitiveness-ranking/

SSA: https://www.ssa.gov/policy/docs/ssb/v46n12/v46n12p16.pdf

Región Metropolitana De Santiago índice de Prioridad Social de Comunas 2022: https://www.desarrollosocialyfamilia.gob.cl/storage/docs/INDICE-DE-PRIORIDAD-SOCIAL-2022_V2.pdf

Implementation of a course on disruptive technologies for nursing students in Chile: https://dm.saludcyt.ar/index.php/dm/article/view/129/245