Thoughts on Culture

Tomorrow, we have the final group meeting and we are to talk about the cultural differences we have each noticed. I think I have learned more about the differences in how our health systems work than I have noticed unexpected cultural differences.

One obvious one is that most women I have met in clinics are breast feeding their babies. Of course, women in the US also breastfeed. But as a nurse, I have spent a lot of time trying to convince American women to breast feed without success. Here, it is the norm and those who are bottle feeding stick out. Monday, I worked with the nurse giving immunizations. She instructed women to start breastfeeding their baby before she gave the shots so that the child would be most comfortable. Only one was bottle fed. One of the American participants in this program sarcastically commented, 'Nice, breastfeeding on the street', as we drove past a woman doing just that. She went on to say that she knew she should be supportive of breastfeeding but she was not comfortable with seeing women breastfeeding just anywhere. She went on to discuss how at some hospital in the US there are special rooms women can use to breastfeed. I think it's great, breastfeeding on demand of the baby. I don't see lots of babies in public places but those I do see are not crying.

Another area that I have been pondering is the lack of confrontation. On the bus or in the clinic, people will chose not to confront. If someone wants to get on the bus with two large boxes, others just make room. When the doctor gives instructions, the patients simply nod their heads. If they have just received instructions they don't understand, they don't ask for clarification. If they can't read and the doctor just hands them a sheet about how to take their medicine, they don't remind the doctor about their inability to read. It is that no one complains. But then, there is also little discussion about the issues as well.

For instance, Dra. Isabel, the doctor who arranges our clinic schedules changed my assignment to follow nurses in the main public health clinic here in Puerto Escondido this week. I didn't ask her why, I just expected that she had a good reason. After Monday, which was interesting, (read a future post) I called her because the nurse I followed said she would be doing the same thing (vaccines) for the entire week. I asked Dra. Isabel why she thought I would benefit from following the nurses. She didn't answer my question, but asked 'What's the problem?' I explained that I was concerned that the clinic work would prove repetitious and stated I would prefer to go to a rural clinic. She arranged for me to begin on Tuesday at Bajos de Chila. I still wonder a little if there was something going on at the main clinic that would have been really beneficial for me. This may be more of a personality issue rather than a cultural one.

The first week, I was with Dr. Pablo, who is no doubt under 30 years old. I noticed that when he made recommendations to his elderly patients he didn't make eye contact with them. He would make eye contact while asking about their symptoms or complaints. Then I noticed that he also avoided eye contact with me at certain times. This is probably a way to show respect. I haven't noticed this with the other doctors despite my seniority.

I have noticed that each doctor has focused on the patient in front of them and worked on that patient until they are finished with them. I have really appreciated this focus and I think the patients have also. Each doctor only has one exam room which also serves as their office. So, they rarely have patients waiting to be seen in other exam rooms. There are no phone calls from patients or pharmacies to deal with (indeed, I do not think the clinic has a phone.) Usually, they see the patient and do the charting while the patient sits and waits, then they write the prescriptions. If they are lacking some information, like the name of a drug the patient took for the same complaint two months ago or lab results from six months ago, there is no way to obtain that information within a day, and so a decision must be made with the available information.

Well woman care is handled differently. Paps are not done during pregnancy, indeed there is no pelvic exam at the start of pregnancy visits. And birth control is provided to women separately from Pap Smears. In the US, a prescription for a form of contraception is dependent upon getting a Pap Smear done. I believe this is because women wanting birth control in the US also are at an age where they should have regular Pap Smears. I really can make arguments for both systems. On one hand, it is better that all women have Paps and we know that no one will have health problems related to cervical cancer. On the other hand, some women certainly have chosen not to access birth control (resulting in an unwanted pregnancy) due to not wanting to have a Pap Smear done or due to lack of funds to have a Pap Smear done in the US.

There is a stereotype that Mexicans are not timely and not concerned about being on time. I have not experienced this. I see Estela, the woman with whom I have been living as very busy and not having enough time to complete her tasks, the same as a working mother of teenagers in the US. The patients come to clinic and miss appointments both, but that also happens in the US. There have been times when I thought someone was coming to work in clinic and they didn't come for the whole day. I suspect that this was due to reasons which they did not want to explain to me, not because of laziness or the like. I have observed that everyone is working hard when they are working.

There is also a stereotype that Mexicans are dirty. This is not at all true. Even the most humble people are clean. True, live is lived outside and everything outside gets dirty and dusty quicker. If windows are open all day, and the wind blows in dust, the place will quickly become dirty. But the places are also cleaned. There is a problem with garbage removal. People here also buy lots of bags of chips and bottles of water. There often are not sufficient waste bins in public places, so there is garbage about. But, when I have seen waste bins made available, they are used and those areas are cleaner. It´s more a matter of lack of infrastructure than it is the way people are.

While in public, people do stare at me at times. But if I smile and say 'Buenos Dias' to them while they are staring they quickly smile back and reply. It is a curious stare, not a distrustful or hateful stare. I just look different. No one seems upset when I am a woman alone. No one asks, 'Where is your husband?' I have heard women talking about machismo. One woman told me that when she is driving a scooter, some men are obviously upset and do not like the idea of a woman driving. I have seen men looking hardworking and tough. I have also seen older men talk with respect to young women doctors and accept care from them with grace and gratefulness.

I have not felt unsafe or threatened the entire time I have been in Mexico. I have not identified a part of Puerto Escondido where I felt unsafe. I have been in public transportation two to four times a day, and never felt worried for my safety or that there were others who were upset by my presence.