Xkam rujite’ Vicente

Öj tz’uyül chwäch ri kaxa. Najin ye’ok, najin ye’el ri winaqi’ pa jay.

Nuwäch nojnäq rik’in sib’, nutz’am nojnäq rik’in ruxla’ pom. K’o b’ey ninna jun itzel uxla’, kojol ruxla’ pom.

Nqayab’ej.

Rachajil ri kaminäq ndok richin yojruq’ejela’. Man ndoq’ ta chik wakami. Yan q’axnäq oxi’ ik’, oxi’ ik’ tzaqät pa ruxikin ruch’at, tz’uyül warnäq ri 90 q’ij qa. Rija’ nukw’aj rukiy pa ruk’u’x, najin nuchajij ri kaminäq chuqa’ taq rume’al wakami.

Nqayab’ej chik. Tew ri ya’, b’uyül ri kaxlawey. Ral ri kaminäq ndok, nuq’etej Katy. Najin ndoq’, ndoq’ chik rija’. “Gracias, doctora,” ncha, ndel ël.

Nqayab’ej chik.

Nqak’oxaj jun oq’ej. (Ay Dios, rute’ rujite’ Vicente! Majani ri’j ta ri kaminäq.)

“¿Por qué esto le pasó a mi hija? ¿Por qué se murió? ¿Por qué nos dejó? ¡Se ha ido de su casa! ¡Yo no sabía que le iba a pasar algo así a mi hija! La matan…Ayyyyy! ¡Mi hija! ¿Por qué? Señor, ¿por qué?”

Qitzij. Atyux roma?

Npe raxtew chuwij. Npe ya’ pa nuwäch. Man roma ta ri tew ya’, man roma ta ri sib’.

Atyux roma? Man wetaman ta. Rik’in jub’a junan ri kitzolintzij ri taq k’utunïk chik:

Atyux roma xb’anatäj ri k’ayewal pa b’ey pa ox’i ik’ qa? Atyux roma ri aq’omanela’ man xkiq’alajirisaj ta ri situación k’a xapon ri doctora Katy rik’in rupalaj mo’s? Atyux roma xkiya’ jun aq’om chupam betametasona kichin rusokotajik roma ri ch’at? Atyux roma Vicente xojroyoj taq xek’oje pa b’ey, xetzolin pe, richin xuk’utuj achike xekowin xkib’an richin ri itzel uxla’, roma ri man xkiya’ ta formaldehida ke la Roosevelt? Atyux roma man xqatamaj ta si xojek’ulun pa jay, roma ri majun gasolina pa ruch’ich’ Lencho roma ri jotol rajal ronojel wakami?

Röj yojb’a ël ri lunes petenäq. Pero ri k’aslem xtub’an seguir wawe. Röj yojb’a ël, pero ri kamïk manaq.

Kan ke ri, ri kaslem? Pa jaru q’ij xtiq’ax ri uxla’?

...

[Us, seated before the casket. People are entering and exiting the house.

My eyes are filled with smoke, my nostrils are filled with the scent of incense. Sometimes I smell an ugly smell, between wafts of incense.

We wait.

The widower enters to greet us. He is not crying anymore. He’s already spent three months, three months to the day, by her bed, sleeping sitting up for the past 90 days. He carries his pain in his heart, now he is caring for his late wife and for his daughters.

We wait a bit more. The soda is cold, the bread is soft. The daughter enters and hugs Kate. She is crying. She cries more. “Thank you, doctora” she says and steps out.

We wait a bit more.

We hear weeping. (Oh God, it is Vicente’s late mother-in-law’s mother! She was young, yet.)

“Why did this happen to my daughter? Why did she die? Why did she leave us? She has left her house! I did not know that something like this would happen to my daughter! They kill her…Ohhhhh! My dauther! Why? Lord, why?”

True. Why?

A chill comes over me. Water comes to my eyes. Not because of the cold soda, not because of the smoke.

