John’s Oaxaca Week 3
This week, Jo, Luz, and I shadowed at Xoxocotlan, and the class travelled to San Miguel Peras for the weekend. I ended up thinking a lot this week about motivational interviewing and way communities and people are given value.
On Monday, Dr. Garcia taught us about elements of motivational interviewing. He explained that the most important steps were to assess the patient’s goals and current lifestyle, show the discrepancy between their lifestyle and their ability to achieve said goal, understand the barriers between the patient and achieving their goal, and help support self-efficacy to overcome those barriers. These principles have been shown to be the most effective method we have thus far to affect lasting behavior change.
And yet, I felt like many of these elements were missing from the interactions we observed throughout the week. On Wednesday, we shadowed a nutritionist, and rather than asking her patients what they wanted to achieve, she would tell them what they needed to achieve. When an overweight pregnant woman came to see her, the nutritionist informed her that she needed to lose six or seven kilograms by the time the patient gave birth, and rather than asking the patient what ideas she had to achieve this, the nutritionist got a piece of paper and told the woman what she needed to eat at every time of the day until she gave birth.
On Thursday, we were fortunate to get the opportunity to shadow a promotora from Xoxo. She took us to a local preschool where she was going to be checking all of the kids for lice. She told us that she visits every school in the district three times per month doing health education and routine checkups. I found myself reflecting on what sort of impact this could have had on me and my classmates when I was a preschool/elementary student: had my parents not given me the opportunity to learn what a healthy lifestyle looked like, school would have been my only opportunity to learn about being healthy in day to day life. While most kids have very little lifestyle autonomy, it is undeniable that the promotores are building up a first line of defense by checking kids for common problems and teaching them how to avoid them. I think they play a very important role in the Oaxacan system of health.
This weekend the group travelled to San Miguel Peras, a pueblo located a few hours out of the city, to do wellness surveys and learn more about Niño a Niño’s programming. The trip had many interesting facets, but something I found especially interesting to learn about was the perceived value of rural towns and townspeople. In the wellness surveys, no one we interviewed felt like they had much power to change their community; to me, it seemed like every member of the community undervalued and underestimated themselves. On a larger scale, I think the Mexican government does the same to the pueblo people. We learned Tuesday that with 570 rural municipios, Oaxaca contains about half of Mexico’s total. Of these 570, only about 100 have constitutional government, with the remaining being governed by costumbres. Dr. Garcia informed us that the only pueblos that had any sort of constitutional government were those that contained resources that Mexico finds useful. Furthermore, government officials actively neglect areas like San Miguel Peras, rather than simply ignoring them. According to official signage in the Zocalo, the road to San Miguel Peras is completely paved; however, as of two days ago, the pueblo is separated from Oaxaca city by about three hours of dirt road. This kind of access barrier can have serious health implications, and we actually learned that just a few weeks before a baby born in the pueblo had died a few hours after birth. The mother had made the arduous journey to Hospital Civil in the city, only to be sent home because she was there too early. While we can’t be sure of exactly what her reasoning was following this event, we can guess that the prospect of another fruitless 9 hour journey may have discouraged her from seeking medical attention the second time, when she really needed it.
In our final week, I hope to learn more about the systems in place to try and close some of these holes in the system. We’ve already seen how organizations like SiKanda and Puente work to try and improve the lives of the Mexican people, and this week, I’ll be working at Centro Esparanza Infantil to try and get a better idea of how this NGO contributes to closing these gaps as well. By the end of this trip, I hope to have a better idea of how effective social change can be affected.