And there I sat, around a kitchen table somewhere near Quiché, with a bowl of tropical fruits I had no idea how to pronounce and yet continued to eat. What was going on around this table? People were smiling, so that was reassuring. I decided I’d smile too. But I couldn’t have told you what we were smiling about because I couldn’t understand a word of what was being said. Everyone was speaking Kaqchikel.
Let’s pause. How did I get to be in a small town outside of Quiché in the kitchen with a bunch of people speaking Kaqchikel? I’m a US medical student, planning to go into ob-gyn and at this point I was 2 months into a 10 month journey here in Guatemala. For the majority of 2019 I’ll be working with the Mobile Health team at Wuqu’ Kawoq. This is the team that works with over 40 midwives to employ a phone based application to empower midwives to complete prenatal and postnatal check-ups on their patients. Through this program, midwives are guided through a standard prenatal or postnatal visit, one that uses audio, pictures and technology such as fetal dopplers and blood pressure cuffs to evaluate for complications of pregnancy. When complications are detected, women are referred to the hospital and a care navigator helps to organize their transportation and serves as a hospital liaison/translator. To keep this part of my blog post brief, my work in Guatemala is a mix of doing research and partaking in the day to day work of the Mobile Health team.
But back to the table outside of Quiché where I had no idea what was going on, I had some time to reflect on this largely because I couldn’t follow the conversation in Kaqchikel that was happening in front of me. I realized that I was having a very gentle experience with a very serious situation. I was encountering a language barrier. This is not to say that language barriers are new for me. I’ve worked with patients that have not spoken English. I also came to Guatemala with a limited mastery of Spanish and have been living and working here for three months now. The number of times I’ve unknowingly ordered something at a restaurant is significant. This experience was different.
First, I have spent a lot of my life trying to help people. This is one of the main reasons I’m in medical school. I like finding solutions to problems, particularly when it comes to health and gaps in healthcare. However, in this moment, all of the skills and abilities that I rely on to do this – the ability communicate effectively, medical knowledge, experiences with advocacy work – got me nowhere. We were training a midwife on how to use her phone application. While yes, I’ve been involved in maternal and child healthcare in the States, I was not by any means equipped to participate in this teaching. My team, with their understanding of the community, fluency in both Spanish and other Maya languages, and education in maternal health were the experts and adeptly carried out this training.
Second, while I think of myself as a pretty independent person, on this day I experienced an unfamiliar dependence. My overall objective in coming to this field visit was to learn more about the Mobile Health program, how the application works, what the midwives do so that I could actually carry out my social research. I could not do this without the coworkers with me. The program director had to assist me with everything from the content of the conversation to transportation to how one even eats the above mentioned tropical fruits (Do I eat the seed? What about the skin? Is that chalky texture normal?).
Needless to say, for me navigating this situation was challenging. Now let’s imagine an indigenous woman with a pregnancy complication (let’s say it’s pre-eclampsia, which is baseline confusing) trying to navigate the Guatemalan healthcare system. This is profoundly more challenging and stressful for a whole host of reasons. In my situation above, let me not forget to mention that regardless of the challenges I face here in Guatemala, I have a mountain of privilege (I could go on an nauseam about that. I’m not going to at this time, but it still deserves to be said.) Other reasons include but are not at all limited to: hospitals are confusing, care providers don’t speak Maya languages, women could experience overt discrimination, women could face more subtle discrimination, hospital care is expensive, transportation is challenging. And the list could go on.
The importance of culturally competent, linguistically appropriate care that is based in evidence cannot be overstated. This day served as a reminder that language and culture cannot be pushed to the side if quality medical care is to be delivered. I am excited and humbled to continue to work with WK, and ready to venture to other remote locations – prepared to learn and eat more tropical fruit.
Madi Perry, Medical Student and Research Fellow