SOWO 709 Research Proposal Jennifer Wilburn

Transcription

1 Towards a Balanced Understanding of Health Practices of the Maya in the United States Jennifer Wilburn UNC-Chapel Hill School of Social Work SOWO 709 I pledge that I have neither given nor received any unauthorized aid on this paper. Jennifer Wilburn

2 The Maya are descendants of a civilization indigenous to the Yucatan peninsula and present-day Guatemala that dominated the region from around the first century (AD) until the arrival of the Spanish conquistadors. The term indigenous has several definitions, including self-identification, historical continuity within a certain group, strong link to territories, distinct language and/or culture, resolve to maintain community, or distinct political or social systems. However, the UN (2007) states that the most important aspect of an indigenous group is retaining distinct characteristics that are clearly different from those of other segments of national populations. The Maya demonstrate all of these, and this distinctive character is what makes them a vulnerable population in need of interventions specifically tailored toward their specific practices, beliefs and customs. The ancient Mayan culture developed around 2500 BC and peaked during the Classic Period in 250 AD. The Mayan civilization continued for the next 700 years as a collection of interconnected city-states, even after the arrival of the Spanish. However, they eventually began abandoning their cities for unknown reasons. Yet while many people believe the Maya are extinct, they exist to this day. Having been exploited by the Spanish for both labor and land, the Maya now live in poverty in rural villages. The usually live in huts, and men work mainly as sustenance farmers while the women take care of their home and often are artisan craftspeople. The Maya speak 29 officially recognized languages in Guatemala and Mexico that date back to the Proto-Mayan language over 5000 years ago. Mayan immigration to the United States has been in two waves. The first occurred during the Guatemalan Civil War, which lasted from Indigenous Mayans were particularly impacted by the war, as they were believed to be supporting the guerilla movement against the government. Over 400 Mayan villages were destroyed in the war and thousands of Mayans left

3 their homes as refugees, fleeing to Guatemala and the United States. This first wave of migrants from war-torn Guatemala initially settled in Los Angeles, Houston, and southern Florida, areas with long-standing Latin American populations. The second wave of immigration began in the 1980s and 1990s as a result of the challenges that indigenous Mexicans face in Mexico presently. The Mexican government continues to oppress indigenous people through privatization of land, social exclusion, indifference to poor health conditions, restricted political activity through civil rights abuses and military presence in Mayan regions, and language discrimination. About 25% of indigenous Maya who leave their villages choose to go to the United States (the other 75% migrate to the city, often working along the Riviera Maya) and have settled in new communities such as the Bay Area (Brown & Odem, 2007). They often work in construction and agriculture and form tight-knit communities. It is estimated that between 500,000 and one million Maya from Guatemala and Mexico live in the United States (Smithsonian Institute). Mayan spirituality is a fundamental component of daily life for the Maya and it influences their health practices and wellness. The Maya worldview is constructed on the concept of balance, in which everything is connected, including nature, the body, the mind, and other people. Their personal orientation is centered on the community rather than the individual, and that community constructs values and meaning for each individual. The Maya look to each other for advice, knowledge and wellbeing, as they strive for harmony within the community and the greater world. Illnesses of humankind such as hatred, envy, materialism, and disrespect cause imbalance in our lives, while Mayan spirituality seeks to restore harmony to our lives. Concepts such as health and disease are understood as the search to restore balance to the relationship

