I’ve always believed the foundation of the patient-doctor relationship is grounded in trust. Here in the Petén region of Guatemala, while poverty and a culture of violence, mistrust, and corruption dominate, somehow the roots of the trusted patient-doctor relationship remain – for better or for worse.
Guatemaltecas have a unique devotion to health promotion despite limited access to resources and minimal education. On the whole, without their health they cannot work, and without work, life falls apart – so they do their best to take care of themselves in any way they know how. So, for many patients with limited resources and education, their only option in health promotion is to trust their doctors. We’ve seen patients paying exorbitant amounts of money for unneeded tests, treatments, and preventative vitamin injections, simply because "the doctor said so," even when putting food on the table is a constant struggle - and we're talking 1000’s of quetzales for treatment when a meal for a family may only cost 15-30 quetzales. Some of these patients live in homes with dirt-floors, however if the doctor says their health is compromised and can be fixed with X, Y, and Z, patients will somehow get the money, and make it happen. Many patients see no other options because without their health, they have nothing.
For some reason, local physicians are suggesting these exorbitant tests and treatments. I can’t count how many women I met in clinic who had their uterus removed for asymptomatic fibroids after unnecessary ultrasounds from outside hospitals. These women are being proactive personal health promoters, however they continuously fall victim to a system that shows no shame in taking their money and “matriz,” or womb, for no reason.
As a student witnessing this, it has created an overwhelming sense of responsibility as I proceed through my career as a hopeful future ob/gyn. These patients have given me clear, obvious examples of the repercussions of non-evidence based medicine directly impacting a patient and their family’s well-being. This experience has also allowed me to engage in valuable patient education on topics I never thought I would need to discuss. It’s humbling, and has ignited a fire to do absolutely right by these women.
(written my Cydney Siggins, 4th year medical student)