Q&A with Ian Arthur: Medical Student Conducting Research in San Lucas Tolimán

Written by Elizabeth Leighton

 Ian Arthur (pictured above at far right) is a medical student at the University of Wisconsin–Madison. He currently lives in San Lucas Tolimán, Guatemala as a Research Specialist, helping oversee a National Institute of Health funded Hypertension (or High-Blood Pressure) study. Ian has been in San Lucas since last April working closely with the Mission’s internationally recognized Health Promoter Program.

Right now, 38 trained Mission Health Promoters are serving 18 remote communities. Health Promoters live in the communities they serve and receive training to identify the treatment and prevention of different illnesses. Promoters focus on malnutrition, respiratory illness, diarrhea, skin disease and chronic illnesses including diabetes, hypertension and asthma. We sat down with Ian to learn how this experience has impacted him and what he will take away.

1. Why did you want to spend a year working in Guatemala? How did you originally find out about the opportunity?

I got into medical school at the University of Wisconsin, but I really wanted to learn Spanish and live abroad. So I asked to defer my acceptance for a year and I moved to Xela, learned Spanish, and got involved in a variety of different things there. I really liked Guatemala and met a ton of people, met a lot of friends, and got really connected with the [host] family there.

After my first year of med school, an opportunity surfaced to do a research project here in San Lucas because the University of Wisconsin has had a long-standing relationship with the Mission.

So I came here and did a bunch of different interviews with patients surrounding the care they had received at rural medical clinics from the visiting medical groups. I would go down to a ton of different communities and ask patients ‘How is the care?’, ‘How could we do better?, ‘What did you get out of it?’ I was here for three months, and I loved San Lucas.

The following year, Dr. Sean Duffy, who’s a family medicine doctor at University of Wisconsin, had known that I was here and was looking for somebody to take over this [Research Specialist] role. So he approached me and I really wanted to come back.

2. What were your findings from the research you conducted on your first visit to San Lucas?

I think my takeaway, which isn’t super profound, is that options are so limited. So I think people are very creative in piecing together medical care. Because the capacity is really hard to get the care that you need. So these medical clinics are a limited, but considerable piece of that system that people use to get the medicines and get the medical attention that they need. I think it could be a lot better and people deserve much better care. But at the same time, it is helpful. And I think it’s a tool employed by a lot of people successfully.

3. What are some of the biggest takeaways you’ve had so far?

One big takeaway I’ve had is that I just don’t like the verb help as much these days. I think reframing this sort of work, or any sort of work, as support or collaboration or exchange is just really valuable. It really changes the framework with which you do all this stuff.

I’m here to bring certain skills and expertise as are other people from the team here. And I feel like we’re learning from each other. It just feels much more collaborative and horizontal. And that kind of work really excites me. So just being more intentional about that.

4. What have you learned from working in a different cultural environment?

There’s always more to learn. Always just be curious. I’ve spent a good amount of time in Guatemala, but I’m still reminding myself that I’m a foreigner here. That I’m not from here. I may get frustrated at certain things but I don’t have the same level of knowledge or the context. And so I think just stay humble, stay curious, just continue to learn and be open.

It’s such an incredible opportunity to work in these different spaces. There’s just so much to
learn, so try to appreciate it. And not get complacent about it as well.

5. What is an observation you have had that you think people on the U.S. side would be curious to know?

Health Promoters are community health workers; they are people from their community who are informally involved in healthcare work. So they’re not trained typically as nurses or doctors, but they serve as liaisons between their community and the healthcare system. And help connect them to care or help follow up.

The biggest takeaway is that I’m just really, really convinced of how good of care Health Promoters give. You can see it in the way they talk to the patients, the rapport they build.

I think medicine, at least in the US, from my experience, felt very impersonal. You go in and you’re in this new environment. And you don’t always know who’s taking care of you. With the Health Promoters, it feels much more like people from your community are helping you out and supporting your health.

The healthcare system in Guatemala is supposedly universal healthcare, the Constitution gives a right to healthcare for everybody. But in reality, that’s not what happens. There’s just not the level of funding.

It’s a really, really, really hard place to be sick and a lot of people end up going into debt to buy medicine or see a doctor. A lot of people just don’t have options. That’s just another observation that I think is valuable, that is uncomfortable and hard, but the reality for a lot of people in these communities that we’re working with.

The investment just isn’t there, that’s what makes NGOs like the Mission invest a lot in health. And they do, they provide real options for people around here where those options otherwise would be more limited.

6. Do you have any final thoughts?

I’ve seen another big layer that I want to mention which is language. All the Promoters basically speak Kaqchikel and there’s a good number of patients who only speak Kaqchikel or feel much more comfortable in Kaqchikel in comparison to Spanish.

I just think language is a big barrier to care. Generally speaking, Spanish is the default system in these medical systems. And it really disadvantages people who speak Kaqchikel only or any of the many Maya languages. So I think that’s another huge benefit of having Health Promoters is providing medical care in the person’s mother tongue ie language they are most comfortable in, which I think is just something that systems should always strive for.

To learn more about the Mission Healthcare Program, click here.