History of Latin American Dermatology

Historical sketch of Chilean Dermatologythe system of zonal general practitioners was launched: these were newly graduatingphysicians who were sent to the provinces (mainly to areas lacking in doctors) as part ofthe country’s national pubic health programs, with excellent pay, for 3 to 5 years. At theend of that period they could choose, as a reward, to obtain training in the medical branchand hospital center of their choice, with pay. Nevertheless, these doctors showed almostno interest in choosing Dermatology, because of the latter’s scarce attraction. The lack ofdermatologists in Chile became very marked: in 1970 there were around 30 trained dermatologistsand another score without special training. Patients were in a triple bind: therejection of their damaged bodies by their community groups, the difficulty in obtainingsufficient and regular medical attention, and the lack of effective drugs for their pathologiesowing to the limited progress of dermatological medical science up to that time. Thatled to their lesions becoming chronic and more serious, with greater rejection still by theirfamily or community group and, what was worse, a reticence by general practitioners toprovide them with therapeutic treatment. Only after 1980 would the awakening takeplace of a consistent interest in the specialized field among younger doctors.Changes in the preference for Dermatology and reductionof the scarcity of specialistsIn the last 15 years of the twentieth century and in the first years of this century, interestin Dermatology among young doctors has notably increased. In this period, the risingdemand has surpassed the availability of posts as residents in training at the majordermatological centers. This change had several causes: 1) the creation of a national programof graduate training rigorously organized into theoretical and practical subjects andwith the teaching support of the country’s main dermatologists; 2) the spectacular rise inthe scientific status of Dermatology within the concert of medical branches, owing to thenotable penetration of the basic sciences (genetics, biochemistry, immunology, physiology)in the knowledge of the skin and its pathologies; 3) the significant increase in effectivetreatments (antibiotics, corticosteroids); 4) the reduction in demand for urgent treatmentand with this the possibility of treatment within organized timetables, specially attractiveto female physicians; 5) stable economic income derived from private care of patients, and6) over the last five years, the considerable attraction of dermatocosmetic surgery. Theconsequences of this switch were: a) Dermatology as one of the five specialized fields mostpreferred by the doctors newly graduated from medical schools with top grades, b) amarked reduction in the scarcity of dermatologists in the country, and c) a clear improvementin dermatological treatment of patients in large cities.Nevertheless, the problem of a persistent imbalance in the distribution of dermatologistsremains; thus there exists large sectors of our far-spread country with a scarcepresence of specialists. Several causes contribute to this inequity: not only the naturalpreference for the quality of life at the urban centers (especially Santiago) and the qualityof medical progress at the large hospitals, but also the poverty of means of the HealthMinistry and of the regional health services to provide an economic stimulus to graduatesto study this specialized field or to endow them with material and human resourcesfor the treatment of patients and for preventive activities.Chilean Dermatology as a young and predominantlyfemale medical branchToward 1970 a huge generation gap developed in Chile: on one hand, dermatologistswho were almost all older than 50; on the other, a timid emergence of youths under 30,with very few filling the gap between the two extremes. Given the explosive recent increasein the number of young dermatologists and the retirement or death of the older165