Saturday, March 12, 2011

Tales of a sick anthropologist/free health care now (part 1)

Actually, the title of the initial blog in this series, which promised three additional cranky blogs, is not that far off, as cranky must be related to the Yiddish word for sick, khrankh (which is probably similar to the German word, which is probably the root for the English one -- I'm spelling the Yiddish word phonetically; my parents spoke words and phrases but I never saw them write Yiddish - which has its own alphabet, similar to Hebrew). 

So, sick I was. Sick as a dog, as we would say in los estados, although the phrase doesn't really have the same meaning when translated directly into Spanish: tan enfermo como un perro (or tan enferma como una perra -- it would have to be gendered as male or female). 

I am not sure how the sickness arose, as I noted in the earlier blog. I'm generally healthy, and in my various travels around Latin America and the Caribbean and Central America, have avoided most of the usual maladies that befall travelers (which I won't tempt the fates by enumerating).  I do get colds, even in unlikely times and places like Havana in the middle of August when it's over 90 degrees in the shade -- my body's way of reacting to too little sleep, too much information, too much stimulation or movement or stress.  They are rarely severe, however. My digestion seems pretty resilient; I drink bottled water (and a lot of it), but I can pretty much eat whatever looks interesting: deep, rusty-red acaraje in Salvador de Bahia (black-eyed pea fritters that get that lovely color from dende a/k/a palm oil), stuffed with okra, shrimp and other delights; mouth-puckeringly sour sliced green mangoes sprinkled with ground roasted pumpkin seeds, chiles, lime and salt in El Salvador. Well, I could go on about street foods of the world, but that would distract from the main point of this entry: some reflections about health care in Guatemala versus the U.S., occasioned by my interactions with the local health care system.

Clifford Geertz, in one of his most famous (and cited) essays, "Deep Play: Notes on the Balinese Cockfight", writes, "Getting caught, or almost caught, in a vice raid is perhaps not a very generalizable recipe for achieving that mysterious necessity of anthropological field work, rapport, but for me it worked very well." I love the Geertz essay (you can read a version of it here ; the color photographs are not from the original publication but add useful illustration), and I use it every time I teach an introductory class, in part to help students understand something about the unexpected nature of field work: you can only plan so much, but then you wind up somewhere and shit happens, or, as in Geertz's case, it doesn't because no one wants to talk to you because they don't know who you are and you might be with the CIA or some other suspicious and shadowy entity. None of which are unreasonable conjectures about foreigners in a place like Guatemala, where the heavy hand of foreign interference has been felt over the past century.  I have been to Chinique three times before, although I haven't lived here, and even after two months people are still figuring out who I am -- the usual question is "Are you with the Medicos Descalzos (barefoot doctors)?" since they were one of the few NGOs that actually worked in Chinique, and there haven't been any foreigners in town since they left some years back (except the nuns, but they are in a different category). 

I had thoughts of Geertz in mind when I fell so seriously ill and my illness seemed so unresponsive to bed-rest, liquids, and the herbal remedies purchased in NYC Chinatown on my recent visit to los estados, that I knew I would have to go the health clinic. For Geertz, his accidental venture into the world of illegal gambling (he and his first wife Hildred, herself a formidable anthropologist, were at an illegal cockfight when the police raided and they were taken in by a couple they'd never met) opened up a window into many aspects of Balinese society (some that Balinese would rather not discuss with foreigners because they didn't consider them "culture" or important). 

Not that I expected any such dramatic revelations. I am not sure a local centro de salud is a "total social fact" in the same way that the cockfight was for Balinese. It's not ritual, it's not performance, it's not something people do for enjoyment. But I did think it would offer at least an inside view into an aspect of everyday life in a small town.

I do not recommend getting seriously ill as a way of getting to know town life.  I don't recommend getting seriously ill at all. It sucks. Sorry for anyone who was hoping for elegant prose: there may be glimmerings here and there, but why mince words about being sick? It's not fun or elegant; it is not,  in and of itself, necessarily enlightening (yes, perhaps if I were a medical anthropologist I could go on some about how different cultures view the body, classify ailments, group together different symptoms and make them into a specific "ailment" or "illness" with a label). Well, that stuff is actually kind of interesting but hard to appreciate when you are so weak and woozy that sitting upright for a moment to drink water requires at least 5 minutes of lying down before venturing another bold move like trying to stand upright so you can refill the water glass. 

