Wellness Beyond Words: Maya Compositions of Speech and Silence in Medical Care

7: Vaccinated Voices: Lugubrious Logos (Voices of Lamentation and Vexation)

105 Almost two decades before [Dr. John C. Cutler’s] involvement with the [“Tuskegee”] study in Alabama, the PHS [Public Health Service] put Cutler in charge of a two-year research project in Guatemala. This experiment in the global South, rather than the American South, differed from the study in Alabama in two majors ways: government doctors did infect people with syphilis (and gonorrhea and chancroid) and then did treat them with penicillin. (2011:9) —Susan M. Reverby (2011) a historical perspective on clinical distrust At the time of the initial phase of this research (2000–2001), the Maya peoples with whom I lived and worked openly vocalized their misgivings about Western biomedicine and, as this chapter explores, expressed trepidation and leveled charges of maltreatment that were often based in both historical memory and lived experience. Over the intervening decade of follow-up research in rural highland Maya areas, I have witnessed a subtle change in attitudes toward Western biomedicine; tolerance (and in some areas acceptance) has slowly replaced the extremes of all-out-rejection and complete distrust described in this chapter. Yet the significance of these attitudes and experiences are, unfortunately , as relevant and meaningful today as when they were originally observed and recorded. The international disclosure in October 2010 that decades prior to the infamous “Tuskegee” medical experiments performed on African Americans in Alabama, a U.S.-led Public Health Service research project knowingly infected Guatemalans with syphilis will likely again sound a cautionary alarm that might rekindle the embers of disaffection toward state-sponsored biomedicine in Maya communities. The shame of government-sanctioned medical betrayal 7 vaccinated voices Lugubrious Logos (Voices of Lamentation andVexation) 106 chapter 7 in Guatemala exemplifies some of the experiences of Maya peoples, setting a somber tone for the chapter by historically contextualizing clinical distrust. “she’s going to do it!” (clinical coercion and compliance) As we huddled, late into the night, around the blue light from the computer screen, my research assistants and I listened and relistened to each and every word, laugh, and cry. Through the recordings of curative encounters, we entered the participants’ world, felt with them, celebrated their triumphs and lamented their losses. Inching our way through the tapes we faithfully wrote down all that we heard, adding any experiential information from ethnographic observations that we could. As these biomedical and therapeutic scenes unfolded, like children we would try to change the outcome of the unpleasant parts of consultations by turning our heads away or by shutting the machine off all altogether. Finding ourselves caught up in what Coleridge might have called “a willing suspension of disbelief,” we not only transcribed what we heard, but in some instances inserted our voices among those of the participants.1 And as if they could hear us, we admonished them, advised them, and warned them of any impending danger that we foresaw. Once when my research assistant Xuan and I were halfway through transcribing a centro de salud consultation, we heard the Spanishspeaking voice of a Ladina nurse on the tape telling a Maya youth, “También, le toca su vacuna” (N:13) (“Now, it’s your turn for a vaccination ”) (see appendixes E and F). On hearing this, Xuan became infuriated , saying, “She’s going to do it!” His uncharacteristic anger surprised and troubled me. Why this response to the prospect of vaccination? Was it because Xuan felt sure the wellness seeker was going to be forced into it? I understood what he meant, but in spite of it I remained hopeful for a different clinical outcome, perhaps because I was not present when the particular consultation was recorded. I responded to his charge, saying, “Oh . . . maybe not, we don’t know what’s going to happen yet. Let’s see.” As we anxiously advanced through the recording, word by word, the outcome of the consultation gradually began to take shape. The nurse told the young man, “Esa vacuna es contra el tétano yo no sé Vaccinated Voices 107 si usted ha oído . . . esta enfermedad de que causa tétano. ¿Verdad?” (N:13–14) (“That vaccination guards against tetanus. I don’t know if you have heard . . . this illness causes tetanus, right?”). He responded, “Sí. Sí, porque me han vacunado desde mi niñez” (WS:14) (“Yes. Yes, because they have already vaccinated me from the time of my childhood”). With this, my research assistant looked at...