PATIENT CENTERED PEER EDUCATION AND HEALTH
CARE…AMONG THE KICKAPOO/KIKAPU OF TEXAS/MEXICO
The
10-seater van was fairly new, had Mexican License plates. Mena stopped at
various homes in the Kickapoo Reservation in Eagle Pass, Texas, sloping down to
the river, which marks the border between USA and Mexico. We were on our way to
Piedras Negras, Mexico, crossing river on specified bridges under the watchful
eyes of Mexican Police and Military. During this short trip, the van was full
of laughter, the heart felt laughter the Indians are capable of-the
conversation was not in English or Spanish, the languages of the countries we
were traversing but in ancient Algonquin tongue-Kikapu/Kickapoo. I was the only
one that did not understand the language, but as a Physician-anthropologist it
gave me a chance to observe or continue observing the social customs of this ancient
people.
Nobody
would ever guess that the van was transporting a group of patients to be seen,
consulted and treated by three health care professionals.
A
Mexican doctor, specializing in Family Practice, Homeopathy and Complementary
Medicine who had virtually grown up with the Kikapu (her father was their
doctor for many years until his untimely death)
An
AUS/UK/USA trained Endocrinologist-Anthropologist who is a visiting Professor
at the University of Havana, in Cuba as well as a Consultant Endocrinologist to
various Indian tribes.
A
member of the Kikapu tribe, who is a Peer Health Educator of many years
experience and a good friend to both above. She is the central person in this
narrative, who organized this trip, selected the patients from the long list of
Kikapu who consult her at her home, she selected a few who were not satisfied
by the medical care in Eagle Pass or San Antonio by GPs or Specialists (failure
to resolve their sufferings). Mena had taken the day off from work as an
accountant at the Tribal Casino plus sacrificed her family life by spending the
Saturday following doing the same.
In
this Peer Educator oriented Health Care, not just Disease care, the emphasis is
on talking and expressing of emotions. Neither of the doctors could interfere
nor interrupt the conversation since they did not understand the language, and
also both were culturally competent. (In America, where an average medical
consultation lasts only 7-12 minutes; the MD/FNP/PA interrupts the patient
narrative in less than one minute, in the name of guiding the narrative, but
more likely because of lack of interest).
Every
now and then Mena would turn to me and explain the conversation with the
patient and translate the symbolism inherent in the conversation, and hand over
the bag of medications prescribed and purchased in the USA (which they may or
may not be taking).
All
Primary Care Providers could take a point from here: they have to be culturally
sensitive and culturally competent, if you are looking after people in a mixed
cultural setting, which most of the USA is. They also have to understand the
symbolism, hidden in their expressions and have to be very polite when it comes
to counselling the patient. He or She cannot afford to put self-pride before
these.
On
the average, the three of us, the Mexican MD, the
Endocrinologist-anthropologist and Peer Health Educator Mena spent one hour, at
least, with each of the Kikapu patient. We didn't finish our consultation, each
of us taking turns in no particular order, until the patients were satisfied
and their queries answered to their satisfaction. We could order and get the
Laboratory tests as one was open nearby, and the patient could go home with the
prescribed medications from the pharmacy around the corner, thus alleviating extra
trips for blood tests or seeking medications from pharmacy. (Also saving money
for the tribe because medications are only a fraction of the price in Mexico).
From the point of view of the patient: (1) the sociability of the situation
contributes to their wellness, they can socialize while the consultation is
taking place, before and then some afterwards.
(2)
The satisfaction that their problems are attended to in the manner that
culturally and emotionally satisfactory to them.
(3)
No need for an extra trip to draw blood for labs, another visit to the MD for
him to explain it to you, and yet another visit to the pharmacy to pick up the
medication
(4)
During the entire time they were at the clinic, about four hours in all, they
were not forced to speak either English or Spanish but could speak their
traditional language and could explain their symptoms and suffering in symbols
that the Peer Educator understood and translated it to the two doctors. They
know the words for their suffering in their language but not in Spanish or
English.
These
descendants of an ancient culture, striving hard to maintain their cultural
identity, are caught between their holistic belief systems and the
technology/profit/time demand of an American civilization to which the doctors
and other providers in Eagle Pass and San Antonio belong.
Not
only it is the satisfaction of the individual patient where time and cultural
appropriateness is attended to, the tribe also saves money because of the
efficiency of the care and the absence of inappropriate tests and treatments.
It
was more than 5 hours when we had finished with the last of the consultations,
they were patiently waiting knowing fully well that each one is being attended
to, and in the end they all got into the van and returned home.
(Later
that evening, I was told that some of the older ladies were bent on preparing a
traditional Kikapu meal for us when we returned to the reservation)
One
case presentation to demonstrate the effectiveness of
This
Peer Educator!
61-year-old
lady with repeated visits to Emergency Room and Clinic for Anaemia and High
Blood Sugar.
She
was given what appears to be a standard treatment on the other side of the
bridge in Eagle Pass, Texas
70/30
Insulin twice a day, 120 units
Metformin
twice a day, 1000 mg twice a day
Lisinopril
Atorvastatin
Glimipride
Fenofibrate
She
had received blood transfusions for her anaemia at the Emergency Room
By
looking at the treatment regime, any Endocrinologist can tell you that the
Primary Care Physician was treating the lab results in front of him, rather
than the patient.
Using
the anthropological approach, I directed the question at Mena.
Why
does she think she has low blood? (Anaemia)
Then
comes the revelation! She said:
I
think it is because of my habit of peeling and then juicing and drinking the
lemons!
How
may Lemons do you peel, juice and drink?
At
least 8! As if we were unconvinced, she shows us the nail bed of her right
thumb, which is eaten away because of the corrosion! We could only wonder which
other parts of her body were corroding!
She
continued; after the last time I got a bag of blood I made the connection and
stopped eating Lemons.
Did
anyone ever ask you about this habit of yours?
No,
you are the first one!
We
will get a blood test and see how well your blood is responding after you
stopped eating Lemons.
What
about your sugar?
Are
you taking all the medications prescribed for you?
Yes
Then
why do you think your sugar is always over 200?
I
think it is because I drink at least six cans of regular coca cola per day.
I
mentally calculated, 149 calories per can, six cans 900 calories, 15 calories
in one teaspoon of sugar, 60 teaspoons of sugar!!
I
told her
She
did not flinch.
Mena
steps in. It would be good for you to reduce the number of cans you are drinking.
She agrees.
That
simple act will assist her body in more ways than all the Metformin/Glimepiride/Insulin!
The
idea is not to increase medications, the MD had increased all the medications
to their limits but none of which had shown any beneficial effects, these
medications are probably not strong enough to ward off the dangers of High
Fructose Corn Syrup or Maltodextrin or other chemical sweeteners in a can of
coke.
(THE PEER EDUCATOR RECLINING WHILE CONDUCTING THE LAST OF MANY INTERVIEWS LASTING HOURS)
Thanks
as always to the unselfish dedication of Dra Estela Rosales Garza of Muzquiz for
her attention to the well being of the Kikapu. I consider her one of the best
practitioners of the art and science of Medicine…anywhere in the world.
