More thoughts from "the field"

The major causes of morbidity in Central America and the Caribbean are maternal and neonatal problems, depression and violence. This fact, as Peter explained to me while we were awaiting a bus back to Antigua from his clinic in Santiago Sacatepéquez, calls into question the imposition of the appellation, “tropical medicine,” in his words, “wherever it is warm and there are mosquitoes.” Peter’s assessment, that “tropical medicine” is a mythical creation and a relic of imperialism, shed some light on my confusion about the eligibility requirements for the American Society of Tropical Medicine and Hygiene’s certification in tropical medicine: one must work in an impoverished country for at least two months before sitting for the certification exam; this is puzzling because it is implied that the “tropics” are an epidemiologically homogenous zone—somehow, working south of the U.S.-Mexican border is supposed to prepare certificate recipients to manage malaria, even if this work is conducted in the Guatemalan central highlands, where mosquito-borne diseases, as far as I am aware, are essentially nonexistent. This use of the word, “tropics,” reminds me of the equally perplexing use of the word “field” by a certain human rights professor at Northwestern in reference to what amounts to any and all non-First World settings. Such terminology obscures the diversity of different impoverished locales and their inhabitants and, perhaps more importantly, creates the potential for objectifying marginalized peoples and conceiving of their world as laboratories where very real and actively generated death, destruction and disability are rendered “facts of life” that fail to implicate the comforts enjoyed by us who descend from our universities and institutions to work in “the field.”
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On Saturday, I followed Peter and Wicha, a Kaqchikel woman from Santiago who organizes and supports his activities there, on several house calls. Needless to say, the opportunity to enter the intimate sphere of people’s homes and to watch Peter work was unlike anything I had experienced previously, in Guatemala or elsewhere. Despite the relatively slow pace of the work—which is partly due to what Peter calls “the hospitality mechanism”—the relationship-building and patient-centered health education that is made possible through these house calls has allowed the gradual deconstruction of well-founded negative conceptions and assumptions about Western allopathic medicine and its providers. The perspective that comes from this mode of practice, in conjunction with critical analysis, is markedly absent when a physician blames an impoverished HIV-positive patient’s antagonistic posture towards healthcare providers completely on denial (failing to see that physicians are often representatives of oppressive power structures) and when medical students fail to recognize how heavily the Tuskegee syphilis experiments influence some African Americans’ contemporary mistrust of physicians.
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I had asked Peter when we were in the market buying medicines if he and his colleagues had been collecting any quantitative data to demonstrate positive outcomes achieved through their treatment methods. Of course, the collection of such data requires a great deal of time and money, both of which are in short supply for any incipient NGO. Ample anecdotal data, however, directs his work. Again, the limited resources available require definitions of “treatment success” that differ from what would be considered the “standard of care” in resource-rich settings. Peter talks about using what he can to bring a patient’s random blood glucose from 300-400s down to high 100s/low 200s, and, while he admits that this is not “perfect” management and that there are other important treatments and outcome measures to be considered in diabetics, he points to the change in quality of life that he has observed in many of his patients. If the best available care is the ultimate lofty goal, and if the needs of many individuals must be at least temporarily balanced with the needs of a few, then helping a patient progress from a bedridden existence to planting his first maize crop in 3 years can be considered an exciting and unequivocal success—even if his fasting glucose is above 126 mg/dL.
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Today, Monday, I began instruction in Kaqchikel! I learned letters and sounds and some rudimentary conversations (“Good morning. How are you? I am fine, thanks. Where are you from? I am from Chicago.”). Learning a new language is difficult, but it is also a lot of fun. There is nothing more fulfilling than the way one’s head throbs after spending a few hours in the kind of transcendental levels of concentration required by the effort to internalize a completely new vocabulary and grammar. The arrangements for lessons are still a little up in the air, and I’m taking things on a day-to-day basis in terms of teachers and times of day that they are available. The majority of the teachers at the language school are working with a summer class from the United States until the end of this week, which means that things may be a bit disjointed and disorganized this week. In any case, I got a new textbook that Peter suggested and that is a more extensive version than the English language one I got in the United States—this is quite exciting for a Bengali with a book fetish! I also learned from the teacher that I worked with today that the fair rate for personal tutoring with a teacher who lives closer to where we will be spending the rest of the year (that is, on Lake Atitlán) is relatively compatible with our small budget. So, good things, so far—now all I have to do is put in tons of hours and much effort. Ack!