Walking the cobble-stone streets of a Bolivian village, I witnessed how a new clinic in a medically underserved area hadn’t made much of an impact. I was visiting a remote outpost to better understand the challenges in promoting health in poor Latin American communities. People come here only as a last resort because of the relative high costs and they are suspicious and reluctant to enter a facility staffed by foreigners. Only two came to see the doctor during the three days we were there. Likewise, latrines build by the clinic hadn’t improved sanitation because nobody uses them for cultural reasons.
By contrast, in another rural area, a woman with less than a fourth grade education has had a great impact as community health promoter. Because she grew up in the village, she is trusted and understands the problems the people face. Every 15 minutes it seemed liked another person up at her door, quite a contrast to the clinic. No outbreaks of childhood diseases have occurred since she began inoculating children. While limited in formal medical education, she has been trained to understand the importance of clean water and sanitation. More importantly, she had empowered other people in ways to improve their health.
Witnessing both projects created dissonance. While medical knowledge is necessary, more is required. I kept asking myself if the clinic was really addressing the needs of the underprivileged.
While my background in the humanities spans numerous perspectives, putting the various disciplinary puzzle pieces together in an applied manner hadn’t occurred. On the flight back to the United States, I began to recognize what is more formally referred to as the human ecology of health that examines aspects of population, habitat, and behavior. The clinic physician and accompanying nurses had medical training that allows them to understand disease pathogens, prescribe medicines and suture wounds. Yet they didn’t understand daily lives of the people they served. The community health worker, by contrast, was trusted and accepted by the community. She knew how to communicate to them and understand their body language. It was if a light bulb had been turned on in my head in which I realized that no single discipline had a monopoly on understanding. Solving problems that I had just observed in Bolivia were no longer a theoretical exercise, but I now realized that both breadth and depth in the liberal arts were needed to address real world problems.