Culture and Language

Although I experience different patient populations working at different hospitals, the difference between patients at home and patient I saw in Guatemala was very striking. The children we treated in Guatemala seemed to me more independent, stoic, and hardy than those I remember from home. Part of it was an increase in the authority dynamic of medicine. I think the families, parents, and children in Guatemala viewed us in a particular light because we were physicians donating our time to an international medical mission. Families were passive; there was no argument or objection to our medical decision making. For example, if I felt that a 40kg 10 year old needed an IV start rather than an inhaled mask anesthetic, no one complained. None of our patients got any midazolam syrup, a common anti-anxiety premedication we give here, but very few of our patients had irreconcilable separation anxiety. Almost all the children we took to surgery were calm, understood what was going on, and acted a little older than their age. Even after surgery, the patients in Guatemala were stoic and hardy with regard to their pain. There was an understanding, an expectation that surgery would hurt, and they didn't need excessive coddling, treatment, or attention. When our physical therapist pushed the patients to do their exercises, the children did even though it hurt, something we don't always see in American kids.

I also got to practice my Spanish. Over the last several years, I've built up my medical vocabulary, but there are still gaping holes. Immersing myself in the local environment really gave me the opportunity to work on my communication, gain confidence, and learn. Our interpreters were so helpful, encouraging us to speak the language and build relationships with our patients. We also worked with physicians from Guatemala, and that dialogue was not only an opportunity for them to practice English, but also an enlightening experience in understanding medical delivery in a different country.