I have a list going.
Los columpios. órale. compú. inmersión. cafetal.
These words -- a mixture of Spanish medical terminology, slang, and vocabulary relevant to my research project -- are the ones that have filled my experience in Jaltenango, Mexico, thus far. They're the ones I eagerly jot down as I spend my days traveling between the Partners in Health (PIH) office in town and the rural community health clinics that lie two to three hours away. Like my life here, these words represent many worlds melded into one beautiful language.
But before I go too far, let me introduce myself. My name is Ishani. It's nice to meet you. A little about me: I'm Sri Lankan-American, pre-med, a writer, passionate about studying healthcare delivery in resource-constrained environments, a lover of anthropology, a twin and -- for the next three months -- a college student who is living very far away indeed from Harvard Yard. To say the least, this is not my typical semester on campus. This spring, I am studying and working in the state of Chiapas, Mexico, soaking in as much as I can of the breathtaking Sierra Madre mountain range during the beginning of what is both my spring semester as a Harvard college junior and my term as a Global Health Equity Option (GHEO) Scholar.
As part of the GHEO Scholars program, spearheaded by Dr. Paul Farmer, I have been splitting my time between the office of the Mexico chapter of PIH, known as Compañeros En Salud (CES), and the impoverished rural communities that are tucked within the mountain range that meanders through this state. In these communities, I not only have a chance to observe and assist the Mexican and American physicians who have come from far and wide to provide consultations, but I also engage with the patients and interview them about their prior access to healthcare, their perceptions of the severity of various illnesses, and their hopes for their children and their communities with regards to healthcare, education, employment, and more. It is truly a clinical experience unlike any other I have ever had.
The Sierra Madre
Since much of my experience here will be about seeking answers, I'll try to start first by answering a few that you might have for me.
¿Cuáles son mis metas? (What are my goals?) For one, I hope to improve my Spanish. It is a language that I've always loved studying, but I'll admit that I've long been itching to use it in a way that is useful to someone other than myself. After all, language begets reciprocation. I hope I can use Spanish to reciprocate the many kind greetings and conversations that seem to spring up so organically here. I know that these will be the foundation for the lasting relationships I hope to form.
Why did I come to Mexico? This is a question that I've gotten frequently here, especially from the pasantes (Mexican physicians fulfilling their required social service year) who want to know what compelled a 20-year-old undergrad to leave snowy Cambridge and experience a part of Mexico that the average American has never heard of. It also requires a longer answer, so bear with me.
For one, I'm inspired by the work being done by CES to provide high-quality healthcare to one of the most impoverished regions of the country. What's more, CES is still a young organization -- founded in 2011, it has been bolstered by the work of a hearty group of staff members and volunteers who truly know and love this work. To be here is thus the chance to see the heart of an organization that has bootstrapped its way from nothing, and to appreciate the way in which a core group of people can induce that organization to grow.
Ultimately, though, what has most compelled me to spend my semester in rural Chiapas is the chance to live and interact with the people who have known the Sierra Madre their entire lives, even as they are still new to the world of easily accessible healthcare.
For the next three months, I plan on taking only cold showers, facing darkness at seven o'clock when the sun goes down, and sleeping on the floor of a small, adobe home in the middle of the mountains. Sure, much of this will be far from glamorous. In fact, I am certain that almost none of it will be. And this, too, is a key part of my answer to this question. Being here is the chance to experience something new -- not just mentally and emotionally -- but physically as well.
And finally, in order to truly get to the heart of the "why?" question, I recall something that Professor Arthur Kleinman said during one of our first classes this semester. Sitting in the CES office in Jaltenango, his voice emerged from the speakers of my laptop and filled the room. It might have been 7AM, but Professor Kleinman was absolutely chipper as he video-conferenced us in from his iPad. 21st century technology, I tell you. I'll admit that I had my reservations about this long-distance, high-tech learning style, but my fears have been assuaged. This is how I will be taking all of my Harvard classes this semester.
Professor Kleinman is teaching a Clinical Ethnography course that is specific to the two of us GHEO scholars in the inaugural year of the program. On that particular morning we were discussing our research projects in depth and delineating key tenets of the requisite methodology. At one point, I asked a question about the division between quantitative and qualitative methods of research collection-how could I explain and justify the difference to the subjects of my study? And to those who would be receiving my research?
Professor Kleinman paused por un ratito. "You know, I had this same conversation with Paul Farmer and Jim Kim 20 years ago," he began in his characteristically reflective tone.
"Your job is not just to collect data, but to collect stories," he explained, "and their usefulness is that they help to illustrate both problems and impact."
I couldn't help nodding in agreement at Professor Kleinman's slightly pixilated image staring back at me from the computer screen.
Yes, indeed, I thought, I'm here to collect stories. From patients to pasantes to the diligent doctors who left their jobs at large Boston hospitals in order to run rural community health clinics in the most impoverished state of Mexico, I could think of many people whose stories I wanted to hear.
And so, that's why I came to Mexico. For the chance to be welcomed into the homes of the people of the Sierra Madre so that I may hear about a lifetime of experiences that are so different from my own.
Like language, stories have a way of begging for reciprocation too. And so, as I live this new adventure, I hope I can provide a few here. I hope you'll join me.
Up next, a post about "la roya" and the effect it's having on coffee, the most important cash crop for the families we serve here in the Sierra Madre of Chiapas.
Follow Ishani Premaratne on Twitter: www.twitter.com/IPremaratne