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

Introduction

1 introduction My concern with the vitality of indigenous voices (in Guatemala and the United States) began with a recognition of common losses, for me and heirs to legacies of colonialism elsewhere in the Americas, remnants of these voices can be found in our own lives, in the handed-down stories of half-remembered ancestors, African, Native American, and European lives, all clumsily tied and woven together. For some, these voices can be heard in the echoes of native languages still spoken, though sadly many are now too often half understood. What remains of indigenous voices, great and small, oral and written, speak across our disparate histories, cultures, and circumstances not to loss alone but to the endurance, dignity , and worth of human personality. The research presented here and the ethnography of polyphony approach in particular are dedicated to the rediscovery of the vitality of indigenous voices through a commitment to the development of new ways of listening, including describing and analyzing multivoicedness both in the study of interactions and within the composition of ethnography and anthropology. Ironically, though befitting of globalism and indicative of cultural loss, my first encounter with an indigenous language in my home state was not with one of my ancestor’s Algonquian tongues from that region but instead with K’iche’ Maya, which I heard in migrant labor camps on Virginia’s Eastern Shore. It was there that as an undergraduate I participated in public health projects focused on improving crosscultural doctor-patient communication. The summer’s sweltering heat in the migrant camps with their overworked inhabitants, deplorable living conditions, and inadequate health facilities seemed eerily reminiscent of historical accounts of colonial times in Virginia; their histories and experiences were interconnected and that fact left an enduring impression on me. 2 introduction The labor camps, which upended the picture of the inhabitants of Mesoamerica I had inherited from the glossy pages of National Geographic as a child, were my introduction to Maya peoples, languages, and cultures and, more importantly, to the communicative and cultural difficulties that they faced in accessing health care in the United States. Initially, I suspected that answers to cross-cultural medical communication problems in migrant labor camps might be found by studying crosscultural health care interactions in Guatemala but later learned that similar problems (though different in degree and kind) existed there as well. As an undergraduate, this focus on improving doctor-patient communication in U.S. migrant labor camps took me to Mexico and GuatemalaforMayaandSpanishlanguagestudiesandlater,asagraduate student, to Guatemala for dissertation and postdoctoral research where I focused on numerous aspects of indigenous health including, crosscultural medical communication, and health care access. Most recently, I have been researching public health risk translation and communication (see Harvey 2006, 2008, 2011, 2012; Sepehri and Harvey 2009). The study presented here is based on an initial thirteen months of linguistic and medical anthropological field research (2000–2001) conducted among the K’iche’-speaking Maya of Nima’, a term that means meaning “great or abundant river” that I use as pseudonym for a Guatemalan town of roughly fourteen thousand inhabitants located in the western highlands, and a decade (2001–2011) of follow-up research on various aspects and issues of Maya health care in Nima’ and other highland communities in which K’iche’, Tz’utujil, and Kaqchikel are spoken (Harvey 2006a, 2006b, 2008a, 2008b, 2011, 2012). I use a pseudonym for the town where this research was undertaken because of a moral and ethical obligation to carefully guard the anonymity of study participants as well as the cooperating agents and agencies who graciously shared both personal and sometimes extraordinarily controversial health care–related information. My descriptions of distinguishing characteristics of the people and town are, therefore, intentionally guarded and are perhaps less specific than some readers of ethnography may be accustomed, but that does not compromise scientific rigor or richness of data. Taking the study of language use in health care as its focus, this investigation of the unheard voices of indigenous wellness seeking Introduction 3 explores both Maya intracultural therapeutic and cross-cultural biomedical interactions in Nima’, Guatemala, with the aim of uncovering the cultural and linguistic factors that complicate cross-cultural medical care. This focus on Guatemala moves conventional linguistic and medical anthropological studies of doctor-patient interactions beyond canonical Western biomedical clinical encounters (the focus of much of the existing research) and into under investigated non-Western domains of health...