Surgeon, anthropologists help bring Western health care to the world

UCLA Health article
High above a village of shanties in Guatemala, plastic and reconstructive surgeon Dr. Reza Jarrahy hauls concrete bricks to make stoves to replace wood-burning ones that spread soot in people's homes.

UCLA plastic and reconstructive surgeon Reza Jarrahy realized that he was missing something when his young Guatemalan patient developed a mysterious infection after undergoing surgery. That puzzled the surgeon, who travels Guatemala twice a year to do pro bono surgery on people from indigenous communities.
"I knew these people were destitute, uneducated and medically unsophisticated, but I didn't appreciate the deeper social context in which they were living and how that influenced surgical outcomes," said Dr. Jarrahy.

The realization that caring for indigenous people in parts of the world like Latin America requires more than just medical knowledge and skills has brought physicians and public health experts together with anthropologists and others from across the campus to learn from each other under the auspices of the UCLA Latin American Institute.
Funded by a Title VI grant from the U.S. Department of Education as well as a grant from the UCLA Clinical and Translational Science Institute, this UCLA working group, led by Jarrahy, a board-certified plastic surgeon specializing in pediatric plastic surgery and craniofacial surgery, and Bonnie Taub, a medical anthropologist who teaches anthropology as well as public health, met recently for the first of a series of three symposia hosted by the institute to discuss how Westernized health care can intersect with traditional healing practices and beliefs.

UCLA anthropologist Bonnie Taub meets with a family who is getting a new stove she helped install.

Well-meaning American doctors who fly in from the United States to offer their services to the local population usually have limited appreciation for the culture their patients come from, explained Jarrahy, who has been going to Guatemala, Peru, Brazil and Mexico to do medical relief work for more than a decade.
Intent on learning more, Jarrahy joined Mayan Families three years ago, a nonprofit group that builds and installs concrete and ceramic stoves, paid for by donations, to poor households.

What he learned by working in the community changed his approach to practicing medicine in a foreign land. "Working with this group sometimes felt more rewarding than doing surgery," said Jarrahy, who not only paid for the $150 stoves, but hauled concrete and helped build and install them.
He learned that families frequently live four to eight people in an 8x10-foot shanty with a wood-burning stove that spreads soot. Many children suffer from malnutrition. "These [new]stoves reduce smoke inhalation in their homes and greatly improving both post-surgical conditions and the lifetime pulmonary health of young children," said Jarrahy.

His involvement with this community group also enabled him to take a more holistic approach to their surgical care, he said. "Ultimately, to parachute in, operate and leave is not a sustainable model. It is more important to fly in and build something sustainable that [these patients] can take ownership of."

An indigenous Guatemalan woman talks to Jarrahy and Taub, who are studying how surgical interventions intersect with people's beliefs and traditions.

Approached in this way, "local populations who utilize Western medicine feel better understood and are more likely to want to combine their use of traditional medicine with health services at hospitals and clinics," said Taub, interim chair of the UCLA Latin American Studies Graduate Program. And the need for cross-cultural understanding, is urgent as more indigenous people from the countryside migrate to "poverty belts" around cities in the region, she told symposium participants.

In parts of Mexico, for example, there are no medical services for indigenous migrants who were forced to leave Guatemala to escape violence, said Oscar Gil-Garcia, a postdoctoral fellow in anthropology. While doing research there, he met two indigenous midwives, ages 82 and 101, who helped five women survive childbirth as they fled from Guatemala to border towns in Mexico in the early 1980s.

Indigenous women trusted these traditional midwives more than Western doctors, predominantly men who did not speak their language and advocated the use of stirrups instead of the traditional kneeling position used for childbirth, Gil-Garcia said.
There are other conflicts between doctors and traditional healers. Among the Mapuche people of Chile, traditional healers learn about what's wrong with patients by examining urine, unwashed clothes or even a national ID card. This method of diagnosis is highly valued by the Mapuche, said Jennifer Guzmán, a project director in the UCLA Department of Family Medicine. She recently earned her Ph.D. in anthropology.
Western-trained Chilean doctors, however, expect their patients to describe their symptoms; they complain that their Mapuche patients are taciturn and uncooperative, Guzmán said.

Some indigenous communities, like the Zapotec people of Oaxaca, Mexico, have been able to fuse their beliefs in traditional health practices with the practice of modern Western medicine. "They can have a dual diagnosis of "susto" or "chibih" (soul loss) and ... a brain tumor," Taub explained.
Jarrahy's goal these days when he operates in these poor communities is to train and work with local health professionals to treat indigenous people. Back in L.A., the surgeon uses email, Skype and social media to stay in touch with patients and these local healthcare providers.

Dr. Jarrahy and village children mug for the camera.

"Working with local physicians to build clinical programs that are locally managed and incorporating education and training is the future of the project," he said.
Taub, who is also a volunteer with Mayan Families, and Jarrahy have launched a study in Guatemala that looks at how surgical interventions intersect with people's beliefs. They recently received a Transdisciplinary Seed Grant from the UCLA Office of the Vice Chancellor for Research and the Academic Senate Council on Research to fund their research.

"What we hope to do is to develop some kind of patient questionnaire that physicians or medical relief organizations can use when they go overseas to find out about the cultural beliefs and practices of the people they are treating," Jarrahy said.

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