4 between the self and the whole, and physical and emotional health conditions are directly related to social behaviors. Present-day Mayan health practices reflect ancient Mayan practices of diagnosing and curing illness. While the Maya have been influenced by European practices, the isolation of the rural villages enabled the Maya to maintain their traditions and cultural knowledge throughout the colonial period and into the modern day. The Mayan conception of health and disease is based on a balance of temperatures. Health is maintained by avoiding exposure to extreme temperatures and by consuming appropriate foods and beverages to maintain a balance of temperature. They often rely on traditional healers as providers (such as a curandero or partera/midwife) and often prefer herbal remedies to Western medicine. The distinct cultural beliefs and language can create several barriers to care. Providers or receptionists are often unable to distinguish between Maya and Latinos and this misidentification can lead to many problems. Some, but not all, Maya speak Spanish, and avoiding miscommunication about health care is critical. There is a desperate need for medical interpreters who speak indigenous languages; the lack of interpreters often means that children act as interpreters, a situation which puts the child in a difficult place of relaying sensitive and sometimes frightening information. Many Maya are illiterate or have low literacy and therefore have difficulty understanding materials and completing lengthy, complicated paperwork. Also, the preference for traditional healers means that many Maya will wait too long to get treatment, especially in the case of expectant mothers who rely on midwives. Moreover, there often may be conflicting recommendations between the provider and the indigenous healer. Besides differences between cultures, the Maya face many barriers to care that other Latinos face. There is often confusion between multiple last names, which can lead to confusion

5 of hospital staff, which can lead to names being entered into the computer incorrectly, files lost or difficult to locate, babies misnamed, and an overall feeling of disrespect. Likewise, due to the Guatemalan Civil War, many Mayan refugees in the United States do not know their birthdate or family medical history, as those records may have been lost. The high cost of care is also a barrier as traditional healers are usually much less expensive than Western medical care. Many patients do not return for follow-up appointments due to the cost of appointments, their preference for alternative care, transportation issues, a history of bad experiences, or miscommunication about appointments. Finally, due to a history of oppression, many Maya do not admit to being indigenous out of fear of discrimination. Due to the Mayan language, distinctive cultural character, religious beliefs, views about health, and history of oppression, it is crucial that health providers understand their patients' unique history and background since it is relevant to their overall health and wellness. For this reason, my proposed intervention is development of The Maya Health Resource Manual, a resource for health providers and outreach workers that provides a balanced approach for understanding health care practices as related to the Maya in the United States. There are 3 overall goals for the manual, which are: 1. Minimize barriers between patients and medical professionals in order to enhance the health of the Maya community; 2. Identify the major healthcare barriers both from the provider s and the patient s perspective; 3. Create a variety of tools to help providers and patients communicate better. The manual will include a cultural profile, key medical terms and phrases in several of the main Mayan languages, Key Medical Terms and Key Phrases in Translation (in main Mayan languages), a body chart, an herbal medicine chart, a mental health assessment tool, and a list of interpreters. The goal is to respectfully build on cultural knowledge and to reinforce the value of

6 Maya cultural traditions while also incorporating sound health practices. This will increase the likelihood that the Maya's beneficial practices remain a part of their transnational culture, while also helping them to understand valuable biomedical knowledge and incorporate it into their cultural framework. While there are other similar manuals already available, my hope is to focus on enhancing cultural and linguistic communication between Mayan immigrants to the United States and their health care providers. This requires studying Mayan history and learning about their cultural practices and beliefs. It also requires learning about Mayan health in the United States, of which there are very few studies. There have been six studies published particularly related to Mayan health in the United States in the past twenty-five years, three of which specifically looked at barriers to care. The first with Maria Miralles in the 1980s was a study in Florida. In 2002, Cecile Menjivar studied the use of social networks to access healthcare information as a response to confronting barriers to care. Finally, Colleen Supanich analyzed barriers to care for Guatemalan Mayan women seeking prenatal care in All of these studies demonstrate that the Maya face many barriers to receiving health care and information and that they are a population that are misunderstood and understudied. The concept of cultural competency is the core of this manual. Through knowledge of diverse cultural customs that might affect health care beliefs and practices, medical providers can offer the best care to patients. Therefore, a review of the literature on cultural competency will also be helpful. Studies show that when working with indigenous populations and refugee communities, providers can provide better care to their patients when they understand the cultural perspective of their patients (Brach & Fraser, 2007). Understanding a patient s cultural traditions and history can help ease tension, identify potential problems, and improve the patient-

