We have started this blog with an idea that is an integral part of Public Health. The word that has been used mostly in our classes here has been “equidad". When I began to think of the blog post I would make for this I started to reflect on the English translation of the word. Equality did not sound as though it encompassed the ideas that “equidad” brings. To me health equity seems to be a more appropriate translation. As much as equality seems to be a value that is ideal it seems to me that equity is what is needed.
This idea of equity reminds me of an experience
I had while living in Guatemala. I was working in San Mateo Ixtatán,
Huehuetenango, Guatemala. Truly, the middle of nowhere in the mountains of
Guatemala near the border with Mexico. I was working as a Latin American
literature and English teacher at a small school run by an NGO. I had been
there for about 5 months when the administration informed the teachers that our
salaries would be late that month. The transfers were late and they were in a
very tight financial situation so we would have to wait up to a week to receive
our monthly salary. This normally wouldn’t be an issue but I travelled to
Guatemala City that month so when I found out I had about 10 Quetzales
(approximately $1.30 USD) to live off of for the next week or so. Food was
rather inexpensive and buying fruits and vegetables at the local market would
still leave me with 5 Quetzales but what I desperately needed and did not have
access to was clean drinking water. The administration had told us to drink
only bottled water but a large jug of water cost 4 Quetzales and I wanted to
have (a very small amount of) emergency money.
Looking back now I should have simply bought that water and
just dealt with a situation if it arose but coming from the United States, it
did not occur to me that drinking even a small amount of water from the tap
would have repercussions. My family is originally from El Salvador and growing
up I would go quite often and we were always told to be careful with the water.
We would brush our teeth with it, and it would inevitably get in your mouth if
you showered, but nothing would really come of it. It was always just advice
like not going out with your hair wet, or wearing an extra sweater, almost like
preventative advice. It was only a few days after I had drank some water to
take some medicine that I started to feel ill. I have had food poisoning and
other gastrointestinal ailments but NOTHING like this. My symptoms were all
over the place- immense bloating, vomiting and diarrhea, essentially, the
works. I initially thought I had eaten something bad and it would go away on its
own. After two weeks of worsening
symptoms, the local teachers suggested I go to the local health center
approximately 2 kilometers away.
I went with a colleague of mine to wait in line until I was
seen. 4 hours later, I lay down on the dingy exam bed and begin to tell the
medical school student ( I later found out she was in her second year of
medical school and was assisting in a rotation here and had never been outside
of Guatemala City) my symptoms. She quickly tells me that I am eating too much spicy
food (I am not) and too much acid in my diet (not really) and that her
diagnosis is that I have gastroenteritis. I tell her that that cannot be the
case- the diarrhea, the bloating, it has to be something serious. She quickly
gives me a Maalox generic and tells me to go home.
To make a long story short, I found out a week and a half
later that I had Giardia. Giardia is a parasite that lives in the intestine
that comes from drinking contaminated water. I confirmed this two ways- 1) I am
lucky enough that my brother and father are both physicians. I called my
brother who is an Internist and told him my symptoms and he instantly knew what
I had (mostly because he gotten it also on a trip to India) and 2) A colleague
of mine was worried and had me visit her father. He is a General Practitioner
but was trained by USAID Epidemiologists and had a small lab in his office.
After submitting a sample, sure enough he confirmed what my brother had said. (I
even got to look at the darn thing)
I thought of all the situations that led me to receive my
treatment to cure myself- my brother that is a physician, the community doctor
who was trained by USAID, access to anti-parasitic pills, money (finally I did
receive my money) to pay for those pills. I also thought about the decision
that I had made that led me to where I was, but mostly, I thought about what if
I didn’t have any of those resources. No access, no money, no knowledge, no
ability to question.
I went back to the health center and told the medical
student my actual diagnosis. She was sorry but also told me that she sees people
with such worse ailments that she felt bad but was glad and also expecting me
to figure it out on my own. In the end, I don’t blame her. She needs to
dedicate her time and resources to helping those that do not have the knowledge
or resources that I have been blessed with.
- J. Nuila
- J. Nuila