The ailment started on Sunday.. that is, I started to feel like something wasn't quite right. I started taking the "preventive" Chinese herbs and slept a few hours, but woke at around 2:45 and was unable to really get back to sleep. I had set my alarm for 5:10 (and of course I managed to get back into fairly sound sleep just before that) since I had to meet Doña Anastasia at 6 so we could go together to the offices of Ixmukané in Chichicastenango and be there by 7. I, of course, didn't have to be there at 7. I am a trabajadora voluntaria and don't have a set timetable; I had been told that Monday was a good day for me to come, and since I always try to offer people who don't have their own means of transportation rides whenever possible, I'd asked Doña Anastasia and Doña Reina (both of whom live in the Chinique area and both of whom occasionally work out of the main offices) if they wanted rides and they told me they had to be there by 7. So I whined internally (not to them -- to meet me at 6, they would both have to get up earlier than I would) and agreed to meet at 6 at La Cruz, which both refers to the community right at the eastern edge of the town, an actual green cross at the roadside, and the large gravelly area between two stores where the road to Tapesquillo starts -- this is where inter-urban buses stop, where camionetas let people off, and so forth.

I wasn't feeling well at all; I managed to down about 3 spoonfuls of oatmeal (I normally eat a very healthy-sized bowl) and something told me I needed a thermos of hot rose hip tea with honey and not a double latte.  But since I had agreed to give Anastasia a ride and I know that rural indigenous women, and especially those who have children, do a lot under very adverse circumstances, so I decided to go through with this rather than call and tell her she'd have to take the bus (in retrospect, the hard part for her is getting to La Cruz; once there, buses pass pretty regularly so I was just saving her money, not necessarily time or convenience).  So I wasn't as essential as I thought. Oh well.

As I was walking in the dark chill morning to where I keep my car, two and a half blocks away from where I live, my phone rang. Doña Anastasia. Saying "no tengas pena, voy a llegar a las 6:20," ("oh, don't worry, I'll be there at 6:20"). In other words, as though she were cutting me a break by arriving 20 minutes later than our agreed-upon time of 6 (it was 5:45 when she called me). As politely as I could, I explained that I was already out of the house and taking the car out of the parking space and that there was no point in my going back home so I was just going to have to sit in the car and wait for her (I guess I could have walked back home and done, I'm not sure what, drink tea, read the paper online, something).  "Ah, no tengas pena", she replied gaily, either missing or choosing to miss my meaning.

Now grumpy as well as sick, I managed to get my car out of its spot with no mishaps (three "cars" -- usually mine, a Toyota sedan and a Kia flatbed share the space wedged between two houses and it's sometimes a very tight squeeze), and drove to La Cruz. What to do for 20 or 30 minutes? I tried to lean back and doze. That didn't work well. I listened to the radio (motor off but battery on) for a little while. I tried to see if I could wedge my laptop onto my lap underneath the steering wheel so I could work. That wasn't entirely unsuccessful. I tried to observe my surroundings and note the morning activity (hey, I"m getting paid to be an anthropologist right?) Counted how many people were waiting, mostly men, several wearing straw cowboy-style hats, and so forth. Catch up on field notes. 

Eventually Anastasia and her 15-(or 16-) year-old daughter arrived (her daughter is going to be staying in my spare room -- and a good thing this turned out to be this week when I was too sick to heat food or water for tea).  We dropped by my house to drop the daughter's things off, and then when we emerged, there were three other people waiting -- Anastasia's brother, his fianceé, and a child who was probably the fianceé's younger sibling. We drove, or rather I drove. All but Anastasia and I were stopping off in Santa Cruz del Quiché, which is about midway between Chichicastenango (where Ixmukané's offices are) and Chinique. I made two stops in Santa Cruz; the brother and his group got off near the central plaza, but the bilingual colegio that Anastasia's daughter attends is actually about 2-3 kilometers on the road towards Chichi.

Reina, by the way, had decided not to wait and had gotten a ride from her husband who has a motorcycle. 

