Thursday, November 6, 2014

Togetherness in Health Care

I think I had forgotten, or had ignored, the possibility of cultural collaboration. Sitting on the concrete floor, surrounded by Ngobe healers and Costa Rican doctors, I realize it can work, just as it does between La Caja and the Ngobe at the local primary care clinic, an EBAIS.

La Caja Costarricense de Seguro Social, affectionately known as La Caja, provides the infrastructure for Costa Rica's healthcare system and los Equipos Básicos de Atención Integral en Salud, EBAISes, deliver primary care to ticos. However, traditional biomedical practices clash with traditional ethnobotanical ones of indigenous peoples. It's easy, it's simple, and it's efficient to put up an ideological barrier along with the physical barrier of the indigenous territory and move around the difference. It's much harder to slowly bring the barrier down.

The EBAIS La Casona serves four communities and 3000 people. On either side of the main concrete entrance path, the octagonal buildings cluster together, some orange and some purple, but all with traditional designs and decorations. The orange represents the traditional medicine; purple represents the biomedical side. Together, the octagons are surrounded by a fence, a physical reminder of the beauty of connection. The Ngobe have adapted to visit both health care methodologies at once, depending on their affliction. The EBAIS biomedical doctors have adapted to share their medical expertise with Ngobe healers, as have the Ngobe healers to the doctors.

I think, when we acknowledge that which is common, we truly make a difference. We tend to focus on stratification, on practices that are better or cure faster. But as the health care workers of La Casona demonstrate, health is not something that should be dividing us, but rather bringing us together.

Progress is not one individual moving toward a goal, but rather the betterment of the group. Progress, as I know it, implies improvement, and change. Progress in health means that we acknowledge this collective need for health, for wellness, and for well-being, while simultaneously acknowledging our unique methodologies of getting there. Health care delivery seems as complicated as the body that it attempts to cure. As Americans, we tend to believe in the power and sway of modern biomedicine. I tended to doubt and criticize Ngobe methodology, of urine sampling and of "sustos". But, in hindsight, I forgot about the possibility of, not a dichotomy but of a union.

To see the possibility of progress must mean that we step away from our own personalized views of medicine. The delivery, the successful delivery, of health care is complex. Its complexity lies in the simple yet delicate human body.

As the conversation wraps up, I'm getting antsy on the concrete floor, but not because of restlessness, but rather intense interest. I start thinking about La Casona as an example for the rest of the health care world. I think we need to forget about our differences and start to bridge our similarities. Together, we have a lot to learn.


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