Friday, July 22, 2011

16-June-2011: The Language of Medicine

Today we've returned to Arajuno, this time clinic-bound and open for walk-in patients.  Arajuno has a defined "downtown", a long grass strip runway, and is considerably larger than Pitirishca (which is effectively a collection of homes around a long stretch of road).  Arajuno is also home to a large Quichua community, something the bilingual school and the Subcentro's signage reinforce.  People may be surprised to hear that Quichua have a strong presence in the jungle.  I always thought them a people of the Andean highlands, and having visited both regions, the differences in dress and appearance are often stark.

That said, it turns out much of the spread of the language "Quichua" was independent of the Quichua people.  First off, Quichua was the language of the Incan empire, and its presence throughout the Andes and beyond tracks Incan conquest fairly closely.  It wasn't the original language of the Inca however, but rather that of several cultures they conquered (think Roman cultural adoptions).  "Quichua" (of Ecuador) and "Quechua" (of Bolivia and Peru) are two flavors of the same language (much like "Castellano" and "Spanish"), though the people of each are more culturally associated to their indigenous ancestors than to a single dominant tribe.

In that light, the "selva Quichua" (jungle) and "highland Quichua" are likely quite distinct in their culture and lifestyle, but no less bound by a shared tongue.  Shuar on the other hand, one of the dominant selva cultures, were never conquered by the Inca (nor the least militarily) and retained an entirely independent cultural trajectory.  Pitirishca in contrast, is a Shuar community.  They also have a bilingual school, giving their children an additional tool to be successful in a developing Ecuador.

While I noted these differences, I didn't give much thought to the challenges they presented until faced with them in the clinic.  Most of the "year of service" doctors come from wealthier parts of the country (Quito, Guyaquil, or other major cities), are of "mixed" or European background, and only speak Spanish.  Though the government, and other local healthcare professionals, try to create ample translations of their materials, they're no replacement for bilingualism.  So today I was intrigued to watch a scene play out that I foolishly imagined restricted to the U.S.

I called the next patient, an elderly indigenous woman, back to the office (thankfully, most names are phonetic), but before I could begin interviewing her she spouted off something in Quichua.  Most patients I would interview and begin to examine as the physician listened, and then he would jump in to focus on specific issues and questions.  This time, however, he started in immediately.  "No hablo Quichua. hablo Quichua!"  As the woman continued to speak in rapid Quichua, clearly not understanding the problem, the doctor stormed out of the room in search of a translator.  She looked at me expectantly, and I tried to signal through charades that I knew no Quichua either.  Eventually, the doctor returned with a nurse from the area and hastily tried to complete the interview, clearly uncomfortable with the need to translate.

As far as I could tell, we identified the source of her problem...a painful, growing abdominal mass...but I couldn't help but feel there was something lost in the process.  While her condition wasn't debilitating yet, it remained serious and would need to be addressed if she hoped to improve.  Further, with such a significant language barrier, it's difficult to determine if the severity of the situation was impressed upon her, or for that matter elucidated by a physician with a significant handicap.  In either sense, it's clear that such a case requires a measure of sensitivity, care and an empathetic ear, which were no doubt absent in any reasonable quantity.  As I watched these events unfold, and I watched the pain and frustration on faces that should be signalling comfort, I thought to myself, "THIS is why I want to learn Spanish."

No comments:

Post a Comment