A Women's World

Most people are aware that my interest is in Women's Health but it has been more challenging to me here than anywhere I have ever been before.  The Maya women have me stumped!  As a physician I am trained to observe.  I will admit that I am not usually that observant of peoples' physical traits but when I walk into an exam room, it is data collection time.  What does the patient look like?  How are they dressed?  How old are they?  How do they interact and respond to me and to my recommendations?  

For starters, there are very little facial expressions.  I can usually judge if someone understands what I am saying by their face but here most faces are blank even when they are engaging in conversation with you.  I have watched them talk amongst themselves with more animation but with the "white doctor," it is a blank face.

Next, it is difficult to examine them.  They are very open about breastfeeding and will do it publicly without any covering until the child is about 2 years old, on the street, in church, etc., but the moment you want to examine their abdomen, they are pulling their clothes over themselves and hesitant.  It is very difficult to convince them to have a Pap smear or a pelvic exam even if they are symptomatic.  Many times they will simply refuse.

That said, I have great empathy for the Maya women.  From my industrialized country perspective, they live a very difficult life.  They marry young and have many children.  For some reason, it is very common for them to have 10 children.  Although we bring options for family planning with us, there is still some stigma associated with it.  We often see patients in open areas with very little privacy from the other villagers which makes it more difficult for the women to discuss these things.  The women often really want these services but are afraid of what the other villagers (or her husband) might think.

Women wait with their children to be seen in the village of San Jose

A Maya "washing machine" - stones set in the river for washing

Their daily work is not easy.  They have to carry their laundry to the river where they wash their clothes on rocks while their children play in the water.  They then carry these buckets of wet clothes home and hang them to dry.  They have to haul drinking water for their family from the village wells.  Most villages now have a communal corn mill powered by a generator but they still must take the corn to the mill before every meal to grind it and then make tortillas over an open fire in the hut.  They sew their family's clothes on a pedal sewing achine or weave cloth by hand on a loom.  Most of this is done while carrying their babies and even toddlers in slings from their heads.  Many go from looking very young when they are first married to looking 20 years older than their age within a decade.  They suffer from chronic headaches and backaches from the heavy work.  Many develop COPD (chronic obstructive pulmonary disease otherwise known as emphysema) and have carbon monoxide headaches from cooking over open fires without ventilation in their thatch-roofed huts.  There are a couple of organizations that have worked to provide well-ventilated cooking stoves for the Maya people in Guatemala however, the Maya of Belize have not been accepting of these.  They also develop significant degenerative joint disease, especially in their knees and shoulders.

So we give them a lot of Tylenol or Ibuprofen.  We treat their lung disease symptoms with inhalers and we inject many joints with steroids for comfort.  We have only seen a handful of cases of depression in these women even though we have asked and looked for it.  We just have to continue to educate them, encourage them to have regular pap smears and pelvic exams and otherwise to try and be there to care for them.