In a paper published this month in the journal Social Science and Medicine, the medical anthropologist Nicole Berry examines the role of short-term medical missions in rural Guatemala. One North American aid worker interviewed says this:
I had helped to advise a primary health care clinic that had a strong short-term volunteer focus, and I was the person who advised them on continuity. It didn’t go well…You cannot provide for patient support, confidence and dignity without compromising the experience of volunteers. The patients need to see someone who they have a long-term relationship with, you have to minimize as much as possible [volunteers’] contact with patients. Get them to do useless things like counting pills, which they don’t want to do, they want to be the doctor. This led to irreconcilable differences between myself and this organization that had a good clinic but really relied on this funding stream. I think that they were attached to this because of funding. People might say it is other things, but it is really lucrative. (Emphasis mine.)
I’ve learned over the past year that so much of clinical care and health education in Guatemala is really about confianza, which translates roughly into English as “confidence” or “trust,” though neither of these words truly convey the thrust of the word in Spanish. Confianza might derive from speaking the Mayan language of your patient, following through on a pledge as promised, or simply showing up in the same community week after week, month after month, year after year.
As health care in Guatemala is heavy on chronic diseases–diabetes and child malnutrition serving as the paradigmatic examples–I strongly agree that “patients need to see someone who they have a long-term relationship with.” Chronic diseases by definition are chronic.
I’m thankful that at Wuqu’ Kawoq, I’ve been able to partner with an organization that has earned confianza by delivering the longitudinal, dignified, and high-quality medical care that our patients deserve.