I parked my car on the street in front of the office; the previous time I'd used a parking lot that one of the women had recommended and it not only set me back Q40 but we had to wait over 5 minutes for the attendant to get change for me.  I staggered upstairs and went into the work room. Reina and two of the full-time organizers who work out of the main office, Lucero and Sebastiana, were there; Reina was huddled into her sweater and white crocheted scarf and I saw that she had a roll of toilet paper on the table and was pulling off a length to blow her nose. I sat down, greeted everyone, pulled out my computer and set it up and then waited for someone to tell me what they needed me to do, taking swigs from my rapidly depleting travel mug of rosa jamaica tea.  Reina and I commiserated about our ailments; she'd been sick for a week, she said. This did not bode well, as it would turn out.

Between swigs of tea (I had brought my own honey) and nose-blowing sessions, I finally gathered that they wanted me to figure out how to analyze the results of a survey of women's organizations in the Chinique area. I'd helped write the survey a few weeks before and now we had eight responses. I took the sheaf of papers from Anastasia and immediately saw some confusion in how the interviewers had marked the forms. Partly because of some confusion in how we had designed them (oops). On some questions we had put the line to check off the response to the left of the response(s): 
QUESTION QUESTION QUESTION?____yes _____no____maybe

And on others, it was to the right of the response:

QUESTION QUESTION QUESTION?  yes ____ no_____maybe___

The person who had filled out the forms (they were used in interviews with leaders of the organizations; I don't think the leaders filled them out themselves) had decided that, regardless of what we had on the form, the correct place to check off a response was on the line to the RIGHT of the key word. Once I figured that out, I was able to make somewhat more sense. And made a note to myself to be more conscientious about that sort of thing in the future (in my defense, I did not think when I handed over the draft I had done, or my revisions on a previous draft, that it would not be given back to me or someone for proofreading before it was used).

I realized soon after I started that I was not going to make it through the day. When I arrived at the office, I thought, "I'll stick it out until noon." Now I was worried if I could make it to 9:30. Well, I decided I would finish the task at hand and then leave. I had brought the second bottle of Chinese herbs, the ones you are supposed to take if you are already sick, not trying to ward off a sickness, and decided it was time for a dose. 

I managed to create a spreadsheet with summaries of the responses to what I thought were the essential ones of the 32 questions we had on the form, checked over my work, saved it, and then said I was leaving (I had told people earlier that I was starting to feel very sick and would finish the task and then leave).

I got one more thermos (my trusty Coffee Exchange on Wickenden St. travel mug!) full of hot tea for the road and set off with a sinking feeling. Why had I come? Why was Chinique so far? If I lived closer I would leave the car and come back for it. If anyone I knew drove I'd ask someone to bring the car back for me and take a microbus. None of these were available to me so I girded my loins (figuratively speaking: literally speaking I put on my seat belt, something almost no one in the highlands does unless they are a passenger in my car and then I have to fasten it for them).

It is not entirely clear to me how I made the trip home safely. I was feeling feverish and congested and weak. I tried to drive more slowly (and yet somehow I managed the trip in under 50 minutes). I ticked off milestones: a bridge between two screwy hairpin parts of the road; a stretch without speed bumps; a lumber yard near the outskirts of Quiché. The bus station -- halfway point? Exit from Quiché in the direction of Chinique. Speed bumps. Stretches without too many. Gulp tea. Tienda de Luky (where there used to be a humongous pothole that finally got filled in). Chiché. More speed bumps. Finally hitting the green and white, and black and white road signs that marked the final few KM into Chinique. The ironical (to me alone) ZONA URBANA sign and up the hill, make a left at the tope and then two short blocks, luckily there are not six cars in front of the garage across the street and I have a space for now.

Grabbing everything from the car (I have a bad habit of taking out my phone or wallet and then leaving them in the car) I staggered down the concrete ramp, unlocked the door, put down my backpack, checked that I still had hot tea in the mug and took that and my phone and a water bottle into the bedroom, a pack of tissues and undressed and threw myself into the bed. From which I only arose intermittently over the next nearly 48 hours (it was around 11 am when I got home, and the next time I left the house was around 7:30 Wednesday morning). But that's for another blog.

Let's leave me laid out flat, achey, congested, now fully aware that my throat is very, very tender, not quite able to sleep, too weak to do much else other than lie in bed and try to rest and relax....

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