By Dr. Juan J. Delgado-Hurtado
Guatemala is a very diverse country; it is considered pluricultural, multiethnic, and multilingual. I grew up in Guatemala City and was raised in a very culturally aware family (my mother is a social scientist and my father is a public health specialist). In medical school, I took medical anthropology and learned of the importance of understanding local culture (the social behavior and norms in human societies) when treating patients. I did not know some of the concepts I learned in class would be so important in my personal life and career ahead. I took this class before and while doing a three-month community medicine rotation in one of Guatemala’s municipalities, San Juan Sacatepéquez. In this community, that is a 45-minute drive away from Guatemala City, we cared predominantly for patients of Mayan descent. In class, we learned about the Kakchiquel ethnic group, their culture and plural health system. We explored topics related to cultural change, cultural relativism, ethnomedicine, culture shock and ethnocentrism.
Our professor, who happened to be my grandfather, had a fascinating career that exemplifies at its best medical training in an unfamiliar setting, including foreign countries. After finishing medical school in the 1950’s, he practiced medicine in San Juan Sacatepéquez. In class, he admitted to us how, even though he is Guatemalan, he experienced culture shock when first interacting with patients who spoke another language (in this case Kakchiquel which is a Mayan language), who had another way of living, and who behaved and thought in a very different way. He often needed an interpreter, and had to construct and learn a different system of classifying diseases to best and more effectively provide counseling and treatment that would be accepted by patients. Many of the things he learned related to culture when practicing in this setting he had not learned in medical school. This is why, years later; he helped introduce the medical anthropology course in my medical school’s curriculum (source).
My grandfather did his pediatrics training in Lausanne and Zurich in Switzerland where he again had contact with a very different culture and experienced, again and to a different degree, culture shock. He started to write about the medical systems he observed, to better understand his practice and his patients. In the 1970’s, following the advice of anthropologists, he decided to do formal training in cultural anthropology at the University of Kansas and apply it to medicine, in what it is now known as medical anthropology. Today, at 93 years old, he is still sought by many generations of Mayan and non-Mayan families and remains intellectually active. He has been an inspiration and has helped me throughout my career. In fact, part of the reason why I wanted to pursue my training abroad was because of him.
When I did the community medicine rotation in medical school and when I moved to the United States to do my medicine residency I experienced culture shock. Due to globalization, my personality, prior personal experiences, prior education, and the amount of support I have had at the places where I have trained, I probably experienced culture shock differently than my grandfather did decades ago. Culture shock is defined as “a sense of confusion and uncertainty sometimes with feeling of anxiety that may affect people exposed to an alien culture or environment without adequate preparation”. (source) Culture shock is well described among international students and when foreign medical graduates move to the United States. It is a natural and a common process which medical providers from anywhere could experience when moving or providing care elsewhere. I saw it among U.S. providers when volunteering at medical missions in Guatemala where I had to help them understand local behaviors and traditions and I have seen it when American providers care for a Hispanic population in the United States.
I think it is very important for medical students and physicians who will start training in another country to be aware of medical anthropological concepts and know how to best deal with culture shock. When you come to the United Sates, you may not just be exposing yourself to a different culture, but often caring for patients in your second language, and learning about and adjusting to the prevailing health care system. There are many changes happening all at once and the learning curve is very steep.
Likewise, I think it is important for training programs to support foreign medical graduates during this transition. I was fortunate to receive classes on anthropology in medical school and did my residency at a place where I felt supported and where I would get assistance if I needed it. I am currently doing my endocrinology fellowship and combining it with a leadership and preventive medicine residency at a place where I have also found this support.
Many blogs and websites address how to best deal with culture shock. Some of the ways my wife and I have dealt with it include:
- Learning more about the United States, its tradition and its people,
- Traveling in the United States,
- Talking with people who have a similar background and expressing our feelings,
- Exposing ourselves to the local culture by attending events and making friends,
- Getting involved with the community,
- Being self-aware of our identity and background,
- Recognizing it takes time to feel comfortable and that it is a normal part of every transition.
I believe dealing with culture shock and learning more about the local culture helps you not just feel better, more comfortable, less anxious, and be part of the community, but it helps you understand, counsel and treat patients in a better way. With the ethnic and cultural diversity there is in the United States and the current political, migratory and social situation, U.S. medical and foreign medical graduates more than ever have to exercise cultural awareness, respect and empathy. This will not just help us as a group of providers, but will serve the community and our patients. After all, culture is tightly linked to health and disease. It is comforting when attendings and peers recognize the huge sacrifice that foreign medical graduates make to be where they are. I am proud to be Guatemalan, I am proud to be where I am and I am very grateful to those who have given me the opportunity to train in this great country.
My daughter who is almost two years old was born in the United States, and this gives me yet another very important reason to learn more about U.S. cultures in the society.