To be a practitioner in Guatemala, one needs to find harmony between western and traditional medicine. I had never thought about or tried natural herbal medicine before coming to Guatemala. Though I still don't usually recommend it to my patients, I have begun exploring the natural remedies so that I can hopefully help my patients to navigate their own health. The women's program teaches patients that if their symptoms do not improve after two days of at home treatment with herbal remedies, they need to go to the doctor for medication.
Many of the herbal remedies are geared towards symptom relief of aliments for which we do not currently have cures. For example, there are many herbal remedies for the cold virus, specifically for cough. In the states, there are anti-tussives, mucolitics and expectorants, but these don't cure the virus, they just alleviate or mask the cough. Though many patients request antibiotics, these target bacterial rather than viral illnesses and only lead to resistance and de-sensitization to medication. This is a specifically frightening concept when any Guatemalan can go into the pharmacy and buy any medication in any amount with less than the scribbled name of a medication written by their neighbor counting as a prescription. However, with Guatemala being among the poorest of Latin-American countries, the cost of western medications is a major deterrent leading to the preference of herbal medication in addition to its cultural implications. Many patients admit to filling half prescriptions due to the cost of medications or stopping medication regimens when they achieve symptom relief and saving the few remaining antibiotic pills for the next time they start feeling sick (of any sort).
It is terrifying to know that partial regimens is the way we have created and continue to create multi-drug resistant organisms, such as multidrug resistance tuberculosis which has been on the rise recently in Latin America. The fear of drug-resistance is a constant motivator, as we pass by the country's tuberculosis hospital daily on the way to the Primeros Pasos clinic. For this reason it is just as important that we educate the patients as it is to provide medical care. A good medication can be a weapon if used incorrectly; it is important to empower the patients to be responsible for their own health and healthcare, which is largely where herbal remedies come into play.
In the states, most Dr. Mom's would recommend a bowl of grandma's chicken noodle soup, a cup of tea and rest -- symptom relief. The idea is not too different with herbal medicine here -- herbal teas to alleviate the aches and calm the cough. Graced with the same viruses that my patients bring to the clinic, I was personally compelled to try herbal teas for my back to back stomach and cold viruses. I went to the local market with a Guatemalan friend and we sought out all the teas for cough. I was surprised by the number of plants and herbal remedies that exist. There are different teas for dry cough, productive cough and coughs with sneezes. Among the busy, hustling market, the herbal medicine vendor was one of the most popular. I do not claim an instant cure, but the effect was certainly soothing as the virus ran its course.
Balance between hot and cold is very important concept in Mayan health; a warm remedy is used to cure a cold illness. Health is not only viewed as freedom from illness, but also as general happiness and life balance. It has been important for me to begin understanding these concepts, so as to provide patient education and recommendations that complement rather than clash with their worldview. It has been specifically important for the care of pregnant patients as many cultural concepts, which do not have an equivalent in western medicine, are said to affect the development of the baby. For example, newborn babies get sick when the mothers breast milk becomes cold from eating foods that are considered cold, which does not always correspond to temperature.
In order to be respected as a practitioner, one must respect the viewpoint and frame of reference of the patient. Respect however, does not always mean agree. I believe that one of the most important things that I can learn in my investigation of natural medicine is to understand what herbal remedies may be dangerous to pregnant women. Certain herbal remedies are actually known to be incredibly potent. Something about this approach and mind-set has been successful, as my patients rapidly continue to increase in number. Though as a foreigner, my recommendations of herbal remedies would ever be taken too seriously, my warnings are generally heeded. Thankfully, there are many other traditional practitioners to provide these recommendations and I am seeking partnerships with them in order to incorporate their work into a more holistic model of patient care.