Navigating the challenges of working in the field and bridging the gap between doctor and patient
Wellbeing At Work Program Senior Researcher Deirdre Guthrie, Ph.D., has been working with Companeros en Salud, Parter In Health’s Mexican sister organization, since the Fall of 2015. In addition to conducting interviews with its members, she has introduced a field diary design method to further deepen the depth and scope of the research.
Below are some excerpts from our first set of field diaries in which pasantes, Mexican medical students who are doing their “service year” in the remote highlands of the Sierra Madre Mountains in Chiapas, Mexico, document the “sweetest” and “most challenging” moments of their week over the course of a month. Here, I will focus on what pasantes observe enhance their well-being, even amidst days that typically include formidable challenges ranging from unpredictable weather and travel conditions, mind-numbing state bureaucracy, loss of power, shortages of medicines, patients in serious conditions or with complications, and the effects of structural violence, those social structures that result in disparate access to resources and “rights" (political voice, healthcare, legal standing, safety, education).
Facilitators of Wellbeing
1. Feeling Useful or Productive
Whether it was getting power lines installed, cleaning an isolated elderly patient’s home, getting ladies motivated to participate in a nutrition program, or seeing a healthy outcome in a complicated or resistant patient, pasantes are a group who are energized by seeing the results of their efforts (and conversely, who sometimes struggle at accepting the inevitable limits of their impact).
Many of the “sweetest moments of the day” include details of patients or family members expressing heartfelt gratitude for the efforts of the doctors, gestures that communicate the community is aware of and grateful for the extra hours pasantes put in, the tedious paperwork and bureaucracy they must navigate through on their behalf, and the way they heal their family members, often with kind attentiveness and deep listening, in addition to medical treatment. (Conversely, it stings when those efforts go unrecognized.)
3. Belonging: an invitation to go beyond the doctor role
Along these lines, many of the pasantes welcome hospitality as a sign of appreciation; an invitation to eat at a neighbor’s home or have a bonfire or movie night with kids. There are many reasons why this feels so satisfying. These invitations cultivate a sense of belonging to a place initially experienced as alien and new and that is a comfort. Further, there is this gesture of acceptance from people in the community, a sign that the pasantes have gained their trust. And trust is something pasantes value (perhaps this is why “non compliance” is so difficult at times to accept, it may signify a lack of trust). These activities are also outside of work where pasantes can step outside of the doctor role and just be a young person for a few hours, enjoying the evening without all the weight and responsibility of the needs of the community. (When this doesn’t happen it can be particularly frustrating, however.)
As one pasante said, “...it's comforting to get there after your work hours, getting to a house where the whole family is waiting for you to give you food, the best they can do; sitting and eating next to them, the entire family, mother, father and daughters; and talking to them about your day. It’s... also very nice; being able to feel... Well, yes, I could call it “home.” In this place that at first was so unknown and so far away for me, it’s something neutral, but at the end of theday, something I’m really grateful for ...”
4. Social Support
And this connects to the idea of social support in general; which is often lacking in the lives of pasantes in some areas because of the long-distance and infrequent contact from family or romantic partners. However, among their colleagues, pasantes are energized by support from fellow CES team members (supervisors, acompanantes, drivers, fellow pasantes, nurse aides). Some wrote about the pleasure of learning from supervisors. Of course, clinically, they appreciate the education and opportunity to become better practitioners. But also, they welcome getting to know colleagues as people, even friends, outside of a work context.
HoIn terms of community health, many pasantes have observed how crucial social/family support is to well being, even a matter of life and death. I was particularly struck when I observed the compassion with which a pasante consulted with an elderly woman, who walked in the room with her cane, alone, almost blind. He told me later she had asked him why she was still here, still alive, when she did not recognize anyone around her? We can speak of a “social death” in such cases and the toll that it takes on physical health is well documented.
5. Practicing the Art of Medicine
A quick look at a commonly used modern version of the Hippocratic oath states, “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. “ And in this vein, some pasantes are learning to use wonderful creativity in their prescriptions of treatment to community members to address this ever-present challenge of bridging the gap between biomedical and lay knowledge, and translating disease categories into social illness models.
For example, a supervisor once explained to me how she wrote scripts for pharmaceuticals along with traditional remedies (herbal teas or compresses, for example) as long as they were not contra-indicated. And, in a moving field diary entry, a pasante describes how he wrote a script for an ill (and isolated) older, man, in the company of his daughter, advising him “to eat with his daughter daily and receive a hug” and then demonstrated by taking the man in his arms (much to both of their surprise). When the old man passed away weeks later his daughter thanked him for brokering this opportunity for her to embrace her father before he died.
Finally, we know that a sustainable sense of well being is the result of an ability to feel the full spectrum of human emotions and respond to the slings and arrows of outrageous fortune with resilience or at least endurance. And it means we can rest in the knowledge that we are all in this together, that the seeds we are planting will indeed grow and bear fruit, one fine day. This entry is from a pasante who, after a difficult day, received a surprise visit from a fellow CES volunteer, which warmed her spirit.
“...and even though I look outside my window and sometimes I’m scared of the enormity in which I’m in, I see mountains and mountains, and I feel like I’m lost in the middle of nowhere, suddenly these things happen and make you see that, after all, you are not alone and that far away. And... Well, yeah, that’s really cool. It makes you feel like you’re part of something bigger than you think, and you’re part of a team that is really a team. Many times at school you work in teams or doing surgery at a hospital, but it’s only for a short time. Here it’s all the time, it’s constant, like knowing and being convinced that if something happens, your team is going to be there to support you. Because the number one thing, the most basic thing is that we share the vision and the ideals that we are here for, fighting for equality, for social justice, to bring high quality health services that gives preference for the poor. I think that's something that unites us all; all of us here share those ideals and vision.”
That’s transcendence, a connecting with something greater, and purposeful. It’s the stuff wellbeing is made of.
*Gracias a FATIMA RODRIGUEZ, JESUS HERNANDEZ, ZULEMA GARCÍA, ANDREA JIMENEZ y RODRIGO BAZÚA para los fotos