7 provider relationship. Therefore, a review of best practices models for working in indigenous communities will be useful in the development of the manual. Ideally this manual would be more relevant for areas with dense Mayan populations, such as California and Georgia. However, within North Carolina most of the indigenous peoples work in agriculture; therefore, my intervention will be aimed at partnering with organizations working with farmworkers. While farmworkers are generally an invisible population whose work is often forgotten and undercompensated, indigenous farmworkers are a group that is even more marginalized. Farmworkers from indigenous communities are more likely to be exploited due to language barriers and the difficulties of finding interpreters. For example, there is a community of Maya in Morganton, located west of Raleigh. When several hundred Guatemalan-born workers arrived in Morganton over 20 years ago, they began working in poultry plants. Concerns about safety and fair pay led the workers to strike and eventually organize a campaign against Case Farms. While the labor disputes have been settled, a small diaspora of Mayans are still trying to retain their sense of community amidst a changing global marketplace. This community demonstrates why it is necessary for advocates and service providers to be respectful of indigenous beliefs and be able to communicate openly with indigenous communities, who may be in our backyard. Too often we are unable to identify them based on our naive cultural constructions. I plan to partner with two farmworker groups here in the Triangle: The Farmworker Advocacy Network, a statewide network of organizations that work to improve living and working conditions of farmworkers and poultry workers in North Carolina, and the North Carolina Farmworker Health Program, a statewide migrant health voucher program that works with local agencies to provide care throughout the state to meet the needs of farmworkers. The

8 Farmworker Advocacy Network, now in its 10 th year of advocating for farmworkers in North Carolina, has a variety of research, handouts, and factsheets on its website, and I believe that the Maya Health Resource Manual would be a good addition to their resources. Likewise, the outreach workers at the NCFHP would benefit from training in how to use the Maya Health Resource Manual in case they encounter Mayan farmworkers. The NCFHP works to provide culturally and linguistically appropriate care for farmworker families, therefore, this manual would serve as a general tool to help them distinguish the needs of indigenous farmworkers from those of other Latino farmworkers. Finally, I realize that learning about the needs of a group as diverse as the Maya in one semester will be difficult. I hope to use the Maya Heritage Project at Kennesaw State University as a resource for learning about contemporary Mayan communities. The Maya Heritage Community Project is an interdisciplinary program that works in partnership with Maya organizations and people of Maya heritage throughout the United States. The Maya Heritage Community Project works with Maya leaders to promote knowledge about United States law, health, and customs and to educate others in the community about the ancient and modern culture of the Maya. They have already done much research around health practices of the Maya and attempts to create a national network of Mayan translators, research which I think will be helpful for the project of developing a new manual. The Maya Heritage Community Project uses the method of community-based participatory research (CBPR) in that they partner with Mayan immigrant groups in order to better understand the contemporary Maya. CBPR is an orientation to research that focuses on relationships between academics and community partners, with principles of colearning, mutual benefit, and long-term commitment and incorporates community theories, participation, and

9 practice into the research efforts. (Wallerstein & Duran, 2006, p.#). This type of research is particularly applicable to this manual because it uses principles of self-determination in order to incorporate the ideas and the experience of the Maya in the final project. The new manual will only be successful in minimizing communication barriers if it, like CBPR, is based on realizing what is mutually beneficial to health care providers and the Mayan community they serve. My next step in completing this project will be research. While I have a basic understanding of Mayan beliefs and health practices, in order to write this manual I will need to do much more. I plan to contact the Maya Heritage Community Project to see what research around health practices they have done. I also plan on contacting the NCFHP to try and talk with outreach workers who have experience working with the Maya. Finally, I plan to contact my Mayan teachers who live in the Yucatan to see if they can put me into contact with Mayan immigrants or traditional healers. I also plan to look at other toolkits available online to use as a model for my own (for an example:

