Friday, October 3, 2014

Christian's Pop Wuj Medical Program Experience, Part 3 of 4

Christian Ngo was a 4th year medical student at the State University of New York, Downstate Medical Center when he participated in the Pop Wuj Medical Spanish Program in the spring of 2014. He is now a first year internal medicine resident in Dallas at UT Southwestern.  Thank you Christian for sharing your insights with the Pop Wuj blog!

The Gendered Experience of Health
As I mentioned earlier, machismo culture is very prevalent throughout Guatemala. This culture of machismo affected the way in which both men and women interacted with the health care system. A majority of the visitors to the clinic were women and children. Many of these women were well aware of the chronic conditions that they had – GERD, amebiasis, diabetes, hypertension, and hyperlipidemia. A majority of these women had come to the clinic because they had either run out of the medications that had been prescribed to them previously or they had a minor acute illness for which they wanted to be seen by a doctor.

This was in stark contrast to the few men who I treated in the clinic. They would typically come in after several days of chest pain or a severe acute change in their health status. A good number of the men who presented to the clinic were in hypertensive urgency or had serum glucose levels in the unreadable range by finger stick glucometer. In my short time with the clinic, the majority of the cases which had to be referred directly to the hospital were men.

In reflecting on why this happened, I realized that this was not far off from my own experiences with health care in the United States. In my outpatient rotations, many of the men whom I treated only presented after strong coaxing from their spouses or after they had had a frightening symptom. On the other hand, women were more likely to present for routine care. It is clear that there need to be efforts to improve the way health care professionals engage men in the maintenance of their health both at a local and at a global level.

Another interesting aspect of working in Xela was the intersectionality of gender, language, and age. For many of the geriatric female patients who came from outlying areas of Xela, Spanish was a second or third language. These patients spoke only Mam, K’iche’, or other Mayan language. In these situations, husbands or sons would typically act as translators for the patients as there were no translators who worked at the clinic.[1]  This represented another significant barrier to treatment and left me wondering if the patient fully understood what was being explained to them.

In addition to barriers in spoken language, I also encountered a high rate of illiteracy, particularly amongst older women and women who we saw on mobile clinics. This presented problems when dispensing medications and giving instructions on how to take medications. In these situations, I would indicate the ways to take the medication and how many to take pictographically. In addition, I would be sure to ask if there was someone in the patient’s home who was literate and able to help them with their medications. However, when I first started at the clinic, I did not know to ask if the patient was able to read. It was only after another student mentioned that one of his patients was illiterate did I make this a standard part of my patient encounter. This experience has made me wonder how well our patients in the United States understand how to take their medications and if literacy might be an issue that we as medical providers are unaware of.

[1] Pop Wuj provides translators during mobile clinics in the more isolated, rural areas, however not in the Xela clinic where the patient population speaks Spanish.

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