In the past few blogs, I’ve mentioned a few cultural-taboo based issues that make it hard to administer healthcare here in Brazil. I’d like to profile them all here. Some are new, some already mentioned. These are entirely anecdotal, based on the experiences of the doctors I’ve been shadowing and the patients we’ve been around, but I think it’s interesting to hear the kinds of things patients are worried about. These taboos are a real issue, prevalent in the US as well, if in different ways or about different issues. Controversies regarding the HPV vaccine, for instance, feel very similar to these concerns. Anyways, I hope you all find this interesting, if only because I’ve found so many instances of this in so short a time here.
Cancer Screening
When we went on the mobile units, we found that many patients objected to cancer prevention because they simply didn’t want to know if they had cancer. They feared that if doctors were looking for cancer, they’d find it, and they were happy to live without that knowledge.
Cancer Treatment
We were talking to a medical student who had observed a biopsy of a patient with cervical cancer. He told us the story of how the patient had begun crying, certain that she would no longer be able to have kids. Medically, that wasn’t the case, and the doctor tried to explain that to her, but she wouldn’t listen. The associations that accompanied cervical cancer treatment left her extremely frightened, whether or not her condition merited it.
Physicians Fear Too
There’s a real fear of cancer patients here. The way it is explained to us, it’s something similar to the fear of HIV in the US in the 70’s. Many doctors are frightened by the prospect of patients with cancer and will send them elsewhere just so that they don’t have to see them themselves.
The Bridge
The cancer prevention department and cancer treatment departments are connected by a bridge. We walk this bridge every day to get to lunch, but it’s only ever traversed by professionals. Someone told us that the bridge was designed that way to keep cancer patients and cancer prevention patients apart.
Diabetes Taboos
When prescribed insulin, patients often go into denial. They think they’re going to die, and we were told many patients have negative mental health issues such as depression. According to some of the staff, patients too often see diabetic relatives get an amputation due to a diabetic ulcer soon after being prescribed insulin, so they forge an association – insulin, in their mind, is less of an attempt to maintain their health than a signal that they are about to die.
Palliative Care Haunts
Patients are actively scared of the palliative care center. The doctor there told us that many in the city talk about the street it’s on as if it’s haunted, and some are worried that the palliative care doctors are trying to kill them.
This is a huge part of what makes healthcare so interesting. It’s not just a game of rationality, where you can see the target and the obstacles and you only need to find the straightest path. There are obstacles to healthcare that you don’t see until you get here in person. It’s easy to dismiss these taboos and fears as irrational and petty, but the intense emotion we have, especially regarding our health and the health of our loved ones, is a significant part of what makes us who we are. Digging into these emotions and understanding where they come from and how to react to them in our healthcare approach is a fascinating facet of healthcare that I hadn’t really been exposed too before.