13 Feb 2013
In the highlands of Guatemala people are fiercely protective of their traditions. Despite the more affordable prices of modern apparel, women continue to wear traditional clothes. The views on the street are a dance of colour. Corte Mayan skirts fanning out like ballgowns or rolled tight like tacos. Huipil Mayan blouses embroidered with flowers, birds, patterns depending on where you come from.
But not the men. To overcome discrimination against indigenous backgrounds in the workplace (where men have made more ground while most women have remained at home), they abandoned traditional wear. A man wearing elaborately made pants, held up with a belt, and a figure-adorned shirt is a rare sight. If you see such a man on a non-celebration day you’re probably in a smaller town. He is certainly elderly and more likely to be poor.
Don Agosto was a patient I saw in mobile clinic. He hobbled up towards me, using his walking stick and dressed in traditional Kaqchikel Mayan clothes. I complimented him on the rich embroidery.
“Gracias. My wife made them a long time ago.”
The knee pain of his osteoarthritis had been bothering him. As a secondary complaint he mentioned he’d had trouble breathing and a cough, on and off, for a year. When asked, he responded affirmatively to sometimes having fevers at night.
Through a stethoscope his left lung was different from the right. The breath sounds were deeper and harsher. I percussed his lungs, tapped on them like a drum, and found that his left lower lobe was dull instead of the normal resonant that lungs should be. There was something there, solid or water, but not the mostly air that it should have been.
I asked Carmen Rosa, one of the clinic’s new physicians, to check my findings. She did. We were both worried about tuberculosis.
As I listened Carmen explained to Don Agosto that he should go to Hospital Rodolfo Robles in Xela. Named for a famous Guatemalan doctor, it is a national hospital that offers specialized care for pulmonary diseases and especially TB. Their physicians would do the diagnostic workup then offer treatment if necessary, for an affordable price.
After we mentioned that – if he had the disease – he could spread TB to his family, Don Agosto agreed to go. But, fidgeting in his seat, in an anxious voice he asked us to please give him clear directions on how to get there.
“Es que yo no viajo mucho.” I don’t travel much. “And I’m worried about getting lost.”
Don Agosto’s community was more than an hour away in the private van that we took. He’d have to walk to the nearest bus stop, probably not close by. Once in Xela he’d have to transfer, finding the right local microbús.
As a point of reference: It took me more than a month to figure out the microbús public transportation in Xela. There are no printed schedules, no maps of routes. I got my information from repeatedly asking locals.
By how worried he was, he probably didn’t have anyone in Xela. No one to ask directions from. No one to stay the night with. To make lining up in the early morning easier, or in case the processes at the hospital took all day.
One of things I like the least about developing country life are the “travel politics”. With no published prices, as an extranjera I’m constantly taken an advantage of.
“She doesn’t know any better. And she’s a gringa, she has money. Let’s try to charge her twice as much.”
Never mind that I’m a volunteer at non-profits, not making and in fact losing money by being here.
With no obvious routes, early on I was told, “Never ask a bus driver if he’s going to ___. He will say yes, and you could end up in the middle of nowhere. Always ask where he’s going.”
This was the first time I saw how deeply these “travel politics” could affect health care.
Carmen Rosa and I wrote directions on a piece of scratch paper. After giving them to Don Agosto, he stood up to leave. He was my last patient of the morning. I snacked on a granola bar while watching him make his way through the village. A gust of wind blew up, throwing dust on the rich pattern at the bottom of his white trousers. He tread away unnoticing, supported by his walking stick.