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The father wore cowboy boots, faded jeans, and a navy polo
shirt; a trinket attached to a leather bracelet dangled from his
wrist. The mother, in gray sweatpants and a black t-shirt, had long
dark hair that matched her darker complexion. With them were their
four daughters. Walking into the clinic room, I found the three
older daughters laughing, shouting, and jumping around two chairs
and the exam table as their father pleaded with them to calm down.
Their three-month-old sister, my patient that morning, was cradled
in her mother's arms. What made this family different from all the
other patients I had seen that week was that they were speaking
Spanish and had emigrated from Guatemala.
I was in Southwest Virginia, completing my pediatric rotation as
a third-year medical student. Spanish-speaking patients account for
just six percent of the persons living in this region, best known
for its coal-mining and its population of long-settled Scots-Irish.
Somewhat surprisingly, I had seen quite a few Hispanic patients
here in Appalachia, evidence that the demography of this
mountainous region is changing. Very few physicians in the area
spoke Spanish, and I was pleased that I would be able to
communicate with this family because I had learned some Spanish
during the months I spent in Guatemala between my first and second
years of medical school.
I was sitting in the physician's office when the Guatemalan
family pulled into the parking lot. From the window I watched the
girls and their parents get out of their truck and start toward the
clinic door. "Can you believe how many people they can fit in one
car? It really is true, isn't it, how Mexicans just pile people
into a vehicle!" I turned around to discover one of the nurses in
the office doorway. She'd noticed this family, too, and was eying
them with a mix of curiosity and suspicion. I was shocked at her
derisive words, too shocked to reply.
I immediately volunteered to see the family, not actually
Mexican but Guatemalan. I said, "hello" to the parents and the
girls in Spanish, then asked the oldest girl how old she was. Nine,
she said. "Ah, muy bien, muy bien," I replied. I frequently have
conversations with a classmate about whether it is rude to
automatically speak Spanish to someone who actually might speak
English. I decided on this occasion to continue with Spanish unless
the parents indicated they preferred to speak English.
From the electronic medical record, I saw that my patient was a
healthy three-month-old girl who had been having two days of
diarrhea. In my mind I formed a differential diagnosis and list of
questions that could help me settle on the diagnosis. I started
with open-ended questions and progressively narrowed my focus. Only
at the end of our discussion though, did he tell me what he thought
was going on with his daughter: "mal de ojo," or evil eye. I
remembered learning about mal de ojo during my first trip
to Guatemala, the summer between my first and second years of
medical school. Mal de ojo can be contracted when someone
casts a hex by gazing upon another person with envy or desire.
Babies and young children are thought to be especially vulnerable,
so much so in fact that to prevent this type of gaze from reaching
a baby, many women will carry their infant on their backs and
completely cover the child with cloth.
The father's story was classic for mal de ojo. A few
days before, when he and his wife were walking the baby outdoors, a
neighbor had stared at the little girl in her stroller. When I
first heard about mal de ojo, I was surprised to learn
that the condition can be avoided if the person gazing at the child
also touches the child's head. I recall thinking how upset most
American parents would be if a stranger admiring their baby started
touching the baby's head!
I noticed again the father's bracelet and recognized it as a
traditional talisman meant to ward off evil spirits. While I did
not specifically acknowledge the talisman, I did explain to him
that I was familiar with mal de ojo and would mention it
to the physician before he examined the baby.
In the end, the doctor's exam and treatment plan remained fully
grounded in Western medicine and did not address spiritual
concerns. Still, it seemed that my having acknowledged the father's
explanation for his daughter's illness fostered some trust. It may
even have been comforting, helping the family to feel more at home
in Appalachia and in our medical system.
In this small way, I brought global health to a local medical
practice in Southwest Virginia, where new Spanish-speaking
immigrants may not be accustomed to being treated by doctors who
speak their language or understand some of their customs. Medical
students who choose to participate in global health electives may
not only care for patients abroad but also provide comfort and
cultural competency to patients in the US.
Jonathan Abelson, MD
University of Virginia School of Medicine
Class of 2012
August 2012 Issue of IMpact
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