Why? I don’t know. Perhaps these questions have similar answers:

Why did the accident on the highway three months ago happen? Why did the doctors not clear up the situation until doctora Katy arrived with her cara de gringa? Why did they apply an ointment containing betamethasone for her bedsores? Why did Vicente call us when they were on the highway, coming back with the body, to ask what they could do for the smell, because they had not embalmed her with formaldehyde at Roosevelt? Why did we not know whether we would make it home, because the tank in Lencho’s car was empty because everything is expensive nowadays?

We are leaving this coming Monday. But life will go on here. We will leave, but death will not.

Is that just the way life is? In how many days will the smell pass?]

Accompaniment and conversion

We are scheduled to fly to Atlanta on June 3, and the proximity of our departure date has provoked a good deal of reflection on the 9 months we have spent here with the health promoters.

When we arrived in San Lucas, I had expected to spend the year investigating etiologies of child malnutrition in the health promoters’ catchment area. It became clear very quickly that this would be difficult, if not impossible. The parish expected us, as foreign visitors, to do nothing more than “accompany” the people we met—that is, observe their work and their lives and ask a few questions, learning about another people mainly for our own edification. Attempting anything more would mean we were trying to “become indigenous” (a preposterous but perplexingly real concern of the parish; I never got up the courage to point out to the gringo priest and co-administrators that, as a Bengali, I am, in fact, indigenous); or that we were “interfering” (I learned not to ask, “with what?”) or “generating dependency” (similarly, “how, and on what?”). Ultimately, I agree that my research plan was naïve, over-ambitious and, if actually executed, would have been potentially disruptive of a locally driven program whose broader objectives I did not fully understand.

Moreover, it seemed that my attempts to fulfill the most basic requirements of critically engaged, quality ethnographic research—learning the preferred language of the communities, living in an indigenous aldea, and responding responsibly and justly to the petitions and opinions of my indigenous colleagues—engendered passive-aggressive and patronizing skepticism towards me and, more importantly, towards Vicente and his team of health promoters. The treatment we received, and the overflow to Vicente, was confusing and painful for all of us, and I decided that insistence on my part could endanger the program.

Despite the apparent failure that this “research year” has been—my mother has been asking all year when I will start my study, which was supposed to be the basis of my MPH thesis—I think that we have done something infinitely more valuable than a limited, qualitative study on child malnutrition. In light of the parish administration’s hostile perception of our activities, it is ironic that the best way I have of describing what we have done here is precisely what they told us to do—“accompany” Vicente, Dominga, Rosa, Abelino, and the rest of our friends and colleagues living and working in the aldeas around San Lucas.

The “accompaniment” prescribed to us by the parish co-administrators is inspired by the philosophy guiding organizations like Peace Brigades, International. Such organizations focus on situations (such as exhumations of mass graves) where marginalized actors are predisposed to acute, severe human rights violations. The role played by international “observers” in such instances is a very crucial one; even if the “accompaniment” required amounts to little more than physical presence, the transfer of our symbolic power confers protection to otherwise vulnerable individuals.

Nonetheless, the “nonpartisanship” and “objectivity” that are a part of this sort of accompaniment cannot be applied beyond the limited involvement of short-term accompaniers. In forging substantive relationships with the people we are accompanying, and in coming to a fuller understanding of the milieu in which we are working, we would have to suspend our intellects and/or our hearts to continue a shallow and ultimately inconsequential form of “bearing witness.” And in our particular situation, we are faced with morally clear decisions when our new friends ask us to contribute our relevant skills and resources to support their work.

It is hard to define neatly the kind of accompaniment we have been engaged in here. For me, it has involved learning to communicate in Kaqchikel, and living, working, eating and recreating with our indigenous colleagues and friends on a daily basis. It has meant talking with Vicente in the small anteroom of his house, discussing his dreams, both for the community health program and for his life. It has meant sitting with Rosa working on her backstrap loom on a cloudy day, listening as she weaves personal concerns into conversation about her community and family. It has meant being woken up in the middle of the night to attend to neighbors’ medical emergencies. It has meant frustration and anger at the care that our friends are forced to beg or become indebted for at health centers and hospitals. It has meant being acutely aware of my deficiencies—in speaking Kaqchikel, in speaking Spanish, in providing healthcare, in learning from and teaching others. It has meant becoming acutely aware of how distracted I am by mundane and selfish concerns.

