Visiting Ecuador: A lesson in empathy

Editor’s note: This blog post is the second part of a two-part series. Read part one.

A few months ago, a group of faculty and staff members from the Center for Medical Ethics and Health Policy at Baylor College of Medicine traveled to Ecuador with the hope of challenging our conceptions of medicine. Beyond experiencing the beauty of another culture, the trip provided an unexpected lesson in empathy and what it means to be ‘culturally competent’ as I became the outsider seeking healing in a foreign place.

Traditional medicine

The afternoon I learned about ‘Pachamama’ was when we had our first healing. It was described to us as a cleansing. We were given basic instructions: sit by the fire and reflect, descend into a small cave where the shaman and his daughter would be waiting, remove your clothes, accept the cleansing, re-clothe, and do not touch or talk to anyone for a while after the ritual. I anxiously waited in front of the flames, unsure of how to mentally prepare for something I still didn’t understand.

My time came and I followed the shaman’s daughter’s beckoning hand. I walked down the steps, removed my clothes, and stepped in front of the shaman. He chanted things in Kichua I did not understand, rubbed candles on my body, sprayed me with a traditional form of alcohol, traced my head and arms with eggs, scrubbed me down with what I later learned was stinging nettle, left me with a handful of flowers to rub on my limbs, and placed a strung flower around my neck.

I left the cave and found a space to sit with what I’d just experienced. My memory of it already fuzzying, I was left wondering – what had just been done to my body? What was the purpose of each step? I looked at the raised bumps that blossomed on my arms and wondered if this reaction was something I should be concerned about. How long was ‘long enough’ to wait before interacting with others?

Cultural competency

This early moment stands as one of the memories I have spent the most time trying to pull apart.

I thought back to the moments I experienced as a translator years before in the San José Clinic. I remembered the faces in the waiting room as they eyed the doorway where the nurses emerged, one by one calling patients in, and could suddenly feel the anxiety that comes with not knowing what will happen, but having some vague trust in and desire for ‘healing.’

My memory of the older, hospital gown-wearing woman was now accompanied by that sense of vulnerability I felt in removing my clothes in a foreign place. I saw her furrowed brows as she hung onto each word I translated and felt my confusion that continued even after I heard the basic descriptions of a ‘cleansing’ treatment I would be undergoing. I was still unsure of what exactly it entailed and confused if what I felt afterwards was to be expected or if something had gone wrong.

In medical education, there is a push to increase ‘cultural competency’ – the ability to effectively deliver healthcare services that meet the social, cultural, and linguistic needs of patients. I had heard of the importance to train culturally competent physicians, but it was through this trip that I was able to understand the difference it can make in patients’ experiences.

Bringing these lessons home

If I felt anxiety and unease on a temporary trip I took of my own choice, I can only begin to imagine the extent of those emotions felt by the many diverse and displaced populations seeking healthcare within the Texas Medical Center. My memory of stinging nettle pain and the bumps on my skin that temporarily arose are mite-sized compared to the side effects and post-treatment processes patients often face after care.

These are experiences they must make sense of and understand when they leave our clinic doors, whether we provide guidance or not.

The treatments developed and delivered in the Texas Medical Center are beautiful and incredible, but we do both the patients and providers a disservice if we do not take the patient’s cultural and linguistic backgrounds into account in caring for them.

Refusal to undergo a surgery could be rooted in needing to wait for a waning moon phase; hesitance to take a pill could come from a history of being treated by medicinal plants instead of distilled capsules. Gaining patient consent and trust hinges on deeper understanding – them of us and us of them.

-By Erika Versalovic, project coordinator, Center for Medical Ethics and Health Policy at Baylor