VOH DALE!!

This is the expression "vos dale" in a chilean accent. It means "just do it!!" So I'm finally going to stop thinking about how to go about doing this-- finally writing about my first abortion talk with a Chilean doctor. 

But first lets talk about the weekend!!!! I had a wonderful time playing in the Women's ultimate frisbee tournament in Santiago. 5 women teams went head to head over 3 days, and our team "The Sharks" from Vina del Mar came out in 4th place. This was the first time that I was a more experienced player on a women's team and the first time that I was expected to be a Handler, so I was thrilled that we won anything! Not to mention the thrill of bonding with people over a common love for a sport. Both the female and male Sharks stayed in an abandoned grandpa house that my friend's family owns and we had BBQ and drinks after games, ugh so fun. After the 3-day weekend/frisbee-love-fest, I was sore in body and rejuvenated in mind. FELT GREAT!!!

I had my first full-blown conversation about abortion the very next day. Setting the stage: I feel that up until this point that I've gotten to know Dr. V pretty well over the last 3 weeks. He respects his patients, has a beautiful family, is supportive/kind/encouraging when I need to voice my concerns or learn a new word, is a goofball/weirdo, and, best of all, thrives in evidence-based medicine. So when we were at the end of the clinic day on Tuesday, and he asked if the USA had an abortion law, I took a deep breath to brace myself for deeply intellectual conversation. At first, the conversation was a lot of him asking questions and me explaining my stances. We touched upon several topics such as the resources needed to raise a child, a woman's right to her body, and how and when most women go about getting an abortion in the US. It was pretty clear to me from our conversation that Dr. V was of the opinion that a fetus is a life worth preserving even if it's a few cells big (just from how I phrased this sentence you can tell how I felt about that). But then the conversation took a weird turn. Dr. V's voice turned from curious to confrontational/authoritative. He suddenly compared abortions to euthanasia of people with terminal illness. I thought I didn't understand the Spanish, so I asked for a clarification. And then I heard a stranger argument; if we allow abortion, parents will abort all children with Down syndrome. And then I heard something stranger; the reason why Chile has Teleton (a nationally televised annual fundraiser for sick children) and other countries like the USA don't have Telethon is that we abort all of our sick fetuses so we have fewer sick children. 

Is it just me or did that just sound crazy on so many levels.... ? How did the doctor that has been teaching me evidence-based medicine for the last two weeks not do his homework on this one...?

Here's the math: 

1) Generally speaking, two-thirds of US abortions are done before the 8th week gestation, 90% (nearly all) of abortions take place by the 13th week gestation which is the end of the first trimester. 
2) You can't diagnose chromosomal abnormalities, like Trisomy 21/Downs, without amniocentesis. Given that its an invasive procedure (risk of fetal loss is 1/200) doctors don't want everyone getting amniocentesis. Therefore, there are several screening tests before the ultimate confirmation test. The earliest and most effective screening test is called the Cell-Free DNA screen, and is reserved for women with a higher than average fetal risk for Down syndrome. That's women over 35 years old, women with a previous pregnancy with chromosomal abnormality, and women who've had high risk demonstrated by other less effective screens. Its a blood test that you can get starting at 10 weeks and you get results 2 weeks later.
3) Random Google searching has taught me that the rate of Down syndrome in US live-newborns is 0.00142. The rate of Down syndrome in Chilean live-newborns is 0.000336. The Chilean rate is actually lower than the US rate, not higher...

In summary, by week 13 the end of the first trimester, 90% of US women seeking an abortion have received one and a US doctor is counseling her highest risk patient that the fetus MIGHT have a chromosomal abnormality. You can't purposefully abort a fetus with Downs if you never knew it had Downs. What is this slippery slope everyone is so afraid of? 

So, why does Chile have Telethon and the US doesn't? I don't know! Maybe Americans are just assholes! 

On another note, I watched a matrona (a nurse practitioner who specializes in women's health and maternity care) do an intake today. The patient was a  17 year old girl who didn't use protection with her high school boyfriend and now had an unplanned pregnancy. Upon discovering she was pregnant at 20 weeks gestation, her boyfriend broke up with her. Her face showed no emotion when we held the doppler to her abdomen and she heard the fetus's heartbeat for the first time. I remember wishing Dr. V was in the room with us, wondering what he would have said to this patient to excuse the society that wasn't giving her any options.