In short, our “accompaniment,” while profoundly fulfilling, has been quite nebulous, variegated, and difficult. It is difficult because there is no endpoint. We cannot exit the friendships we have made and experiences we have had—we could try to suppress the memory of them, only to suffer pain when they resurface. It is difficult because we have, in some way, begun to see our lives as dictated by the experience of communion with our neighbor. How can my life remain unchanged by the encounters we have had? It becomes increasingly more difficult to consider a life that is dedicated to something other than the people whose lives have become so tangible to us. This, I think, is the beginning of the “conversion to the neighbor” described in Gustavo Gutiérrez’s spirituality of liberation. How much can I really rejoice about studying medical anthropology (a strange area of study to most of our friends here) next year at Harvard University (which, similarly, none of our friends here have ever heard of), when that year of study means that I will not be here to continue helping and will be simultaneously postponing the completion of training that will allow me to provide effective, pragmatic services to the poor?

Xkojb’a ke la Boston!

During our time here in Guatemala, I have been forced to reflect quite a bit on how to respond to our experiences here. When we arrived, I had thought that all I needed to do was apply my existing skills in medicine and public health and my linguistic capacity in Spanish, and I would be able to do good work.

In encountering the limits of my abilities in medicine and public health, my perspective on my remaining training has changed significantly. Before, I thought of the years of training before me as a series of prerequisites; now, I have become aware of the clinical opportunities I need to seek out if I am to become a competent physician to impoverished populations in complex healthcare landscapes like the one we have encountered here. Honestly, in light of our experiences, I feel that 3 years of residency training is not enough—I need to gain an internist’s knowledge of medicine, a pediatrician’s knowledge of children’s health, a psychologist’s aptitude for psychiatric elements of illness, and an obstetrician’s experience and surgical dexterity. This makes the prospect of choosing a specialty for residency more complicated. In any case, this past year will make me a more deliberate learner as I continue in my clinical training.

Another unexpected realization of this year is the narrow scope of the training and education I have pursued thus far. Issues of cultural and socioeconomic justice have only been touched upon in passing in my medical and public health education. While I have a natural predilection to trying to contextualize my experiences in broader perspectives of political economy and history, I have neglected this as a focal practice in my life, partly because I have been overwhelmed by the pace of medical school and partly because this is not something that is emphasized as important for medical students, at least not in my experience at my school. I have experienced a growing awareness of the necessity of anthropologic perspectives and ethnographic practice through my engagement here in Guatemala. I have had inklings of this awareness over the past three years, and I somehow knew that at some point I would probably pursue studies in medical anthropology—to the point that when I started thinking concretely about applying to programs this past fall, I already knew where to look and which schools to consider. In December and January, with the encouragement of Elena, friends and mentors, I submitted applications to a number of schools that offer Master’s programs in anthropology for healthcare professionals.

Of the programs to which I was accepted, I decided that Harvard University’s MA in Social Anthropology with a focus in Medical Anthropology was best suited to my needs. The program offers a broad introduction to anthropological theory and the opportunity for in-depth study of a variety of topics of utmost importance to a student of the health and lives of the global poor. In addition, the institutional partners participating in the Program in Medical Anthropology at Harvard (e.g. Partners in Health and the Dept of Social Medicine and Health Inequalities) are exciting to me as a physician-in-training who hopes to couple critically engaged scholarship and social justice work to clinical medicine.

So I am taking another leave of absence from the MD/MPH program at Northwestern, and Elena and I are making preparations to move to the Boston area this summer. We are looking forward to this next step in our journey, and Elena has already begun to look for jobs in Boston’s non-profit sector. Once we have an apartment, we would love visitors!