Decision-Making Strategies of the Mam Mayans

Student research reveals a complement of health care, new and old, in a Guatemalan highland community

Lisa Ladewski spent a month after her first year of medical school living in a municipality in the western highlands of Guatemala where 99.9 percent of the 100,000 residents are Mam Mayans, indigenous people descended from migrant farm workers, and 98.7 percent of them live on less than $2 per day.

There is a free public health clinic, with long wait times and a chronic shortage of supplies, that’s open only on weekdays from 9 a.m. to 4 p.m. There is one private physician who goes home every weekend. There is a U.S. missionary who runs a low-cost eye clinic and provides some general medical advice — even though he has no formal training — as well as transportation to the nearest hospital, an hour and a half away in San Marcos. Every three or four months, a traveling clinic of nurses or physicians visits to provide various services.

Ladewski was there to research the medical decision-making strategies of the Mam Mayans. She learned that, even though biomedical care was not available at all in this part of Guatemala less than a generation ago, it’s the primary choice for urgent medical problems, in part because it’s free; otherwise, residents seek the assistance of Mayan priests and use herbal remedies and the traditional sweat bath, or “chuj.” And she learned that midwives remain the preferred providers for childbirth, in part because they’re the only people in the municipality available for obstetrics care 24 hours a day.

In such a medically pluralistic environment, “Understanding what makes a positive health care encounter for these Mam residents would be beneficial to both health care providers and policymakers,” Ladewski says.

She learned something else, too: “I think the ability to travel internationally as a medical student is incredibly valuable,” she says, “especially to a place where medical care is less readily available than it is here. It’s a chance to see and experience a little bit of life from a different perspective, to know that medical care is precious, to see the never-ending and sometimes futile attempts to keep people healthy with very few resources … and to see health care providers, many of whom could be working in much cushier settings, working there because they really care about their community.”

Inspired by their example, Ladewski hopes to return to the area as a clinician rather than a researcher, perhaps for a fourth-year rotation. “I think the fourth year would be the most ideal time for international travel,” she says. “Students’ medical knowledge is greater and, therefore, so is their ability to provide medical services to the locations they visit.”

—JM

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Decision-Making Strategies of the Mam Mayans

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