Abuse and discrimination towards indigenous people in public health care facilities: experiences from rural Guatemala

By Maggie Sullivan Moderator | 03 Jun, 2016

A disturbing study documenting long-existant trends. It calls to mind our discussion here about abuse/discrimination against laboring women. While I'm very grateful the research and documentation is being done, a vital step needed before the problem can be adequately addressed, it's upsetting both as a nurse and as a person. However, I also must challenge myself to think about how the infrasctructure of health care in Guatemala, not only health care workers, perpetuate abuse and discrimination. To be a health care worker in an effectively crippled system fosters its own illnesses. And, unfortunately, Guatemala is not alone; in high-income countries, such as the U.S., abuse and discrimination in health care also abounds. Please find the attached link to the freely accessible open access article in full, and share any thoughts or comments you may have.

Health inequalities disproportionally affect indigenous people in Guatemala. Previous studies have noted that the disadvantageous situation of indigenous people is the result of complex and structural elements such as social exclusion, racism and discrimination. These elements need to be addressed in order to tackle the social determinants of health. This research was part of a larger participatory collaboration between Centro de Estudios para la Equidad y Gobernanza en los Servicios de Salud (CEGSS) and community based organizations aiming to implement social accountability in rural indigenous municipalities of Guatemala. Discrimination while seeking health care services in public facilities was ranked among the top three problems by communities and that should be addressed in the social accountability intervention. This study aimed to understand and categorize the episodes of discrimination as reported by indigenous communities.

A participatory approach was used, involving CEGSS’s researchers and field staff and community leaders. One focus group in one rural village of 13 different municipalities was implemented. Focus groups were aimed at identifying instances of mistreatment in health care services and documenting the account of those who were affected or who witnessed them. All of the 132 obtained episodes were transcribed and scrutinized using a thematic analysis.

Episodes described by participants ranged from indifference to violence (psychological, symbolic, and physical), including coercion, mockery, deception and racism. Different expressions of discrimination and mistreatment associated to poverty, language barriers, gender, ethnicity and social class were narrated by participants.

Addressing mistreatment in public health settings will involve tackling the prevalent forms of discrimination, including racism. This will likely require profound, complex and sustained interventions at the programmatic and policy levels beyond the strict realm of public health services. Future studies should assess the magnitude of the occurrence of episodes of maltreatment and racism within indigenous areas and also explore the providers’ perceptions about the problem.

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Elizabeth Glaser Moderator Emeritus Replied at 12:01 PM, 3 Jun 2016

Thank you for posting.

Sadly this is not unique to one place.
Here is a paper discussing strategies to improve respectful care to Aboriginal and Torres Strait Islander Australians. They suggest that care can be improved through community controlled models and increased development and training of indigenous people in the healthcare workforce.

Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S. and Francis, T. (2014), Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Australian and New Zealand Journal of Public Health, 38: 355–361.

At least in my past experience, the homeless men and women from the Micmac and other tribes/bands received their fair share of of abuse in the healthcare system in New England, not sure if that situation has improved over the past decade.

Similar to abuse of laboring women, I do wonder if staff take out their anger and frustration, evidence of burnout, on those most vulnerable. If we could better support staff and bring in more community involvement it might well decrease dehumanizing treatment of patients.

Tess Panizales, DNP, MSN, RN Replied at 12:16 PM, 3 Jun 2016

Maggie, thanks for this posting. We have a public health issue to address and be a voice to the minority of the minorities in our population, so their true politics supersede the politics of policies and those in political power.

Elizabeth you touched upon an important point, this remind me of what I was told before that the abused becomes the abuser (cycle). We do need to take care of the care providers, ourselves - we need to be cognizant that beyond our humanitarian work we are humans risking ourselves to physical and psychological trauma. From upstream to downstream efforts and policies, we need to put humans first not to commodify.

Monique Germain Moderator Replied at 10:35 PM, 15 Jun 2016

Thanks for posting this information. This is an important study for it makes us aware of what is being neglected. True, we need upstream interventions to correct this practice. But where do we begin?

Milka Ogayo Moderator Replied at 6:29 AM, 6 Jul 2016

Hi Monique.

I think we can begin from referring to our Constitutions because laws that regulate health care are clearly articulated there in.

Discrimination of people that seek care in public health facility is experienced, I believe world wide. We see discrimination based on ethnicity, social class; patient mistreatment and psychological abuse. Different countries have come up with constitutions to guide and provide space for the vulnerable and their public at large. I would encourage nurses to be cognizant of these policies. This means that we need to explore more outside health field


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