Wellness Beyond Words: Maya Compositions of Speech and Silence in Medical Care by T. S. Harvey (review)

Wellness Beyond Words is a creative and innovative analysis of communication in Maya medical encounters in highland Guatemala, both within the Maya group and in cross-cultural dimensions. Harvey uses the device of a musical “polyphonic” score applied to recordings of two different types of consultation. He compares a patient-doctor encounter during a biomedical interview in a health center and a consultation in a dispensary, located on the grounds of the Catholic church in the town of Nima’ (pseudonym) and staffed by a therapeutic practitioner (or theurgical herbalist) who is both a Maya healer (in K’iche’, ajkun) and a certified nurse, and her Maya assistant. Their treatment is a syncretistic combination of sacred and secular approaches. Harvey is able to map out both the simultaneous and sequential interplay of multiple players, as well as the communicative roles of both speaking and silence during medical encounters, which a traditional linear transcript cannot show.

Using this analytic method, he reveals the multiplicity of voices (polyphonic, in contrast to monophonic) and the importance of the companions of the wellness speaker and patient—these in contrast to the biomedical expectations of only the patient talking and the doctor doing most of the questioning. The participation of the Maya patient’s companions highlights the fact that the encounter is really a group consultation. The concept of companion is an important aspect of social relations and runs through various domains of Maya culture—food, family, and work, as well as healing. Harvey shows how silence, questions, and comments stimulate a response of a statement, a question, or silence. This type of “ethnography of polyphony” highlights the differences between the two types of encounter and the complications that lead to mis-communication during biomedical encounters.

Such miscommunication is highlighted in Harvey’s chapter 7, which focuses explicitly on the village vaccination program. Here he presents a scathing and discouraging analysis of the vaccination program for the villagers. The subterfuges and deceptions used by the staff to get villagers vaccinated are very revealing of the biases against the Mayans and the discriminatory practices that have arisen to express them. The clinic’s rule that the person seeking the consultation must have their vaccination card with them in order to be seen vividly illustrates the biases of the nurses. By rigidly applying this rule to the Mayans, people, especially children, get multiple vaccines for the same illness, this in contrast to the greater flexibility used in dealing with non-Mayas (ladinos). While the intent of the vaccination program regulations is to encourage people to participate, the effect is to discourage people not only from getting vaccinations but also from using the clinic at all.

Harvey’s work is not meant to be a study of the ethnomedical system itself. Rather, it is an excellent study of language use in health care. The emphasis is on the social relations and communication in medical encounters and how they affect resource utilization and healing, with the aim of uncovering the cultural and linguistic factors that complicate cross-cultural medical care, rather than revealing Maya medical beliefs and practices. Nevertheless, more detail on the syncretism reflected in and practiced by Miriam, the nurse and Maya healer would have sharpened the analysis. Although he shows that her healer role is considered by the Maya to be a divine or a spiritual gift mandated from birth, and her manner of communication during the consultation follows a Maya pattern rather than a biomedical one, the analysis would better illustrate this syncretism if there were more information concerning what it is about her beliefs or practices that derives from her training as a nurse vs. her training as an ajkun.

A suggested next step would be to expand the “ethnography of polyphony” methodology to incorporate the behaviors that accompany the verbal interaction, such as lighting candles, burning incense, spraying with holy...