Culturally Sensitive Healthcare for the Ngöbe: Glass Half Empty or Glass Half Full? by Jessica Kenny

LA CASONA, COTO BRUS – In the span of one afternoon, I witnessed two very different expressions of how culturally sensitive healthcare can turn out. First, before arriving at Las Cruces OTS station for the second block of our program, we made a stop to visit EBAIS La Casona, the primary healthcare clinic that services the Ngöbe indigenous community in the canton of Coto Brus. Compared to the EBAIS we visited in Horquetas, Sarapiqui, this one looked welcoming, spacious and newly painted in bright colors, resembling the style of the traditional dresses worn by Ngöbe women. The clinic consisted of seven octagonal houses, including a restroom area, an office for the traditional healer and a separate office for Dr. Quirós Saénz, the Caja primary physician who was in consultation with a young mother at that moment. When her patient walked out, she welcomed our group with a friendly, but serious expression and went straight to the point, “I don’t want to repeat information you’ve already heard, so what questions do you have for me?” Some shuffled their feet, others looked pensive. I shot my hand up and asked about what conditions were most frequently treated in this community. Interestingly, the first one she said was respiratory illnesses, which my group has now chosen to investigate for our independent project in November.

Dr. Quirós then ushered us into her office to continue the conversation. She seemed irritated and frustrated – because she cared deeply. She vented to us about how the greatest challenge she faces in working with this indigenous community is the issue of trust. Even after being there at La Casona for nine years, her communication with the Ngöbe healer who works next door is minimal. He speaks excellent Spanish, but she had failed to learn Ngäbere. She would ask him about what herbal medicines he used and he would only reply, “plants.” She often felt like patients were deliberately pretending not to understand her, would not correct her Ngäbere, and would make fun of her attempts to stop them from littering or urinating outside. It felt a bit strange for all of us non-Costa Rican students to be having this conversation about trust, inside her office with the door shut, while Ngöbe patients were right outside. I can only imagine the effort it has taken Dr. Quirós and La Caja to even come this far and have a clinic in which traditional medicine can run side by side with western health care, and to be able to convince patients to attend both. Indeed, she stays there because she is passionate about her patients, and perhaps enjoys the challenge. But this also seems like a classic case of ethnocentrism – struggling, unsuccessfully, to change a group’s practices because you are interpreting them through your own [foreign] cultural lens.

Later that evening, we had the pleasure of meeting Dr. Pablo Ortiz, the director of the Coto Brus Health District, who also works with the Ngöbe, specifically the migrant coffee workers. Or, I should say, highly mobile workers –the term preferred, according to his patients. Dr. Ortiz struck me as being progressively minded, lecturing to us about how poor health practices are a result of poverty, not culture: the same low health indicators of maternal and child mortality and respiratory infections are seen in populations with similar economic status, across the board from Coto Brus to sub-Saharan Africa. Dr. Ortiz told us about the success of their cultural advisors program and the traffic light bags for maternal health – many of the same initiatives Dr. Quirós discussed. I guess it comes down to which half of the glass you choose to focus on. As I well know, women are usually more self-critical.