10 References Brach, C. & Fraser, I. (2000). Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model. Medical Care Research and Review, vol. 57, Brown, W. and Odem, M. (2011). Living Across Borders: Guatemala Maya Immigrants in the U.S. South. Southern Spaces, Special Series. Fink, L. (2003). The Maya of Morganton: Work and Community in the Nuevo New South. Chapel Hill, NC: The University of North Carolina Press. Menjivar, C. (2002). The Ties that Heal: Guatemalan Immigrant Women s Networks and Medical Treatment. International Migration Review, vol. 36, no. 2, Miralles, M.A. (1989). A Matter of Life and Death: Health-seeking Behavior of Guatemalan Refugees in South Florida. New York: AMS Press. Smithsonian Institute, Department of Anthropology. Unmasking the Maya. Retrieved from Supanich, C. (2009). You re Too Late! : Prenatal Health Seeking Behaviors of Guatemalan Mayan Women in Palm Beach County. Master s thesis, Florida Atlantic University. UN General Assembly, United Nations Declaration on the Rights of Indigenous Peoples: resolution / adopted by the General Assembly, 2 October 2007, A/RES/61/295, available at: Wallerstein, N.B. & Duran, B. (2006). Using Community-Based Participatory Research to Address Health Disparities. Health Promotion Practice, vol. 7, 312.

11 Annotated Bibliography Adams, W.R. Randolph & Hawkins, J.P. (2007). Ed. Health Care in Maya Guatemala: Confronting Medical Pluralism in a Developing Country. Norman: University of Oklahoma Press, This collection of essays addresses a variety of health care concerns that are currently facing the Maya living in Guatemala. Examining the Guatemalan health care system and the way that it interacts with traditional Mayan medical practices is important for understanding how Mayan traditions interact with biomedical practices in the United States. Anckermann, S., Dominguez, M., Soto, N., Kjaerulf, F., Berliner, P., & Mikkelsen, E.N. (2005). Psycho-Social Support to Large Numbers of Traumatized People in Post-Conflict Societies: An Approach to Community Development in Guatemala. Journal of Community & Applied Social Psychology, Vol. 15, Issue 2, I am considering creating a section in the Maya Health Resource Manual devoted to mental health as many Mayan immigrants have come to the United States as a result of the Guatemalan Civil War. Due to the fact that the majority were either tortured or witnessed torture, murder or disappearances, mental health screening is very important. This paper describes a community development approach in Guatemala to support people affected by organized violence and torture. It could be useful in terms of helping me to develop a mental health section that is culturally appropriate. Haffner, L. (1992). Cross-cultural Medicine: A Decade Later. Translation Is Not Enough, Interpreting in a Medical Setting. The Western Journal of Medicine, 157 (3) Linda Haffner, a professional medical interpreter and Spanish translator, offers unique insights into the complexities of bilingual and bicultural communication in a hospital setting. While she does not particularly address indigenous languages, her work with Hispanic patients can be extended to other foreign language patients. Her work around miscommunication, differences in attitudes about health care, and other misunderstandings due to translation is important for my

12 Maya Health Resource Manual in terms of promoting good communication and interpretation practices. Loustaunau, M.O. & Sobo, E.J. (1997). The Cultural Context of Health, Illness, and Medicine. Westport, Conn: Bergin and Garvey. Written by a medical sociologist and a medical anthropologist, this book examines how culture (including institutions, social class, and gender) affects our perceptions of health and illness. The goal of the book is, "to examine the role of cultural differences in defining and dealing with health and illness and to investigate the health-related factors that link humanity cross-culturally through common needs." This will be useful for the cross-cultural ideas about wellness and the ways that the Maya define health and wellness differently than Western cultures. Odem, M. & Gonzalez, B. (2005) Health and Welfare of Maya Immigrant Families: Perspectives of Maya Parents and County Agencies. In Maya Pastoral: National Conferences and Essays on the Maya Immigrants, ed. Alan LeBaron. Kennesaw: Kennesaw State University Press. This paper, presented at the 2005 national Maya Pastoral conference, is a broad overview of the barriers to care faced by many Maya. The authors identify many of the problems the Maya face in the United States, including problems related to accessing health care. It outlines all of the major gaps in services, which is essential for understanding the unique situation of the Maya in the United States. Odem and Gonzalez s work will be important for me in terms of analyzing what the Maya Health Resource Manual needs to address.