Reflections From a Service Learning Project in Oaxaca
What struck me the most about Oaxaca was the noise; music filled every street and bus, cars honked incessantly, planes flew low over the city with announcements blaring over loud speakers, and gas trucks made their rounds, their horns sounding just like mooing cows.
I was in Oaxaca with a non-profit international health organization to be part of a service-learning project. My desire to take part in such a project stemmed from being a regular volunteer at a free medical clinic that serves a predominantly Hispanic population. After a few short months of interacting with the staff and patients at RotaCare, I developed a strong interest in the Hispanic culture and a desire to learn Spanish. Although the clinic has a regular staff of Spanish interpreters, it bothered me that I was unable to speak directly to the patients I was working with. Additionally, because of cultural differences, I felt that I was not identifying with Spanish-speaking patients as well as I would have liked.
Traveling to Oaxaca, Mexico was the perfect solution. Not only did I have the opportunity to live in a city rich in culture and traditions, I was able to see firsthand how the medical system in Mexico was run. By shadowing and learning from Mexican doctors, I gained a deeper understanding of how best to communicate and relate to Mexican and other Hispanic patients. Additionally, being in a city where the majority of citizens did not speak English, I was thrown into an environment that facilitated a rapid and immense improvement in my Spanish language skills in a mere four weeks.
My time in Oaxaca was divided into four, one week, sections that enabled me to observe four different aspects of the health care system - low income health care, hospital care, rural health care, and private practice. Throughout the course of my stay I learned much of value. Aside from the medical knowledge, what was most important to me was how to translate what I was learning in Mexico into how to better serve the Hispanic community back home - the essence of service-learning. Throughout the duration of my stay I actively observed my surroundings and paid special attention to the manner in which doctors, or other medical professionals, and patients interacted.
The Hispanic culture places high value on medical providers. Doctors are well respected and trusted, to a much higher degree than in the US. In the Hispanic culture, it is commonly believed that doctors are infallible and that they do not make mistakes. I witnessed this phenomenon first hand while in Mexico. Patient after patient would enter the doctor's office without asking a single question. They simply came in, explained their symptoms, listened to the doctor's diagnosis and treatment plan, and were ready to leave. And they would have left, had it not been for the doctors' insistence on making sure each person understood what they had been told. Many of the people with whom I interacted felt that going to the doctor was the solution to their problems without realizing that they had the ability to play a role in their own health.
While in Oaxaca, one of my favorite doctors worked in one of the city's Centro de Salud, literally translated as Center of Health, which is a primary care clinic for unemployed or self-employed individuals. This particular provider spent up to an hour with each patient, regardless of how simple the case might have been. What struck me most about this provider was that he empowered his patients to take an active role in their own health care. By being a doctor, therapist, dietician, and friend, he was able to instill a sense of comfort in his patients that allowed them to speak openly about their problems and be receptive to suggestions that could affect their overall health and wellbeing. This ability is extremely important because it is common for Hispanics to place doctors on a pedestal and to be unwilling or afraid to engage in a dialogue with them.
Providers, however, have the ability to help change this cycle. One way to achieve this goal is to initiate a conversation with the patient. If questions are not brought to the table by the patient, the provider should be proactive and ask if they have any. He or she should probe a little to ensure that they understand the diagnosis and treatment. And if a medical provider suspects that a patient is still unclear, he or she should ask them to explain what they understood in their own words. To the average American this may seem insulting or rude, but this type of questioning does not seem inappropriate in the Hispanic community, for I witnessed it to be commonly used in Mexico. In fact, the patients that I spoke with always felt that doctors who used this tactic were the ones who were the most caring and most highly regarded.
The other trend I noticed while in Mexico was that many people visited the doctor with several unrelated complaints. Whether this practice is due to a lack of continuous access to health care or to the faulty idea that doctors have the ability to cure everything in one visit, providers should help these patients narrow down their list of symptoms. Like many of my counterparts, I used to believe that documenting four to five complaints per patient was normal; each ailment deserved the full attention of the doctor. The problem with this tactic, in addition to being inefficient for the doctor, is that it is detrimental to the patient. Despite any clinic's best efforts, resources, including time, are always limited. When dealing with time constraints, a patient benefits more from discussing one problem in depth than touching on many complaints superficially.
A simple way for providers to broach this issue with patients is to ask them which symptom, or group of related symptoms, led them to make the appointment that day. Regardless of the number of complaints an individual may have, he or she will rarely deny that one problem outweighed the others. If, after the provider has discerned the chief complaint, the patient continues to discuss other issues, it is well to let them. These patients simply need to feel that they are being listened to. From my experience in the Oaxacan clinics, the patients with the most complaints typically wanted to talk more than they needed medical attention.
Again, listening and showing genuine concern builds trust and establishes a positive working relationship with the patient. After actively listening, providers find that most patients are more receptive to discerning a chief complaint and focusing on treating that one issue. They also are less likely to delay seeking medical advice the next time they have a problem. In the end, not only does this benefit the patient, it benefits the providers by saving valuable time during future visits.
Danielle Granieri is an SCU alumna on the staff of the Leavey School of Business at Santa Clara University.