LESSONS FROM BOLIVIA: Emotional and Cultural Competence

By Yvonne M. Chasser

Published on June 2009

RESIZE Decrease • Increase	SAVE PDF
PRINT	COMMENT

A large desk, buried in papers, separates a psychiatrist and a young Mexican woman. His hands are folded. Her hands are shaking. He is looking down, intensely reading his notebook. She is scanning my face for understanding. We are five people in this office: the doctor, the patient, her five-year old son, her two-year old daughter and me. I feel angry and embarrassed. Something is very wrong.

Three months ago, I was performing hospital rotations in La Paz, Bolivia through Child Family Health International, an exchange program that exposes American premedical and medical school students to health care systems in third-world countries. While Bolivia is considered the most impoverished nation in Latin America, they are certainly not lacking in human emotional capital. For example, the day that I left the country, a taxi driver picked me up at 4 AM. As Jorge helped me pack my suitcases in the trunk, he immediately perceived my sadness. On the one-hour ride to the airport, he engaged me in conversation about my love for his country and her people. He dropped me off at my gate, we hugged and kissed on the cheek, and he promised to personally pick me up from the airport if I should ever return again.

What struck me most about the culture I experienced in Latin America was the closeness of the people. They kiss when they greet, they chat with the boy shining their shoes, and they even stand closer together when speaking. That isn’t to say these differences render their culture superior. Simply, it is these differences which must be recognized and embraced; when we fail to do so, we commit ignorant, hurtful acts.

And so I found myself yesterday, standing in a psychiatrist’s office in New Jersey where I volunteer as a Spanish translator. A woman came in with her two kids, silent and withdrawn. Her son took a pen from the doctor’s desk and entertained himself by coloring smiley faces on his hands while his sister climbed under the chairs.  The doctor began a routine sequence of questions.

Click on any of the images below to start the image gallery. You must have JavaScript enabled on your browser in order for the gallery to work properly. The gallery is best viewed with the Firefox browser.

With each response, I felt more and more torn between past and present, Bolivia and New Jersey, who I have become and who I am now expected to be. Three months ago I was encouraged to interact with patients, to embrace them if they cried, to love them; to be a professional, yes, but first and foremost, a human. Then, I was free to use my head and my heart. Now, I am a mouth for the doctor’s ears.

The mother’s name is Lidia and she reveals her past, bit by bit.  Growing up in Oaxaca, Mexico with only a brother to love her, she was abandoned and abused, passed from relatives to projects to the streets.  In her own words, “They treated us like animals.”  She became pregnant with her son at age sixteen and is married to a man who drinks and hits her.  Her brother died of causes related to their traumatic past. She is only twenty-six years old, and she is seriously depressed, but most of all, she is alone.

She breaks down in the dimly lit office, sobs shaking her body. Her children rush to her, touching her arms lightly. I put my arm around her and place my other hand on her shoulder. We are like this for a while and then I look up, focusing on what the doctor is doing. He is looking at his computer’s screen.

“Do you have Kleenex?” I ask.

He looks surprised at the question and says no. He waits for her to calm down, finishes his notes, and prescribes her Prozac. He recommends her to a counseling center, but can’t remember the phone number. His hand crosses his desk for the first time as he hands Lidia the prescription and he tells her to get the phone number from the receptionist.

I close my eyes for a moment and remember Bolivia.

Lady comes in with her baby son on a frigid morning. He doesn’t have socks or shoes on his tiny, red feet. The chill of the Andean wind sweeps the bare examination room, lit only by the warmth of Doctora Uribe’s smile. Lady is seventeen and lives with her twenty-seven year old, abusive boyfriend. He won’t let her leave the house so she sneaks out, praying he does not notice she has left to speak with Doctora Uribe. Doctora Uribe greets her with a tender hug, cupping Lady’s tiny face with her hands. “How are you?” Her sincerity melts Lady’s fear. “I am horrible!” she wails. Lady begins to divulge her most recent problems as Doctora Uribe massages her son’s tiny feet and ties alpaca wool socks over them. They talk for a long time, their foreheads nearly touching, discussing Lady’s situation and her remaining options. It doesn’t matter that there is no computer. It doesn’t matter that there are no pills. As Lady leaves the room, Doctora Uribe inhales sharply and her eyes are filled with sadness.  She let herself get close; she had let Lady in. Lady will take her advice and get the help she so desperately needs because she trusts Doctora Uribe. She trusts her because she knows Doctora Uribe loves her.

What Lady, Lidia, Doctora Uribe and I share in common is a cultural expectation of closeness. We expect emotive and physical expressions of tenderness from taxi drivers as well as from doctors. This seems strange in American culture, which by comparison is more closed and cold. Displays of emotion are viewed as unprofessional and inappropriate. The disappointment of this expectation is what I confronted that Wednesday morning in a New Jersey clinic.

Because medicine is a business that centers around helping people, it cannot afford to maintain such a narrow perspective. Doctors must be culturally and emotionally competent in order to respond to the diverse needs of those whom they serve. Today, over 40 million Hispanics call our country home and deserve medical care that is sensitive to their needs. Dr. Alfredo Quiñones, the director of neurosurgery at Johns Hopkins Bayview Medical Center makes an accurate diagnosis (Hopkins Medicine, Fall 2008):

“…you can’t succeed in today’s world without being open, without having feelings…the challenge in what we do is not in the surgery—it’s in the emotional connection you form with the patients.”

Doctors in America need to reprioritize. We cannot rely on Prozac to treat problems that penetrate deep emotional, cultural and social complexes. The prominence of the Hispanic population in America is finally forcing us to examine these issues, some of them for the first time. It is time that medical school curricula are revised to include education on cultural awareness, improved opportunities for service abroad during forth year elective studies, and more active participation in community-service projects, especially those serving immigrant populations.

It is my hope that the next generation of doctors brings a more diverse range of approaches to medicine and a passionate, acquired sensitivity targeted to the needs of the changing American population. Although she was clinically depressed, Lidia needed more than a bottle of pills. Undoubtedly, her doctor had good intentions, believing that maintaining a distance was proper professional behavior, but he met her need for human closeness and understanding with ignorance if not callousness. The rising generation of doctors has the potential to change this uncomfortable climate, so that in ten years, no matter where Lidia goes for treatment, she will receive the help she truly needs – a hug, a compassionate listener, a sincere concern for her personal well-being, “closeness”, and maybe even a “chao, cuídate mucho querida” as she leaves the doctor’s office.

Yvonne Chasser is a premed undergraduate at Princeton University, studying in the department of Spanish & Portuguese Languages and Cultures. She volunteered in La Paz, Bolivia during the summer of 2008 through the International Internship Program and currently volunteers as a Spanish translator at Princeton Medical Center. Following graduation, she plans to begin medical school where she hopes to continue to serve the Latino community. She can be contacted for questions or comments at ychasser@princeton.edu.

Article downloaded from http://www.globalpulsejournal.com/2009_chasser_yvonne_lessons_bolivia.html