Since August of last year, Feinberg student Nicole Araneta has been working in a medical clinic in Guatemala, honing her Spanish and immersing herself in a community in need of medical care. Asociación Pop Wuj, the non-profit cooperative where Araneta spends her days, offers the services of a primary care clinic for free to families involved in their community projects. Clinic services are available at a low cost to everyone else.
When the Global Health Portal recently spoke with Araneta, she was just finishing up her time at Pop Wuj, before going on to spend her final few months in Guatemala volunteering with a hospital in another city. She said that Feinberg has been “very supportive” of her work, and that the experience has cemented her desire to be a primary care physician. She will be entering her fourth year of medical school later this year.
Q: What made you want to study medicine abroad? How did you decide on Pop Wuj?
A: Progressing through medical school, it became apparent to me that I want to be family medicine doctor for the underserved. This meant that making my Spanish better was a necessity as well as an aspiration. I also wanted to see medical care in an underserved setting for an extended period of time. The Global Health Office assisted me and provided a list of programs that Northwestern students had attended in the past and spoke well of. Asociación Pop Wuj, a non-profit Spanish School with community outreach projects including a primary care clinic, was on the list.
Q: Tell me a little bit about Pop Wuj.
A: Pop Wuj uses a holistic model in its outreach. It’s an organization that’s trying to make a difference with the communities it works with in various ways. They have a before-and-after school program, provide scholarships, build stoves for families to replace cooking over open fires, and have on-site and mobile clinics.
One of our chronic patients is “Manuel,” a two year old with a seizure disorder. We were helping pay for specialist appointments and providing his medication. Several months ago he got sick with pneumonia when our clinic was closed. One of our health workers took him to another outreach clinic. The pediatrician there prescribed an antibiotic regimen. She also diagnosed him with chronic malnutrition, which our organization had missed. We are now working the whole family comprehensively – they will receive nutrition supplements, counseling, scholarships for the older children, a new stove, and of course continued health support for Manuel.
Q: How is Guatemala?
A: My experience here has been exceptional. The people are welcoming, friendly, and patient with me. I’ve seen and learned a lot. Pop Wuj has ties with several communities, so I’ve been able to do home visits where I see how different people live. Something that I didn’t know about Guatemala before coming here is how varied it is. For example – with respect to only the climate – this one small country spans mountains, coast, and tropical jungle. Through this variety of landscape and terrain have evolved many different ways of living.
Q: Do people view medicine differently in Guatemala than people do in the U.S.?
A: People’s ideas of illness and cure are different. There is a long history of traditional Mayan medicine that has been at odds with the western medicine in which I’ve been trained. Many Guatemalans will go to a traditional curandero before a western-trained physician (Guatemalan or foreign). If they finally get to a physician, their ailment may have advanced and the physician may scold them for “waiting it out”. But in their minds the western physician is the last resort. Only recently have the two systems started to learn to work together and respect one another – I was told that, if a patient refuses western medical care, I shouldn’t push it and to respect their decision. I also read a text by a curandera who said she used Mayan medicine for everyday aches and ailments, but that for anything acutely dangerous she would send her patients to a western physician.
Q: What are some other common health problems that your patients experience?
A: Most of the common diseases here are not medically complicated. They are malnutrition, diarrheal issues, and a variety of infections. In some populations there is also a notable amount of diabetes and high blood pressure, where junk/fast food and a sedentary lifestyle are becoming more common.
What is complicated is the social context of these diseases. Malnutrition is common because of poverty, and perhaps because of some eating practices. Diarrheal infections are common because of poor water sanitation. In rural communities with the mobile clinic, I’ve seen many more advanced infections and growths that have gotten out of hand (one woman had a mass growing over her eye which she left for two years) because of lack of access to care. From some villages you would have to travel for hours and hours to get to an already busy health post.
Q: What is a typical day like for you?
A: A typical day is clinic from 8am-1pm then Spanish class from 2-6pm. I go home and spend time with my host family and do work for Pop Wuj’s other projects. I’ve also been a de facto health advocate for our chronic patients. “Isaías” was one of my most memorable patients. I helped him and his mom navigate the somewhat labyrinth health care system here, taking them to different diagnostic tests and specialist appointments.
Q: Have there been any surprises?
A: Something I was ignorant about before I came to Guatemala was the circumstance of languages. I thought everyone would speak Spanish. However, many Guatemalan’s don’t speak it as a first language. They have one of the existing 21 Mayan dialects as a native and primary language; Spanish is learned in school.
This language situation has complicated effects. For example, parents typically keep their sons in school longer than daughters. So often men speak better Spanish – the language of government, achievement, and power here. Once, during a mobile clinic in a rural community, I was working with a female patient. All the translators helping us that day were male. I thought the patient’s clinic visit was almost over, but then the translator had to step out for a second. Immediately the patient started telling me about her gynecologic concerns, which she ostensibly was too shy to mention in front of the male translator. I had to scramble to find a woman in the village who could translate for me.
Q: Besides medical knowledge, what have you gained from this experience?
A: Good communication between patients and their physicians is extremely important. As is training physicians to be sympathetic of their patients’ beliefs and understanding of their ways of thinking. Being removed from my comfort zone – seeing the resilience people have developed to deal with massive poverty; simply being exposed to different points of view and approaches to life – has helped me well on my way to becoming a more culturally competent doctor.
Q: Now that your experience with Pop Wuj is coming to a close, how do you feel?
A: It’s sad and scary and exciting to move on to do something else. Whenever something new is on the horizon I’m nervous about it, but usually I’m glad that I did it. I will miss Pop Wuj. It’s been a good community for me. But I am excited to see how hospital medicine is practiced in Guatemala, after having spent so many months in a primary care clinic.
To learn more about Nicole’s experiences, visit her blog at naranetacrossing.wordpress.com.