“Understanding the Reality” of the Poor: Physicians’ Experiences of Compulsory Medical Service in Rural Guatemala

• In Event: Aspirations to National Health: Social Medicine and Political Subjectivity in Latin America

Abstract

In Guatemala, as in many Latin American countries, the constitution guarantees free government-sponsored healthcare to all citizens. However, in practice, indigenous Maya peoples in Guatemala, who comprise 45% of the population, have severely limited access to public healthcare. Rural areas, where the majority of the Maya population lives, lack infrastructure and health personnel. Within the last decade, a government initiative to improve primary care access in rural areas collapsed due to funding problems and political scandals, leaving approximately one fourth of the Guatemalan population without care.

This presentation describes an ongoing strategy to improve care for rural and indigenous populations in Guatemala: the Ejercicio Profesional Supervisado (EPS), a program which requires medical students to rotate in a rural government health post for 4-6 months prior to graduation. Based on semi-structured interviews conducted with forty recently-graduated physicians, this presentation highlights the forms of social conscience and political subjectivity that emerge from physicians’ experiences with EPS. For many Guatemalan medical students, who are upper-middle class, of European or mixed descent, and live in the capital city, EPS represents their first significant exposure to rural and indigenous life. For some physicians, witnessing firsthand how infrastructural failures, poverty, and culture affect health outcomes fostered interest in rural health and primary care, motivating them to continue clinical practice in rural indigenous areas. However, even those not intending to continue practicing in rural areas viewed EPS as a necessary part of their education that taught them to “understand the reality of the country.”

Author

• Anita Chary, Harvard University