We have begun our last two weeks of working in the hospitals. While I have enjoyed working on this research project, I am ready to head home to enjoy the last bit of summer with my family.
Even though we have been doing these surveys for over six weeks now, I still learn something new every day about both the health care system and people's lives here.
The thing about doing quantitative surveys in place of qualitative surveys is that it becomes very easy to fixate on a certain quota. When you only have to check a box for a patient's response, you start to only become concerned with moving on to the next question. Many times I have found myself getting annoyed when I encounter Chatty Cathys who want to tell me everything about themselves and their mother. If the survey doesn't take less than twenty minutes, I sometimes feel time is being wasted that could be used to survey another patient and add to the total.
While yes, it is important that we try and get a good number of surveys completed while we're in La Paz, I need to remember why I am here. I need to remember why I decided to travel to another country to do my public health internship, one of the poorest countries in South America, nonetheless. I'll tell you what, it wasn't to be a mindless robot and check boxes on a survey.
A conversation that I had with a patient last week reminded me that I need to take time to listen, actually listen, to patients while I am here. This is my education. These conversations are going to propel me into my future public health career. Understanding how health care functions (or doesn't function) and affects people in Bolivia is going to allow me to understand health disparities in the United States and what I can do to help.
When I began the survey with a woman, whom I will call Maria, last week, I quickly found out that she was one of the Chatty Cathys. Each question that I asked warranted a complete story, enough so that I had to repeat the question because she didn't remember what I had asked in the first place. I kept looking at my watch, realizing that this was going to take at least twice as long as it should.
One of the questions on the survey screener is: "Have you given birth to a baby who weighed more than four kilograms?" (Four kilograms is almost nine pounds.) Maria said, "Oh, no, all of my children were around two kilograms." Here's where I come in, making the very ignorant mistake of saying, "Oh, they were small!"
Immediately, Maria began crying. I was shocked. There is a section of the survey that gets at depression, which, actually, comes directly after this four-kilogram baby question. Usually, if the patient is going to cry during the survey, it is during the depression section. Never has asking about heavy babies triggered an unpleasant emotion. The most common reaction I get is women laughing and saying, "Oh, wow, that's a big baby!"
Here I am, sitting with this sobbing woman who is talking very loudly. Because she had very poor vision, she was unable to see that the entire waiting room had gone quiet and was listening to her tell her life story. Although normally I would be very uncomfortable that an entire room of Bolivians was watching me awkwardly console a patient who was breaking down (I am hardly good at comforting people in English, much less in Spanish), a switch went off in me. I realized then that letting Maria unload her burdens was one of the reasons I had come to Bolivia. Who cares how long it takes her to finish this dang survey? I came to learn these stories. I came to listen.
As it turns out, Maria had been very poor while she was pregnant with her children and could not afford to eat very often. She was very skinny and undernourished, and thus, so were her children. She said that the doctors would always yell at her while she was pregnant and tell her to eat, but she was unable to buy any food. When her children were growing up, they didn't even have enough money to buy bread, so they would search in the trash to eat fat off of bones.
I also learned that although Maria and her husband still live together, he has another woman. "What good is a husband for?" Maria asked me. "Only to have babies? They hit you, they yell at you, it's not worth it having a husband."
Maria is currently unable to work because her health is deteriorating. Her feet hurt very much and she is unable to walk well or be on her feet for very long. She lives with her children and three grandchildren, but feels very depressed that she is still, after all these years, unable to provide for her family.
She told me much more about her life, some of which I didn't understand over the sobbing. The worst part for me was that it seemed like this was the first time she was unloading all of these emotions and all of these stories at once. I mean, really, who is she going to tell? She can't really talk to her children about it, and I don't think she can have an effective conversation with her husband about all of these burdens.
While I have been in La Paz, I have been making my way through Paul Farmer's Infections and Inequalities, albeit very slowly. Although our study deals with chronic diseases and Paul Farmer's book discusses infectious diseases, the two are intricately related and both are absolutely related to wealth inequalities. It has been a very good read while spending time in a country with a weak public health system, where I can see daily the effect of such a system on the health of a country's people.
I read this quote after experiencing the emotionally draining conversation with Maria:
"One of the chief benefits of choosing to see illness in global systemic terms is that it encourages physicians (and others concerned to protect or promote health) to make common cause with people who are both poor and sick."
I am here in La Paz to better understand how to "see illness in global systemic terms." Learning stories like Maria's and really listening is, I think, one of the most important pieces of public health training. And, of course, it is an education that should continue throughout one's public health career. Sometimes it is best that I take off my watch and forget about the numbers. In order to know how to serve the people, how to "make common cause" with them, I need to remember to keep my ears wide open.
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